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What makes up the stroma?
- smooth muscle cells
- fibroblasts
- extracellular matrix proteins
- *is the connective tissue that provides structural support to the prostate gland
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What does the prostatic secretion consist of?
- simple sugars
- prostate-specific antigens (PSA)
- acid phosphate
- *also make up 20-40% of the volume of ejactulate
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Fibroblast Growth Hormone (FGH)
- bFGF, FGF7
- polypeptides
- stimulate cell division
- stimulate growth
-
Transforming Growth Hormone (TGH)
- TF-B1, TGF-B2
- polypeptides
- inhibit cell division
-
agonists/antagonist of α1-adrenergic receptors
- agonists of α1-adrenergic receptors in prostate promote constriction of the prostatic urethra
- antagonists promote relaxation of prostate smooth muscle, leading to opening of urinary bladder neck
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BPH complications
- acute painful urinary retention (painful dilation of bladder w/inability to void)
- persistent hematuria
- overflow urinary incontinence
- recurrent UTI due to stagnation of urine w/in bladder
- bladder diverticula due to chronic bladder dilation
- bladder stones
- chronic renal failure from bladder outlet obstruction (BOO)
-
Irritative symptoms result from:
- bladder hypertrophy
- bladder filling
- urinary frequency
- nocturia
- urinary urgency
-
Obstructive symptoms
- caused by narrowing of bladder neck and incomplete emptying of bladder
- difficulty initiating urination
- decreased force of urinary stream
- intermittency of stream
- urinary hesitancy
- feeling of incomplete bladder emptying
- dribbling
-
Urinalysis evaluates the prescence of:
- hematuria
- infection
- glucosuria
- ketonuria
- renal disease
-
Gold standard Surgeries for BPH
- Open Prostatectomy
- Transurethral Resection of the Prostate (TURP)
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Lifestyle Modifications
- fluid restriction (1500-2000ml of fluid/day) restrict fluid at bedtime
- avoid: caffine, alcohol, spicy foods
- replace binge drinking w/moderate drinking
- avoid meds: diuretics, decongestants, antihistamines, antidepressants
- timed or scheduled voiding (bladder retention)
- pelvic floor exercises
- avoidance of constipation
- use frequency & volume charts (diaries)
-
Tamsulosin adverse effects
- congestion
- floppy iris syndrome
- *discontinue tamsulosin prior to cataract surgery
-
5α-reductase inhibitors adverse effects
- erectile dysfunction
- decreased libido
- gynecomastia
- abdominal pain
- asthenia
- muscle weakness
-
Prone to hypotension treat BPH with:
- alfuzosin
- tamsulosin
- silodosin
-
Symptoms of BPH
- acute painful urinary retention
- persistent hematuria
- overflow urinary incontinence
- recurrent UTI due to stagnation of urine w/in bladder
- bladder diverticula due to chronic bladder dilation
- bladder stones
- chronic renal failure from bladder outlet obstruction (BOO)
-
drug-drug interactions w/ α1- adrenergic antagonists
- cimetidine (decreases metabolism of α1 increasing effect of α1)
- diltiazem (decreases metabolism of α1 increasing effect of α1)
- ketoconazole ( contraindicated)
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