83 %
17 %
Information about BPH

Published on February 27, 2014

Author: minwoldu

Source: authorstream.com

Benign Prostatic Hyperplasia: Benign Prostatic Hyperplasia Minyahil A. Woldu Outline : Outline Objectives Introduction Epidemiology Etiology Pathophysiology Clinical Presentation and Diagnosis Treatment Outcome Evaluation Objectives :  Objectives Explain the pathophysiologic mechanisms underlying BPH Recognize the symptoms and signs of BPH. List the desired treatment outcomes. Identify drug selection factors Compare and contrast α-adrenergic antagonists versus 5α-reductase inhibitors Describe the indications for combination drug treatment of BPH Describe the indications for surgical intervention of BPH. Formulate a monitoring plan for a patient Formulate appropriate counseling information Introduction : Introduction The prostate is a heart-shaped, chestnut-sized organ Encircles the portion of the proximal urethra Is composed of glandular/Epithelial and muscle /stromal tissues The prostate produces secretions which are part of the ejaculate BPH is the most common benign neoplasm in males Drugs are common modes of treatment to reduce symptoms Epidemiology :  Epidemiology BPH is present as microscopic disease in many elderly males . The prevalence increases with advancing patient age. 50 % of which develop an enlarged prostate on palpation and 25 % show clinical voiding symptoms, respectively. 25 % of males >=40 years of age have voiding symptoms≈ BPH 20 % to 30 %(>=80yrs males) will require a prostatectomy Etiology : Etiology Advanced patient age: Beyond age 40 prostate spurt and can lead to BPH Stimulatory effect of androgens: Testosterone stimulate growth of glandular tissues Stromal tissue growth by estrogens(??????) Type II 5 α- reductase activates testosterone to DHT Stromal tissue is innervated by α1A-receptors Pathophysiology :  Pathophysiology Pathophysiologic mxz to clinical manifestation: Static : anatomic obstruction of the bladder neck caused by an enlarged prostate gland. Dynamic : over stimulation of a 1A -adrenergic receptors reduces the caliber of the urethral lumen. Detrusor : prolonged bladder outlet obstruction leads to bladder detrusor muscle instability and decompensation CLINICAL PRESENTATION AND DIAGNOSIS :  CLINICAL PRESENTATION AND DIAGNOSIS Clinical Presentation: Clinical Presentation Obstructive symptoms : due to failure of the urinary bladder to empty urine when the bladder is full . Irritative symptoms : due to the failure of the urinary bladder to store urine until the bladder is full . The natural history of untreated BPH is unclear in patients with mild symptoms In patients with moderate to severe symptoms, the likelihood of developing complications of BPH is higher Diagnosis: Diagnosis Diagnosis of BPH requires a careful medical history, physical examination, objective measures of bladder emptying All prescription and nonprescription medications as well as dietary supplements must be quested PowerPoint Presentation: AUA Symptom Score Complications of Untreated BPH :  Complications of Untreated BPH Upper and lower urinary tract infection Urosepsis Urinary incontinence refractory urinary retentions chronic, Renal failure Bladder diverticuli Bladder stones, or Recurrent gross hematuria TREATMENT :  TREATMENT Desired Outcomes: Desired Outcomes Slowing disease progression Normalize serum BUN and creatinine Preventing complications and reducing the need for surgery Avoiding or minimizing adverse treatment effects Providing economical therapy Maintaining or improving quality of life Non-Pharmacological Therapy: Non-Pharmacological Therapy Discontinue or minimize oral fluid intake after 6 P.M. Void before going to bed Take the diuretic in the morning, not the evening Caution on worsening medications PHARMACOLOGIC THERAPY: PHARMACOLOGIC THERAPY General Approach to Treatment: General Approach to Treatment Introduction : Introduction For patients with moderately severe BPH and as an interim measure for patients with severe BPH. Mechanisms: Reduce prostate gland enlargement => Reduces the static factor Target is on androgens…… Relaxes prostatic smooth muscle => Reduces the dynamic factor Target is on α 1 receptors…… Introduction…………………………………….: Introduction……………………………………. α -adrenergic antagonist for: Faster onset of symptom relief A 5 α- reductase inhibitor for: Prostate gland >40 g Combination therapy for: Prostate gland >40 g and PSA ≥ 0.4 ng/ mL Introduction…………………………………….: Introduction……………………………………. Leuprolide and goserelin decrease libido and can cause erectile dysfunction, gynecomastia , and hot flashes. The antiandrogens bicalutamide and flutamide cause nausea, diarrhea, and hepatotoxicity α-Adrenergic Antagonists: α -Adrenergic Antagonists α -Adrenergic antagonists: Relax the smooth muscle in the prostate and bladder neck Increase urinary flow rates by 2 to 3 mL /sec in 60% to 70% of patients Reducing postvoid residual urine volumes Do not decrease prostate volume or PSA levels α-Adrenergic Antagonists…………….: α -Adrenergic Antagonists……………. Tamsulosin & doxazosin give durable responses for 6 & 10 yrs Terazosin , Doxazosin, and Alfuzosin belongs to 2 nd - Gnr : Cause first dose syncope, orthostatic hypotension, and dizziness Alfuzosin is less likely to cause cardiovascular ADR Slow titration and bedtime administration to minimize ADR Tamsulosin is the only third-generation: Does not cause peripheral vascular smooth muscle relaxation α-Adrenergic Antagonists…………….: α -Adrenergic Antagonists……………. Tamsulosin is a good choice for: Patients who cannot tolerate hypotension; Patients who want to avoid the delay of dose titration. Tamsulosin decreases metabolism of cimetidine and diltiazem Carbamazepine and phenytoin increase catabolism of α- adrenergic antagonists Have severe CAD Volume depletion Cardiac arrhythmias Severe orthostasis Liver failure Who take multiple antihypertensives 5 α-Reductase Inhibitors: 5 α- Reductase Inhibitors 5 α- Reductase inhibitors: Interfere with the stimulatory effect of testosterone Slow Disease progression and decrease the risk of complications Require 6 months to maximally shrink an enlarged prostate ( Demerit) Cause more sexual dysfunction ( Demerit) Dutasteride inhibits types I and II 5 α- reductase More quickly and completely suppresses intraprostatic DHT by 90% (vs. 80%) Decreases serum DHT by 90% (versus 70%). Finasteride inhibits only type II 5 α- reductase 5 α-Reductase Inhibitors…………..: 5 α- Reductase Inhibitors………….. They may be preferred in patients with CVD They reduce serum PSA levels by 50% with in 6 month of R x If not, the patient should be evaluated for prostate cancer 5 α- Reductase inhibitors are in FDA pregnancy category X SURGICAL INTERVENTION: SURGICAL INTERVENTION Surgical intervention: Surgical intervention Prostatectomy for patients with moderate or severe symptoms of BPH and for all patients with complications gold standard Types Complications: Retrograde ejaculation ( 75% of transurethral prostatectomy) bleeding, urinary incontinence, and erectile dysfunction ( 2% to 15%) Transurethral Suprapubical PHYTOTHERAPY: PHYTOTHERAPY PHYTOTHERAPY: PHYTOTHERAPY Widely used in Europe for BPH Phytotherapy with the following products should be avoided: Saw palmetto berry ( Serenoa Repens ) Stinging nettle ( Urtica Dioica ) African plum ( Pygeum Africanum ) Studies of these herbal medicines are inconclusive, and the purity of available products is questionable EVALUATION OF THERAPEUTIC OUTCOMES: EVALUATION OF THERAPEUTIC OUTCOMES Evaluation outcomes: Evaluation outcomes The AUA Symptom Score can be used to assess patient quality of life. Bladder emptying measurements are also useful: After 6 to 12 months of 5 α- reductase inhibitor therapy or 3 to 4 weeks of α-adrenergic antagonist therapy Laboratory tests (e.g., blood urea nitrogen, creatinine, PSA) and urinalysis should be monitored regularly Patients should have an annual digital rectal examination Monitor and manage ADR on every Visit Adverse Effects of α-Adrenergic Antagonists and Management Suggestions: Adverse Effects of α- Adrenergic Antagonists and Management Suggestions Adverse Effects of 5α-Reductase Inhibitors and Management Suggestions,: Adverse Effects of 5α- Reductase Inhibitors and Management Suggestions,

Add a comment

Related presentations

Related pages

Benigne Prostatahyperplasie – Wikipedia

Als benigne Prostatahyperplasie (BPH), früher auch Prostataadenom (PA) oder fälschlich benigne Prostatahypertrophie genannt, wird eine gutartige ...
Read more

Bph.pl - Klienci indywidualni - Bank BPH - konta osobiste ...

Bph.pl - Klienci indywi­dual­ni - Bank BPH - konta osobiste, oszczed­nos­ci, kredyty, karty do konta, karty kredytowe, inwestycje, ubez­piecze­nia ...
Read more

MedizInfo® BPH - Prostatahyperplasie - Prostatavergrösserung

Gutartige Prostatavergrößerung Benignes Prostata-Hyperplasie Syndrom = BPH: Bei ungefähr 60 Prozent aller Männer kommt es ab dem 50. Lebensjahr zu ...
Read more

Benigne Prostatahyperplasie - DocCheck Flexikon

Etwa die Hälfte der Männer über 50 Jahren entwickelt eine BPH, wobei nur 1/5 der Betroffenen therapiebedürftige Miktionsbeschwerden entwickelt.
Read more

BPH - Therapie mit Tablette, Messer oder Laser?

BPH - Therapie mit Tablette, Messer oder Laser? Op bei Restharnmenge über 100 ml und mäßigen bis starken Beschwerden. Jeder zweite Mann über ...
Read more

Benigne Prostatahyperplasie (BPH, Prostatavergrößerung ...

Wie entsteht eine benigne Prostatahyperplasie (BPH, gutartige Prostatavergrößerung)? Wie macht sich eine vergrößerte Prostata bemerkbar und was kann ...
Read more

Die gutartige Prostata-Vergrößerung (BPH) : Deutsches ...

Die gutartige Prostatavergrößerung, die auch als Benigne Prostata-Hyperplasie (BPH) bezeichnet wird, ist die häufigste Erkrankung des älteren Mannes.
Read more

Benigne Prostatahyperplasie (BPH) und benignes ...

Definition und Epidemiologie der BPH (Benigne Prostatahyperplasie) und der BPS (benignes Prostatasyndrom), aus dem Online Urologie-Lehrbuch von D. Manski
Read more

BPH – die gutartige Prostatavergrößerung - prostagutt.de

Wer unter häufigem und nächtlichem Harndrang leidet, sollte herausfinden, ob eine gutartige Prostatavergrößerung (BPH) der Grund ist.
Read more

Prostate Enlargement: Benign Prostatic Hyperplasia

Benign prostatic hyperplasia––also called BPH––is a condition in men in which the prostate gland is enlarged and not cancerous.
Read more