Pharmacological management of Benign Prostatic Hyperplasia (BPH)
A thread
1/8
BPH is the non-malignant enlargement of the prostate causing urinary symptoms.
Observed commonly in ageing men 40<
Risk factors
💢 Age
💢 Family hx
💢 Smoking
💢 Alcohol
A thread
1/8
BPH is the non-malignant enlargement of the prostate causing urinary symptoms.
Observed commonly in ageing men 40<
Risk factors
💢 Age
💢 Family hx
💢 Smoking
💢 Alcohol
2/8
Manifestations
Presents with Lower Urinary Tract Symptoms_LUTS (Prostatism) that are classified into either irritative or obstructive symptoms.
Irritative symptoms
🕸 Urinary frequency
🕸 Nocturia
🕸 Urgency
🕸 Incontinence (Urge)
🕸 Painful micturition
Manifestations
Presents with Lower Urinary Tract Symptoms_LUTS (Prostatism) that are classified into either irritative or obstructive symptoms.
Irritative symptoms
🕸 Urinary frequency
🕸 Nocturia
🕸 Urgency
🕸 Incontinence (Urge)
🕸 Painful micturition
3
Obstructive symptoms
🕸 Hesitancy
🕸 Straining
🕸 Weak flow/stream
🕸 Prolonged voiding
🕸 Partial/complete urinary retention
🕸 Incontinence (over flow)
LUTS interfere with activities of daily living & cause significant impairment in sexual functioning.
Obstructive symptoms
🕸 Hesitancy
🕸 Straining
🕸 Weak flow/stream
🕸 Prolonged voiding
🕸 Partial/complete urinary retention
🕸 Incontinence (over flow)
LUTS interfere with activities of daily living & cause significant impairment in sexual functioning.
4Medical therapy
LUTS due to BPH are caused by 3 main factors;
♧. Dynamic > associated with tone of the prostatic smooth muscle and bladder neck
♧. Static > Enlarging prostatic adenoma causing mechanical obstruction
♧. Compensatory > Hypertrophy & irritability of the bladder
LUTS due to BPH are caused by 3 main factors;
♧. Dynamic > associated with tone of the prostatic smooth muscle and bladder neck
♧. Static > Enlarging prostatic adenoma causing mechanical obstruction
♧. Compensatory > Hypertrophy & irritability of the bladder
5
Medical therapy targets dynamic and static factors as discussed 👇
1. Alpha adrenergic blockers
These treat the dynamic component of BPH by relaxing smooth muscle of the prostate and bladder neck. This causes the urethral lumen to widen so improving urinary flow
Examples👇
Medical therapy targets dynamic and static factors as discussed 👇
1. Alpha adrenergic blockers
These treat the dynamic component of BPH by relaxing smooth muscle of the prostate and bladder neck. This causes the urethral lumen to widen so improving urinary flow
Examples👇
6
♤ Tamsulosin
♤ Silodosin
♤ Terazosin
♤ Prazosin (though not recommended anymore)
2. 5-alpha Reductase inhibitors
Enzyme 5-alpha Reductase converts testosterone to Dihydrotestosterone (DHT) in the prostate. DHT is responsible for maintaining the size of the prostate.
♤ Tamsulosin
♤ Silodosin
♤ Terazosin
♤ Prazosin (though not recommended anymore)
2. 5-alpha Reductase inhibitors
Enzyme 5-alpha Reductase converts testosterone to Dihydrotestosterone (DHT) in the prostate. DHT is responsible for maintaining the size of the prostate.
7
Inhibition of this enzyme reduces androgenic DHT and subsequently reduces prostatic tissue volume and the static contribution of symptoms.
Examples;
♤ Finasteride
♤ Dutasteride
These drugs can be given as monotherapy or in combination. Symptomatic benefit can take
Inhibition of this enzyme reduces androgenic DHT and subsequently reduces prostatic tissue volume and the static contribution of symptoms.
Examples;
♤ Finasteride
♤ Dutasteride
These drugs can be given as monotherapy or in combination. Symptomatic benefit can take
8/8
3-6months to occur. The drugs can reduce concentration of Prostate Specific Antigen (PSA) by 57-66% and avoid surgical intervention (prostatectomy).
Kirenga Emmanuel
MBChB IV
@kiuvarsity
@UnrollHelper
3-6months to occur. The drugs can reduce concentration of Prostate Specific Antigen (PSA) by 57-66% and avoid surgical intervention (prostatectomy).
Kirenga Emmanuel
MBChB IV
@kiuvarsity
@UnrollHelper
• • •
Missing some Tweet in this thread? You can try to
force a refresh
