Benign Prostatic Hypertrophy, Erectile Dysfunction, and Urinary Incontinence

Comprehensive vocabulary flashcards covering the pathophysiology, clinical diagnosis, pharmacology, and treatment algorithms for benign prostatic hypertrophy, erectile dysfunction, and urinary incontinence.

Benign Prostatic Hypertrophy (BPH)

A condition characterized by nonmalignant cellular proliferation of the prostate gland; approximately $80\%$ of elderly men show microscopic evidence, $50\%$ develop an enlarged prostate, and peak clinical incidence occurs at $63\text{ to }65$ years of age.

Normal Prostate Gland

A male reproductive gland situated anterior to the rectum and below the urinary bladder, surrounding the proximal urethra; on digital rectal examination, it is typically round, soft, symmetric, mobile, and weighs between $4\text{ to }20\,g$ in adult men.

Prostatic Epithelial Tissue

The secretory glandular tissue within the prostate that produces prostatic secretions and is physiologically regulated by androgens.

Prostatic Stromal Tissue

Smooth-muscle tissue within the prostate embedded with $\alpha_1$-adrenergic receptors; sympathetic norepinephrine stimulation induces contraction, causing extrinsic urethral compression and reduced bladder emptying.

Prostatic Capsule

The outer anatomical shell of the prostate gland composed of fibrous connective tissue and smooth muscle rich in $\alpha_1$-adrenergic receptors, which contracts around the urethra upon norepinephrine release.

Androstenedione

The principal adrenal androgen contributing to secondary male androgenic activity.

Testosterone

The principal testicular androgen responsible for penile and scrotal enlargement, increased muscle mass, and maintenance of normal male libido.

$5\alpha$-Reductase Type I

The enzyme isoform localized to hair follicles, sebaceous glands of the frontal scalp, liver, and skin that converts androgens to DHT, contributing to acne, increased body and facial hair, and male pattern baldness.

$5\alpha$-Reductase Type II

The enzyme isoform primarily localized to the prostate, genital tissues, and scalp that converts testosterone to DHT, directly promoting prostate enlargement and cellular growth.

Dihydrotestosterone (DHT)

The potent intraprostatic androgen converted from testosterone by $5\alpha$-reductase; it has higher affinity for intraprostatic androgen receptors and drives normal pubertal growth as well as BPH during the secondary growth spurt.

Static Factors (in BPH Pathophysiology)

Pathophysiologic elements causing mechanical outlet obstruction due to physical enlargement of the prostate gland, driven by androgen stimulation of epithelial tissue and estrogen stimulation of stromal tissue.

Dynamic Factors (in BPH Pathophysiology)

Pathophysiologic elements related to excessive $\alpha_1$-adrenergic tone and smooth-muscle contraction in the prostate gland, surgical capsule, bladder neck, and posterior urethra, narrowing the urethral lumen.

BPH Obstructive Symptoms

Lower urinary tract symptoms resulting directly from mechanical bladder outlet narrowing, including hesitancy, weak stream, intermittency, and straining to void.

BPH Irritative Symptoms

Lower urinary tract symptoms occurring in $50\%\text{ to }80\%$ of long-standing BPH patients due to bladder detrusor hypertrophy and eventual decompensation, presenting as urinary frequency, urgency, and nocturia.

American Urological Association Symptom Index (AUASI)

A 7-item clinical questionnaire scored from $0$ to $5$ per item used to quantify voiding dysfunction, categorizing disease as mild ($\le 7$), moderate ($8-19$), or severe ($\ge 20$).

Watchful Waiting (in BPH)

Management strategy indicated for patients with mild BPH (AUASI $<8$) or moderate/severe disease not bothered by symptoms, comprising reassessment every $6\text{ to }12$ months with flow rate, postvoid residual volume, DRE, BUN/SCr, and behavioral modifications.

Doxazosin (Cardura)

A long-acting ($t_{1/2} = 19-22\,\text{hours}$) $\alpha_1$-adrenergic antagonist titrated from $1\,mg/day$ to $4\text{ or }8\,mg/day$, noted in the ALLHAT trial to decrease blood pressure by an average of $15/5\,mmHg$.

Terazosin (Hytrin)

An $\alpha_1$-adrenergic antagonist used for BPH, initiated at $1\,mg/day$ and titrated to a target maintenance dose of $2\text{ to }10\,mg/day$.

Alfuzosin (UroXatral)

A uroselective, sustained-release $\alpha_1$-adrenergic antagonist dosed at $5\,mg/day$ and increased up to $5\,mg$ twice daily or $10\,mg$ once daily for BPH.

Tamsulosin (Flomax)

A prostate-selective $\alpha_1$-adrenergic antagonist dosed at $0.4\,mg/day$ (titratable to $0.8\,mg/day$ after 2 weeks) that causes minimal blood pressure alteration but is linked to ejaculatory dysfunction and floppy iris syndrome.

Silodosin (Rapaflo)

A highly selective $\alpha_1$-adrenergic receptor antagonist dosed at $8\,mg$ orally once daily for the treatment of lower urinary tract symptoms due to BPH.

Intraoperative Floppy Iris Syndrome (IFIS)

A surgical complication occurring during cataract procedures characterized by a billowing flaccid iris and progressive intraoperative miosis, associated with previous or current exposure to $\alpha_1$-blockers.

Finasteride (Proscar)

A competitive $5\alpha$-reductase inhibitor dosed at $5\,mg$ orally daily for prostates enlarged to $>40\text{ to }50\,g$ (or $>30\,cc$) that reduces prostate volume by approximately $25\%$ over $6\text{ to }12$ months.

Dutasteride (Avodart)

A $5\alpha$-reductase inhibitor dosed at $0.5\,mg$ orally daily, designated as Pregnancy Category X because exposure to tablets or semen may result in pseudohermaphroditic abnormalities in male fetuses.

Jalyn

A fixed-dose combination oral product containing the $5\alpha$-reductase inhibitor dutasteride ($0.5\,mg$) and the $\alpha_1$-adrenergic antagonist tamsulosin ($0.4\,mg$).

Transurethral Resection of the Prostate (TURP)

A standard surgical intervention for severe BPH with high symptomatic efficacy, carrying procedural risks such as retrograde ejaculation ($75\%$), erectile dysfunction ($2-15\%$), and an $8$-year reoperation rate of $12-15\%$.

Erectile Dysfunction (ED)

A sexual disorder defined as the consistent or recurrent inability to achieve or maintain a penile erection suitable for satisfactory sexual intercourse.

Corpora Cavernosa

Two paired dorsolateral cylindrical erectile bodies of the penis enclosed within the tunica albuginea that engorge with arterial blood to produce rigidity during erection.

Corpus Spongiosum

The single midventral cylindrical body of the penis that encloses the urethra and expands distally to form the glans penis.

Tunica Albuginea

A thick, fibroelastic connective tissue sheath encasing the corpora cavernosa that facilitates venous occlusion by compressing draining venules as erectile tissue expands.

Buck's Fascia

The deep layer of penile fibrous investing fascia surrounding both the paired corpora cavernosa and the corpus spongiosum.

Cavernous Spaces (Cavernous Sinuses)

Spongelike interconnected vascular spaces within the corpora cavernosa lined by vascular endothelium and separated by smooth muscle trabeculae.

Psychogenic Erections

Erections initiated primarily by the central nervous system in response to cognitive, visual, auditory, or olfactory sexual stimuli generated or received in the brain.

Reflexogenic Erections

Involuntary erections resulting from direct physical or tactile somatosensory stimulation of the genital organs and surrounding tissues.

Nocturnal Penile Tumescence

Spontaneous erections occurring during rapid eye movement (REM) sleep ($\ge 3$ times per night), thought to deliver increased oxygenated blood to corporal tissues.

Sexual Health Inventory for Men (SHIM)

A validated 5-question assessment tool evaluating erectile function over the previous 6 months on a 25-point scale, where a score of $\le 21$ warrants further clinical evaluation.

Organic Erectile Dysfunction

ED stemming from identifiable physiological, structural, surgical, vascular, neurogenic, or endocrine causes, which often coexists with psychogenic factors in clinical presentations.

Nitric Oxide (NO) / cGMP Signaling Pathway

The physiological cascade in erection where neuronal and endothelial nitric oxide stimulates guanylate cyclase to synthesize cGMP, lowering intracellular calcium and promoting cavernosal smooth-muscle relaxation.

Sildenafil (Viagra)

A phosphodiesterase-5 inhibitor with a half-life of 4 hours and duration of $4\text{ to }8\,\text{hours}$, which is delayed in absorption by fatty meals and can cause visual side effects via cross-inhibition of PDE6.

Tadalafil (Cialis)

An oral PDE5 inhibitor characterized by a long half-life ($17.5\,\text{hours}$) and extended duration of action ($24\text{ to }36\,\text{hours}$), taken on demand or at $5\,mg$ daily for dual treatment of BPH and ED.

Vardenafil (Levitra)

A PDE5 inhibitor with a half-life of $4\text{ to }5\,\text{hours}$ and duration of $2\text{ to }8\,\text{hours}$, whose median $T_{\max}$ is delayed by high-fat meals.

Avanafil (Stendra)

A rapid-acting PDE5 inhibitor dosed at $50\text{ to }200\,mg$ taken 30 minutes prior to sexual intercourse, possessing a half-life of approximately 5 hours.

Organic Nitrates (ED Contraindication)

Vasodilator medications absolutely contraindicated with PDE5 inhibitors due to life-threatening hypotension; patients must avoid nitrates for at least $24\,\text{hours}$ after sildenafil or vardenafil, and $48\,\text{hours}$ after tadalafil.

Princeton III Consensus Risk Stratification

Clinical guidelines categorizing cardiac risk in ED patients into low (safe to use PDE5 inhibitors), indeterminate (requires cardiovascular workup), and high risk (PDE5 inhibitors contraindicated).

Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

A rare ophthalmologic adverse event involving sudden loss of vision that mandates immediate cessation of PDE5 inhibitor therapy and urgent medical assessment.

Alprostadil

A synthetic formulation of prostaglandin $E_1$ ($PGE_1$) that augments acetylcholine activity to directly relax smooth muscle and increase penile blood flow without requiring sexual stimulation.

Intracavernosal Injection (ICI) Therapy

A second-line ED therapy where vasoactive medication (alprostadil, Bimix, Trimix) is injected into the lateral penile shaft with a 28g or 30g needle, producing an erection in approximately 15 minutes.

Medicated Urethral System for Erection (MUSE)

An intraurethral delivery system utilizing a plastic applicator to insert a semi-solid alprostadil pellet ($125\text{ to }1000\,\mu g$) into the distal urethra, yielding erections within $5\text{ to }10$ minutes.

Vacuum Erection Device (VED)

A non-oral, nonpharmacologic mechanical device consisting of a clear plastic cylinder, a vacuum pump to draw blood into the penis, and a basal constriction ring to restrict venous return.

Eroxon (MED3000)

An FDA-authorized over-the-counter topical gel composed of water, ethanol, and propylene glycol that applies an evaporative cooling and warming effect on the glans penis to stimulate nerve endings within 10 minutes.

Stress Urinary Incontinence (SUI)

Involuntary loss of urine during physical exertion, sneezing, coughing, or laughing, resulting from urethral underactivity and sphincter incompetence unable to withstand raised intra-abdominal pressure.

Urge Urinary Incontinence (UUI)

Involuntary urine leakage preceded by or concurrent with a sudden, compelling desire to void, caused by uninhibited detrusor muscle contractions during bladder filling.

Overflow Urinary Incontinence

Involuntary urine leakage from an overdistended, full bladder characterized by high residual urine volume, caused by urethral overactivity (anatomical obstruction) or detrusor underactivity (hypotonic bladder).

Functional Incontinence

Urine leakage resulting from external cognitive, physical, mobility, or environmental impairments (e.g., dementia, severe musculoskeletal limitations) rather than intrinsic urological pathology.

Mixed Urinary Incontinence (MUI)

A combined form of urinary incontinence presenting with concomitant features of both stress urinary incontinence (exertional leakage) and urge urinary incontinence (urgency leakage).

DIAPPERS

A clinical mnemonic representing reversible causes of transient urinary incontinence: Delirium, Infection, Atrophic vaginitis/urethritis, Psychiatric disorders, Pharmacological agents, Excessive urine output, Restricted mobility, and Stool impaction.

Normal Detrusor Parasympathetic Innervation

Parasympathetic pathways mediating bladder emptying via postganglionic cholinergic fibers that stimulate muscarinic receptors on the detrusor muscle wall to trigger active bladder contraction.

Normal Internal Urethral Sphincter Innervation

Sympathetic innervation acting via $\alpha_1$-adrenergic receptors to maintain continuous smooth-muscle contraction at the bladder outlet, preventing involuntary urine leakage during the storage phase.

Normal External Urethral Sphincter

The striated muscle ring around the proximal urethra governed by voluntary somatic motor control via the pudendal nerve, providing conscious urinary continence.

Continence Pessary

An intravaginal mechanical anti-incontinence device designed to provide physical support to the bladder neck and urethra in women suffering from stress urinary incontinence.

Oxybutynin (Ditropan)

An antimuscarinic agent used for urge incontinence formulated as IR ($2.5-5\,mg$ $2-3$ times daily), ER ($5-30\,mg$ daily), and transdermal ($3.9\,mg/day$), with transdermal delivery producing markedly less dry mouth ($38\%$ vs $94\%$).

Tolterodine (Detrol)

A competitive muscarinic receptor antagonist for overactive bladder dosed at $1\text{ to }2\,mg$ twice daily (IR) or $2\text{ to }4\,mg$ daily (ER), with a lower risk of dry mouth compared to IR oxybutynin ($\text{relative risk } = 0.54$).

Solifenacin Succinate (Vesicare)

A once-daily antimuscarinic agent dosed at $5\text{ to }10\,mg$ daily exhibiting relative selectivity for $M_3$ muscarinic receptors in the bladder detrusor and gastrointestinal tract, metabolized by CYP3A4.

Darifenacin (Enablex)

An $M_3$-selective muscarinic receptor antagonist dosed at $7.5\,mg$ orally once daily and increasable to $15\,mg$ daily after 2 weeks for the management of urge incontinence.

Trospium Chloride (Sanctura)

A quaternary amine antimuscarinic dosed at $20\,mg$ twice daily (IR) or $60\,mg$ once daily (XR); it must be taken on an empty stomach because high-fat meals reduce oral bioavailability by $70\%\text{ to }80\%$.

Fesoterodine (Toviaz)

A non-selective antimuscarinic prodrug dosed at $4\text{ to }8\,mg$ orally once daily, which restored continence in an estimated 130 per 1000 women in systematic review data.

Mirabegron (Myrbetriq)

A $\beta_3$-adrenoceptor agonist dosed at $25\text{ to }50\,mg$ daily that promotes detrusor relaxation during bladder filling; maximum daily dose is capped at $25\,mg$ if CrCl is $15\text{ to }29\,mL/min$, and it moderately inhibits CYP2D6.

Vibegron (Gemtesa)

A selective $\beta_3$-adrenergic receptor agonist dosed at $75\,mg$ daily as a crushable tablet without need for dose titration or CYP2D6 interactions, showing an OABSS improvement of $-5.3$ in trials.

Botulinum Toxin Type A (Botox) (in UI)

An intradetrusor injectable neurotoxin administered via cystoscopy for refractory neurogenic overactive bladder (e.g., in MS or spinal cord injury) that inhibits detrusor contractions for approximately 9 months.

Vaginal vs. Oral Estrogen for UI

Topical vaginal estrogen (creams or rings) enhances urethral mucosal coaptation and sphincter closing pressure, whereas oral estrogens (demonstrated in WHI and HERS trials) worsen urinary incontinence and are contraindicated.