{"id":3924,"date":"2024-04-17T14:37:00","date_gmt":"2024-04-17T14:37:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3924"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"omm-question-of-the-day-enlarged-prostate","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate","title":{"rendered":"OMM\u00ae Question of the Day: Enlarged prostate"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#E_T11-L2\" >E.&nbsp;T11-L2<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#A_T1-T4\" >A. T1-T4<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#B_T1-T5\" >B. T1-T5<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#C_S2-S4\" >C. S2-S4<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#D_T5-T8\" >D. T5-T8<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Explore the role of sympathetic innervation in urinary symptoms and how manipulation of specific spinal levels can alleviate prostate-related issues.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An 85-year-old man presents to the clinic complaining of needing to urinate over five times a night for the past month. He is frustrated because despite feeling an intense need to go, it takes some time for the stream to begin. Physical exam shows normal external genitalia and digital rectal exam reveals a smooth, rubbery, enlarged prostate. Urinalysis results are shown below:<br><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/osmose-it.s3.amazonaws.com\/cCynmsLKQ2OUkU2QiVKQokJDTk66XrYL\/_.png\" alt=\"\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><br>Based on the most likely diagnosis, manipulation to which of the following levels would affect sympathetic innervation to the affected organ?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. T1-T4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. T1-T5<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. S2-S4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. T5-T8<\/strong><strong>E.&nbsp;<strong>T11-L2<\/strong><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_T11-L2\"><\/span>E.&nbsp;<strong>T11-L2<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_T1-T4\"><\/span>A. T1-T4<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Spinal cord segments T1-T4 are associated with sympathetic innervation of head and neck.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_T1-T5\"><\/span>B. T1-T5<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;&nbsp;Spinal cord segments T1-T5 are associated with sympathetic innervation of the heart.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_S2-S4\"><\/span>C. S2-S4<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Spinal cord segments S2-S4 are associated with parasympathetic, not sympathetic, innervation to the lower ureter, bladder, urethra, uterus, prostate, genitalia, descending colon, sigmoid colon, and rectum.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_T5-T8\"><\/span>D. T5-T8<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Spinal cord segments T5-T9 are associated with sympathetic innervation to the stomach, gallbladder, spleen, pancreas, and liver.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Specific levels of the thoracolumbar spine correspond to the sympathetic innervation of organs. The prostate receives sympathetic innervation from spinal levels T11-L2, therefore this would be the correct choice. Through viscerosomatic and somatovisceral reflexes, manipulation of the muscles, bones, and tissues of the spine can affect the sympathetic and parasympathetic innervation to organs. By manipulating T11-L2, sympathetic outflow to the prostate will be normalized and can help his urinary symptoms. The prostate has an abundance of alpha-1 receptors; when these receptors are stimulated smooth muscle contracts in the prostate and bladder neck leading to symptoms of urinary obstruction, like hesitancy and urgency. By affecting the sympathetic outflow, these receptors can potentially become less stimulated leading to relaxation of the smooth muscle and alleviating the urinary obstruction. Although OMM can be used, this patient will likely require pharmacological treatment with tamsulosin, an alpha-1 antagonist.<br><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"1024\" width=\"747\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/sympathetic-innervation-level.png?w=747\" alt=\"sympathetic innervation level and organs\" class=\"wp-image-3925\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/sympathetic-innervation-level.png 1086w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/sympathetic-innervation-level.png?resize=219,300 219w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/sympathetic-innervation-level.png?resize=768,1052 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/sympathetic-innervation-level.png?resize=747,1024 747w\" sizes=\"auto, (max-width: 747px) 100vw, 747px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Sympathetic fibers from T12-L2 affect not only the prostate but the bladder as well. Sympathetic innervation to the prostate causes smooth muscle to contract via alpha-1 receptors, leading to urinary obstructive symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Moore, R. A., Waheed, A., &amp; Burns, B. (2019). Rule of Nines. In StatPearls [Internet]. StatPearls Publishing.<\/li>\n\n\n\n<li>Monafo, W. W. (1996). Initial management of burns. New England Journal of Medicine, 335(21), 1581-1586.<\/li>\n\n\n\n<li>Wachtel, T. L., Berry, C. C., Wachtel, E. E., &amp; Frank, H. A. (2000). The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns, 26(2), 156-170.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;________________________<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.\u00a0<\/sub><\/em><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore the role of sympathetic innervation in urinary symptoms and how manipulation of specific spinal levels can alleviate prostate-related issues. An 85-year-old man presents to the clinic complaining of needing to urinate over five times a night for the past month. He is frustrated because despite feeling an intense need to go, it takes some [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3926,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,34],"tags":[],"class_list":["post-3924","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM\u00ae Question of the Day: Enlarged prostate - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-enlarged-prostate\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM\u00ae Question of the Day: Enlarged prostate - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Explore the role of sympathetic innervation in urinary symptoms and how manipulation of specific spinal levels can alleviate prostate-related issues. An 85-year-old man presents to the clinic complaining of needing to urinate over five times a night for the past month. 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