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Yr3 Met 3B > 11. Benign Prostatic Hyperplasia > Flashcards

11. Benign Prostatic Hyperplasia Flashcards

1
Q

What is the acronym FUN WISE?

A

LUTS

  • Frequency
  • Urgency
  • Nocturia
  • Weak Stream
  • Intermittency
  • Straining
  • Emptying Incompletely
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2
Q

What is the IPSS?

A

International Prostate Symptom Score:
8 Question Swritten screening tool to screen/diagnose LUTS for BPH
- 20-35 = Severely symptomatic

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3
Q

What are the short term consequences of BPH progression?

A
  1. Pain
  2. Financial Cost
    Recurrent Hospitalisation
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4
Q

What are the long term consequences of BPH progression?

A
  1. Likelihood of subsequent surgery
  2. Increased risk of complications vs elective procedures
  3. Risk of recurrent retention
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5
Q

*What are the NICE 10 Key Priorities for Implementation with regards to LUTS

A
  1. If LUTS, assess their PMH to identify causes of LUTS/comorbidities
  2. Offer men a Physical Exam/Abdo Exam/Genital Exam/DRE
  3. Complete Frequency Volume Chart
  4. Refer for specialist assessment if there is Recurrent/Persistent UTI
  5. Give them care for Physical/Emotional/Psycho/Sexual/Social Needs
  6. Storage LUTS need advice for relevant support groups
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6
Q

In regards to LUTS, give 4 examples of Filling/Storage Symptoms

A
  1. More Frequency of urination
  2. More Urgency of urination
  3. Nocturia
  4. Urge incontinence (Loss of bladder control)
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7
Q

In regards to LUTS, give 4 examples of Voiding Symptoms

A
  1. Weak/Intermittent Stream
  2. Straining
  3. Hesitancy
  4. Incomplete emptying
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8
Q

For those with LUTS, what is the NICE Recommendation for Initial Assessment?

A
  1. Assess GMH and Review of Medication
  2. Focused Physical Exam
  3. Abdo/Ext Genital/Digital Rectal Exam
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9
Q

What Investigations can you offer for those with LUTS

A
  1. Urine Dipstick
  2. Frequency Volume chart (For problematic LUTS)
  3. PSA Test: Advice and Time if their LUTS suggests Bladder Outlet Obstruction secondary to BPE
  4. Serum Creatinine
  5. Treatment
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10
Q

What is the Frequency Volume chart?

A

“Bladder Diary”

  • Simple, non-invasive tool to evaluate patients complaining of LUTS
  • Gives an indication of Voiding patterns/Symptom severity
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11
Q

What can be considered a Moderate IPSS?

A

Moderate: 8-19

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12
Q

What is the approximate size of a 30 cc prostate?

A

Ping pong ball with 4cm diameter

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13
Q

What is a DRE?

A
  • Assessment of Symmetry/Size/Surface Smoothness/Tenderness/MIDLINE GROOVE of Prostate assessed
  • Pelvis and Rectum too
  • Rectal tumours, Impaction too
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14
Q

Why is urinalysis done?

A

Identifies:

  1. Haematuria
  2. Glycosuria
  3. Proteinuria
  4. Pyuria
  5. Urinary Nitrites/Leucocytes
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15
Q

What does a dipstick test for?

A
  1. Microscopy and Culture for Microorganisms
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16
Q

What is NOT offered to men with LUTS?

A
  1. Cytoscopy with NO EVIDENCE of bladder issues
  2. Imagine of Upper UT with NO EVIDENCE of bladder issues
  3. Flow-rate measurement
  4. Post-void residual volume measurement
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17
Q

When would you offer men information/advice/time for a PSA test?

A
  1. If LUTS suggest Bladder Outlet Obstruction secondary to BPE
  2. Abnormal Prostate on DRE
  3. Prostate Cancer concern
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18
Q

If men have Storage LUTS (Urinary Incontinence usually), what can be offered as management?

A
  1. Pads/Collecting devices
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19
Q

If men have Storage LUTS but suggestive of an Overactive Bladder, what can be offered as management

A
  1. Supervised Bladder Training
  2. Advice for fluid intake
  3. Lifestyle advice
  4. Containment products
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20
Q

What are the main aims of treatment in BPH?

A
  1. Improving LUTS (Voiding/Storage)
  2. Improving QoL
  3. Prevent BPE/BPO-related complications
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21
Q

If the LUTS is not bothersome to the patient, what should we do?

A

Active Surveillance

  • Reassurance
  • Advice for lifestyle mods
  • Offer review if symptoms change
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22
Q

If the LUTS is complicated and bothersome to the patient, what should we do?

A

Active Intervention

  • Conservation Management
  • Drug treatment/Surgery
  • Offer baseline assessment (IPSS)
23
Q

What Conservative management can we provide to those with an Overactive Bladder?

A
  1. Supervised Bladder Training
  2. Advice on fluid intake
  3. Lifestyle advice
  4. Containment products
24
Q

What Conservative management can we provide to those with Stress Incontinence caused by Prostatectomy?

A

Supervised Pelvic Floor Muscle Training

25
Q

What do we not offer for those with storage symptoms?

A

Penile clamps

26
Q

What Conservative management can we provide to those with voiding symptoms?

A
  1. Intermittent Bladder Catheterisation before indwelling urethral/suprapubic catheterisation (If LUTS cannot be corrected by less invasive measures)
  2. Bladder training > Surgery
  3. Explain how Urethral Milking works for those with Post Micturition dribble
27
Q

What Drug treatment can we offer men with Moderate-Severe LUTS?

A

Alpha Blocker

28
Q

What Drug treatment can we offer men with LUTS and a Prostate 30+g or PSA 1.4+ ng/ml and high risk of progression?

A

5-Alpha Reductase Inhibitor

29
Q

What Drug treatment can we offer to men with Bothersome moderate-severe LUTS and a prostate 30+g or PSA 1.4+ng/ml

A

Combination of Alpha Blocker and 5ARI

30
Q

What does 5ARI drugs do to manage BPH?

A
  1. Decrease in Dihydrotestosterone synthesis
  2. Reduced androgenic drive of prostate
  3. Reduction in prostate volume = Improved outflow
31
Q

What do Alpha blockers do to manage BPH?

A
  1. Block A1 receptors in prostate/urethra/bladder neck and detrusor
  2. Relaxes smooth muscle to improve urinary flow
32
Q

Give Two examples of 5-ARIs

A

Finasteride and Dutasteride

33
Q

When do we offer men Alpha Blockers for BPH?

A
  1. Moderate to Severe LUTS with no risk factors for progression
34
Q

Give 3 reasons why giving Alpha Blockers is advantageous for men with LUTS?

A
  1. No effect on Prostate Volume/PSA
  2. No effect on serious BPH complications (Acute urinary retention)
  3. MTOPS study suggests no effect on disease progression over 4 years
35
Q

What are the Risk Factors for the Progression of BPH?

A
  1. Age over 70
  2. Moderate-Severe Symptoms (IPSS > 7)
  3. PSA > 1.4 ng/ml
  4. Prostate Volume >30 cc
  5. Flow Rate <12 ml/sec
36
Q

What is the Pathophysiology fo 5ARI?

A
  1. Testosterone binds to it alongside NADPH and 5AR

2. This will prevent conversion of Testosterone to DHT to slow disease progression

37
Q

What is a main side effect of 5ARI?

A

Sexual function issues

38
Q

What enzyme does Finasteride inhibit?

A

5AR Type II Isoenzyme

39
Q

What enzyme does Dutasteride inhibit?

A

Dual inhibitor of 5AR Type I and Type II Isoenzyme

40
Q

Which drugs reduce Prostatic Volume?

A

5ARI

41
Q

What were the names of the two drugs involved in combination therapy for BPH?

A

Tamsulosin

Avodart

42
Q

According to NICE, what drug is recommended for an Overactive Bladder?

A

Anticholinergic

43
Q

According to NICE, what drug is best suited for those with Storage Symptoms dspite Alpha Blocker treatment?

A

Add an Anticholinergic on top

44
Q

When do we review men who have taken Alpha Blockers for their LUTS/BPH?

A

4-6 weeks

THEN every 6-12 months

45
Q

When do we review men who have taken 5ARI for their LUTS/BPH?

A

3-6 months

THEN every 6-12 months

46
Q

When do we review men who have taken Anticholinergics for their LUTS/BPH?

A

4-6 weeks

THEN every 6-12 months

47
Q

When would you recommend Specialist Assessment for LUTS/BPH?

A
  1. Bothersome LUTS and have not responded to Conservative/Drug Treatment
  2. LUTS complicated by UTI
  3. Retention
  4. Renal Impairment
  5. Urological Cancer
  6. Stress urinary incontinence
48
Q

What does NICE recommend on managing Acute Urinary Retention?

A
  1. Catheterisation of Men with acute retention

2. Offer Alpha blocker to them before withdrawing the catheter

49
Q

For Patients trying to manage their Voiding LUTS secondary to BPE, what should be offered as Surgery?

A
  1. Monopolar/Bipolar Transurethral Resection of Prostate (TURP)
  2. Monopolar Transurethral Vaporisation of Prostate (TUVP)
  3. Holmium Laser Enucleation of Prostate (HoLEP)
  4. Open prostatectomy (80+g Prostate)
50
Q

For Patients trying to manage their Voiding LUTS secondary to BPE, what should NOT be offered as Surgery?

A

Minimally invasive treatments

  1. Transurethral Needle ablation (TUNA)
  2. Transurethral Microwave Thermotherapy (TUMT)
  3. High-intensity focused US (HIFU)
  4. Transurethral Ethanol Ablation of Prostate (TEAP)
  5. Laser Coagulation
51
Q

When should surgery be offered to LUTS/BPE patients?

A
  1. When voiding symptoms are severe

2. Drug treatment/Conservative management have been unsuccessful/inappropriate

52
Q

For individuals with Detrusor overactivity, what should be offered as surgical treatment?

A
  1. Cystoplasty: Also willing to self-catheterise
  2. Bladder Wall Injection with Botulinum: Also willing to self-catheterise
  3. Implanted sacral nerve stimulation
53
Q

For individuals with Stress Urinary Incontinence, what should be offered as surgical treatment?

A
  1. Implantation of an artificial sphincter

2. Intramural injectables

Yr3 Met 3B (13 decks)

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