224- BPH

Question 1

is anatomic enlargement necessary for BPH? why?

Answer 1

not absolutely

changes to SM/stroma of prostate and urethral compliance can lead to bladder outlet obstruction

Question 2

what zone has BPH? which has cancer?

Answer 2

trasnsition, peripheral

Question 3

when does BPH begin? what is the later prevelance?

Answer 3

begins by 30. More than 50% by age 60

Question 4

how is BPH diagnosed

Answer 4

clinically. Combination of objective and subjective parameters. Can use the prostate symptom score

Question 5

what urinary tract changes are seen with BPH

Answer 5

bladder dilation, thickening, trabeculation
hydronephrosis which can result in renal atrophy.
Urine stasis can cause UTI and pyelo.

Question 6

medical treatment of BPH

Answer 6

alpha1 adrenergic blockade (tamsulosin, doxazosin)

5alpha reductase inhibitors (finasteride, dutasteride)

Question 7

why not use 5alpha reductase? why use them?

Answer 7

takes longer to work. decreases libido, etc. Falsely lowers PSA!!

they can decrease volume by 20%

Question 8

adverse effects of alpha blockers

Answer 8

postural hypotension (not with tamsulosin), dizziness, nasal congestion, retrograde ejaculation

Question 9

what are the indications for surgery in BPH

Answer 9

urinary retention, gross hematuria, bladder stones, recurrent UTIs