Benign Diseases of the Prostate Flashcards

Question

Give an example of a highly selecting alpha 1a blocker

Answer 1

Tamsulosin

Answer 2

Side effect profiles and pharmacodynamic properties

Answer 3

Convert testosterone to dihydrotestosterone Reduces prostate size and the risk of progression of BPE (if prostate > 25cc) Also reduces LUTS, but not as effectively as alpha blockers Can also reduce prostatic vascularity and hence reduce haematuria due to prostatic bleeding

Answer 4

Finasteride (5AR type II inhibitor) | Dutasteride (5AR type I and II inhibitor)

Answer 5

Combination therapy of 5ARIs and alpha blockers

Answer 6

Transurethral resection of prostate

Answer 7

Very effective in relieving symptoms and improves urodynamic parameters 90% efficacy at 1 year

Answer 8

``` Bleeding Infection Retrograde ejaculation Stress urinary incontinence Prostate regrowth causing recurrent haematuria or BOO ```

Answer 9

Transurethral laser vaporisation Transurethral holmium laser enucleation of prostate (HoLEP) Transurethral needle ablation of prostate using RFA Transurethral microwave therapy of prostate Most have lack of long-term efficacy or lack of long-term data

Answer 10

``` Progression of LUTS Acute urinary retention Chronic urinary retention Urinary incontinence (overflow) UTI Bladder stone Renal failure from obstructed ureteric outflow due to high bladder pressure ```

Answer 11

Medical therapy Most will require surgery Some do not need any treatment, especially if residuals are relatively low, asymptomatic and no complications

Answer 12

Long-term urethral or suprapubic catheterisation | Clean intermittent self-catheterisation

Answer 13

``` Difficult catheterisation Catheter trauma Blockages Frank haematuria Recurrent UTI ```

Answer 14

Painful inability to void with a palpable and percussible bladder

Answer 15

Vary from 500ml to > 1 litre, depending on time lag in seeking medical attention

Answer 16

BPO, but it can also occur independently e.g. UTI, urethral stricture, alcohol excess, post-op causes, acute surgical or medical problems

Answer 17

Spontaneously, as a natural progression, or it can be triggered by an unrelated event e.g. constipation, alcohol excess, urological procedure

Answer 18

Catheterisation

Answer 19

``` UTI Post-decompression haematuria Pathological diuresis Renal failure Electrolyte abnormalities ```

Answer 20

Catheterisation Treat any underlying trigger If no renal failure - start alpha blocker immediately and remove catheter after 2 days If failure to void at this point - recatheterise and organise TURP

Answer 21

Painless, palpable and percussible bladder after voiding

Answer 22

Patients are often able to void but have residuals ranging from 400ml to > 2 litres, depending on the stage of the condition

Answer 23

Detrusor muscle under-activity | May be primary e.g. primary bladder failure or secondary e.g. due to long-standing BOO

Answer 24

As LUTS or complications e.g. UTI, bladder stones, overflow incontinence, post-renal or obstructive renal failure May be incidental finding

Answer 25

At the severe end of the spectrum, when bladder capacity is reached and bladder pressure is in excess of 25cm water

Answer 26

Asymptomatic patients with low residuals may not need treatment Immediate treatment is catheterisation, followed by CISC if appropriate

Answer 27

UTI Post-decompression haematuria Pathological diuresis Electrolyte abnormalities e.g. hyponatraemia, hyperkalaemia Persistent renal dysfunction due to acute tubular necrosis

Answer 28

Urine output > 200ml/hour Postural hypotension (systolic differential > 20mmHg between lying and standing) Weight loss Electrolyte abnormalities

Answer 29

IV fluids Close monitoring and liaise with renal team Subsequent treatment either long-term urethral or suprapubic catheter, CISC or TURP

Answer 30

Acute urinary retention

Answer 31

High-pressure chronic retention