BPH Flashcards
Prostate is derivation of ____derm
endoderm
____ zone is site of BPH
Transitional (encircles urethra)
____ zone is site of prostate ca.
Peripheral (75% of gland)
BPH is cellular proliferation of ____ and ____ parts
stromal & epithelial
alpha-1 blockers inhibit prostate _____ and decrease prostatic urethral resistance
smooth muscle contraction
LUTS work-up
History
Exam
_____ symptom score
Lab test: ____
AUA-SS
UA
Prior to BPH surgery….
Size evaluation with ___, ____, or ___
Voiding studies - ____ & ____
U/S, cystoscopy, or cross-sectional imaging
PVR & Uroflow
1st Line BPH therapies
- Fluid restriction prior to sleeping
- Limiting alcohol and caffeine
- Voiding diary with frequency-volume chart
- Timed voiding
- Double voiding
- Bladder training
- Avoiding constipation
Alpha-blocker side effects
Adverse effects
• Dizziness (orthostasis)
• Retrograde ejaculation (6%)
• Rhinitis (12%)
• Intraoperative floppy iris syndrome (IFIS)
• higher rates of iris trauma and posterior capsule rupture during cataract surgery with ANY use of Tamsulosin
____ has the least risk of ejaculatory dysfunction of all alpha-blockers
Alfuzosin (Uroxatral)
5-ARIs have maximal prostate size reduction after ___ with an average size reduction of ___ %
6 months… 15-30%
Finasteride also suppresses _____ which makes it useful in men with refractory hematuria 2/2 prostatic bleeding
VEGF
Risk reduction of retention or prostate surgery with Finasteride use is ___%
70%
____ medications work by relaxing detrusor muscle to increase bladder storage volumes and decrease sensation for micturition
Beta-3 agonists (Mirabegron)
Side effects of Mirabegron
HTN(7.3%), Nasopharyngitis (3.4%)
PDE-5i with FDA approval for daily use in men with BPH/LUTS
Tadalafil 5 mg (Cialis)
Side effcts of PDE-5i
Headache (15%)
Facial flushing (4-10%)
Dyspepsia (3-11%)
Mechanism of PDE-5i
block breakdown of cGMP to GMP by phosphodiesterase leading to vasodilation
MTOPS study
Compared ___, ____, ___, ____
Results: ____ AUR, BPH surgery, BPH progression
placebo vs doxazosin vs finasteride vs combo
REDUCED aur, bph sx, bph progression
COMBAT trial
Compared ____ vs ____ vs ____
Results: ___ Qmax, PSA, & prostate volume
Tamsulosin vs Dutasteride (Avodart) vs combo
TIMES Trial
Compared ____ vs _____
Results: ____ nocturia, frequency/urgency, ____ in Qmax, PVR
Tolteroderine (Detrol) vs Detrol + Flomax
Improved symptoms
No change in Qmax or PVR
PLUS trial
Compared ____ vs ____
Results: ____ mean volume voided per micturition, & urgency and frequency, ____ in Qmax or PVR, ____
retention rates in the tamsulosin plus mirabegron group
Flomax vs Flomax + Mirabegron
Improved volume & urgency & frequency
No change in Qmax or PVR
Higher retention rates in combo group
Indications for BPH Surgery
Refractory to and/or unwilling to use other therapies Renal insufficiency secondary to BPH Urinary retention secondary to BPH Recurrent UTI Recurrent bladder stones Gross hematuria secondary to BPH
Urolift contraindications
Size >___ cc
Prominent ____ lobe
> 80 cc
Prominent middle lobe
Water Vapor Therapy (Rezum) Mechanism
Water vapor energy leads to disruption of cell membranes and tissue necrosis
AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial
NOT
AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial
NOT
