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AUA Fundamentals 2021 > BPH > Flashcards

BPH Flashcards

1
Q

Prostate is derivation of ____derm

A

endoderm

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2
Q

____ zone is site of BPH

A

Transitional (encircles urethra)

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3
Q

____ zone is site of prostate ca.

A

Peripheral (75% of gland)

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4
Q

BPH is cellular proliferation of ____ and ____ parts

A

stromal & epithelial

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5
Q

alpha-1 blockers inhibit prostate _____ and decrease prostatic urethral resistance

A

smooth muscle contraction

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6
Q

LUTS work-up

History
Exam
_____ symptom score
Lab test: ____

A

AUA-SS

UA

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7
Q

Prior to BPH surgery….

Size evaluation with ___, ____, or ___
Voiding studies - ____ & ____

A

U/S, cystoscopy, or cross-sectional imaging

PVR & Uroflow

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8
Q

1st Line BPH therapies

A
  • Fluid restriction prior to sleeping
  • Limiting alcohol and caffeine
  • Voiding diary with frequency-volume chart
  • Timed voiding
  • Double voiding
  • Bladder training
  • Avoiding constipation
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9
Q

Alpha-blocker side effects

A

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

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10
Q

____ has the least risk of ejaculatory dysfunction of all alpha-blockers

A

Alfuzosin (Uroxatral)

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11
Q

5-ARIs have maximal prostate size reduction after ___ with an average size reduction of ___ %

A

6 months… 15-30%

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12
Q

Finasteride also suppresses _____ which makes it useful in men with refractory hematuria 2/2 prostatic bleeding

A

VEGF

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13
Q

Risk reduction of retention or prostate surgery with Finasteride use is ___%

A

70%

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14
Q

____ medications work by relaxing detrusor muscle to increase bladder storage volumes and decrease sensation for micturition

A

Beta-3 agonists (Mirabegron)

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15
Q

Side effects of Mirabegron

A

HTN(7.3%), Nasopharyngitis (3.4%)

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16
Q

PDE-5i with FDA approval for daily use in men with BPH/LUTS

A

Tadalafil 5 mg (Cialis)

17
Q

Side effcts of PDE-5i

A

Headache (15%)
Facial flushing (4-10%)
Dyspepsia (3-11%)

18
Q

Mechanism of PDE-5i

A

block breakdown of cGMP to GMP by phosphodiesterase leading to vasodilation

19
Q

MTOPS study

Compared ___, ____, ___, ____
Results: ____ AUR, BPH surgery, BPH progression

A

placebo vs doxazosin vs finasteride vs combo

REDUCED aur, bph sx, bph progression

20
Q

COMBAT trial

Compared ____ vs ____ vs ____
Results: ___ Qmax, PSA, & prostate volume

A

Tamsulosin vs Dutasteride (Avodart) vs combo

21
Q

TIMES Trial

Compared ____ vs _____
Results: ____ nocturia, frequency/urgency, ____ in Qmax, PVR

A

Tolteroderine (Detrol) vs Detrol + Flomax

Improved symptoms
No change in Qmax or PVR

22
Q

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

A

Flomax vs Flomax + Mirabegron

Improved volume & urgency & frequency
No change in Qmax or PVR
Higher retention rates in combo group

23
Q

Indications for BPH Surgery

A 
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
24
Q

Urolift contraindications

Size >___ cc
Prominent ____ lobe

A

> 80 cc

Prominent middle lobe

25
Q

Water Vapor Therapy (Rezum) Mechanism

A

Water vapor energy leads to disruption of cell membranes and tissue necrosis

26
Q

AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial

A

NOT

27
Q

AUA Guideline: PAE is ___ recommended for the treatment of LUTS/BPH outside the context of a clinical trial

A

NOT

AUA Fundamentals 2021 (11 decks)

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