BPH Flashcards
Interruption of urinary system
Intermittent
diff. or delay in starting
hesitancy
reduced or weaker urine flow
decreased urinary system
Prostatic enlargementintrusion into the urethral luma - higher bladder outlet resistance
MECHANICAL COMPONENT
prostatic stroma, composed of smooth muscle, and collagen, rich in adrenergic nerve supply,
use of a-blocker therapy decreases this tone, decreases in outlet resistance.
DYNAMIC COMPONENT
Detrussor takes a longer time to generate the initial inrease pressure to overcome urethral resistance
hesitancy
detrussor is unable to sustain the increase pressure until the end of voiding
interruption of urinary system
reliable predictor of degree of LUTS
MILD: 0-7
Moderate- 8-19
SEVERE - 20-35
International Prostate Symptom Score
recommended in the presence of concomitant Uti or complication form boh, hematuria, renal insufficiency
-useful to determine prostate size for men planning to undergo prostate surgery who are suspected to have severe prostate enlargement based on DRE
upper tract imaging
renal utrasound or CT urogram
Has been shown to result in both objective and subj degrees of improvement in symptoms and signs of bph. Contractile properties of the prostate and bladder neck seems to be mediated primarily by this subtype
a1a-receptors
a-blockers nonselective
Phenoxybenzamine 10mg twice a day
a1 short acting
Prazosin 2 mg twice a day
a1 LONG ACTING
Terazosin 5 or 10 mg daily
Doxazosin 4 or 8 mg dailu
5a-reducrase inhibitors
Finasteride 5 mg daily
Dutasteride 0.5. mg daily
a1a - Selective
Tamsulosin 0.4 or 0.8 mg daily
Alfuzosin 10 mg daily
Silodosin 8 mg daily
side effects
orthostatic hypottension
dizzy
tiredness
retrograde ejac
rinitis
headache
a 5a-reductase inhibitor that blocks conversion of testosterone to dihydrotestosrerone DHT
affects epithelial component of the prostate results to reduction of the size of the gland and improve symptoms.
FINASTERIDE
It inhbits both iso-enzymes of 5a-reductase reduces serum PSA and tital prostate volume
Dutasteride
It inhbits both iso-enzymes of 5a-reductase reduces serum PSA and tital prostate volume
Dutasteride
side effects of 5a reductase
erectile dysfunction
decrease libido
gynecomastia
ejaculayion d/o
Phytotherapy
use of plants or plants extratcs
saw palmetto berry (serenoa repens0
VAST MAJORITY OF SUBTITAL PROSTATETCOMIES UNDERTAKEN FOR BPH completed endoscopically.
involces the use of spinal or ge anesthesia - overnight hosp stay8
Turp
retrograde ejaculation &5%
impotence 5-10 &
incontinence (<1)
two most commonly used devoces for TUVP
neodymium doped yttrium alluminum garnet (Nd:YAG)
KTP greenlight laser
denotes an anatomic dissection in the plane between the central and peripheral zones of the prostate
-feel the largest defect and perhaps longest durability
Holmium laser enucleattion of the prostate (HoLEP)
