BPH Flashcards
What is used to grade severity of LUTS?
International prostate symptom score (IPSS) which includes frequency, nocturia, urgency, weak stream and straining. It is reccomended for asking BPH.
What type of urinary abnormalities is associated with BPH?
Urinary frequency and urgency
Urinary hesitancy and incomplete emptying
Weak urinary stream
What investigations can be done for BPH?
International prostate symptom score for severity of LUTS
Digital rectal exam
PSA test
What is the referral guideline for prostate cancer?
Suspicion of prostate malignancy on DRE
What is given for BPH pharmacologically?
Tamsulosin alpha blocker
Finasteride
What is the role of tamsulosin in LUTS?
Alpha blocker Used for dynamic obstruction. Risk of postural hypotension
What is the role of 5-alpha reducate inhibitors?
Reduce prostate size
-> ideal for men at high risk of progression
How does multiparity cause incontinence?
Results in stress inconteince because of weakening of pelvic floor muscles.
Indicated by leakage with coughing
How does excessive caffeine fuse issues with incontinence? .
Causes urgency and frequency incontinence
How does obesity cause icnotneince?
Stress incontinence due to weakening of the abdominal wall
Previous abdominal surgery can also cause this
How does episiotomy cause incontinence?
Leads to stress incontinence
What are the reversible causes of incontinence?
DIAPPERS’:
D - Delirium
I - Infection
A - Atrophic vaginitis or urethritis
P - Pharmaceutical (medications)
P - Psychiatric disorders
E - Endocrine disorders (e.g. diabetes)
R - Restricted mobility
S - Stool impaction
What are importantly investigations for incontinence?
Physical examination of pelvic muscle function
Bladder diary
Urinalysis
Cystometryntonmeasure bladder pressure
What investigation is performed for suspected fistula?
Contrast into bladder
What is the conservative management of incontience?
Avoiding caffeine and fizzy sugary drinks
Pelvic floor exercises
What is the drug management of stress incotneince?
Duloxetine if conservative management fails
What is the surgical management for incotnience?
Mid urethral slings are gold standard to compress urethra and is minally invasive
Alternatives include pedsarie device ideal for prolapse
Bulking agents
What is the medical management of urge incontience?
Anticholinergic medication like oxybutynin, tolderodine and fesoterodine.
Which medication can be used for urge incontience in older people?
Mirabegron a b3 agonist
What procedures can be performed for urge incontinence?
Injection of Botox
Sacral neuromoduoation
What is functional incotnience associated with?
Alcohol
Sedation
Dementia
What is the cause of overflow incotnience?
Under activity if detrusor muscle or urinary outlet pressure is hig like constipation or orostatism
