BPH Flashcards
What is the BPH histological diagnosis?
proliferation of smooth muscle and epithelial cells within the prostatic transition zone. (note: most cancers are found in the peripheral zone, while bph is transitional zone)
What are the main lower urinary tract symptoms for BPH?
- direct bladder outlet obstruction (BOO) (static) and 2. increased smooth muscle tone or resistance (dynamic).
what are the storage symptoms associated with BPH?
frequency, nocturia (current calls this irritative)
what are the voiding symptoms associated with BPH?
hesitancy, intermittency, weak stream, dribbling
What are the ddx for the lower urinary tract symptoms seen with BPH?
prostate cancer, UTI, neurogenic bladder, urethral stricture, renal disease, CV disease
What are some other symptoms that may be present besides lower urinary tract symptoms seen with BPH?
hematuria, urinary retention, UTI, renal insufficiency
This percentage of men suffer from LUTS between 45-80yo
90%. This is very common disease and it is progressive. It has a significant impact on the quality of life.
What is the goal of therapy for BPH?
alleviate bothersome LUTS and alter disease progression (life style medication, medical treatment, surgical intervention)
What is the patient questionnaire that could help you decide how to treat BPH?
AUA-SI (7 questions and a quality of life question)
mild = 0-7
mod = 8-19
severe = 20-35
What are some modifiable factors for BPH?
fluid intake. (have patient monitor what they are drinking and when, and how much they urinate out). If >33% of UOP is at night, then you need to R/O other causes such as heart disease or pulmonary hypertension.
What is the best indicator of who to start treatment on?
the QOL score.
What are the two main drugs primarily used
alpha blockers and 5ARIs (anticholinergics are also used).
What is combo therapy for BPH?
alpha blocker and 5ARI or alpha blocker and anticholinergic
What are some of the SE of alpha blockers, and what do they required?
they require titration and blood pressure monitoring. the SE can be hypotension, dizziness, tiredness, retrograde ejaculation, and headache.
What are the selective long acting alpha blockers?
terazosin, doxazosin, alfuzosin
what are the alpha-1 selective receptor blockers?
tamsulosin and silodosin
Alpha blockers should be stopped if there is a planned surgery for…
cataracts! (floppy iris syndrome)
Describe 5ARIs
they are competitive inhibitors of the enzyme 5alpha reeducates, they block conversion to testosterone in 5HT in prostate tissue, and they help to reduce the gland size.
When should 5ARIs NOT be used?
If there is NO prostate enlargement, then DON’T use these drugs because they work by shrinking the prostate.
Who are anticholinergics appropriate for?
men with LUTS secondary to BPH without an elevated post-void-residual and mainly irritative symptoms.
How do anticholinergics work for BPH?
they target the m3 receptor. its found in the detrusor muscle cells, urothelial cells, and suburethelial cells, urothelial nerves.
Has physiotherapy shown to be useful?
no, it has not shown to be useful in clinical studies
What are some options for conventional surgical therapy for BPH?
TURP, TUIP, protatetectomy
What are minimally invasive therapy options?
laser therapy, needle ablation, electrovaporization, hyperthemia
what patients should be put on watchful waiting for treatment?
aua-si scores of 0-7.
what is a good way to estimate the prostate on DRE?
1 finger breadth = 10-15 grams.
what labs may be indicated if there is an enlarged prostate?
PSA (although it will not be specific to BPH) (labs for a UA should also be ordered based on patient’s symptoms to R/O an infection).
Should you biopsy if you feel an enlarged prostate?
AUA guidelines say yes
When do you need to refer for BPH?
refractory to medical management, recurrent urinary retention, recurrent UTI, renal insuffiency, hematuria, bladder calculi.
