BPH

Question 1

What is the BPH histological diagnosis?

Answer 1

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)

Question 2

What are the main lower urinary tract symptoms for BPH?

Answer 2

1. direct bladder outlet obstruction (BOO) (static) and 2. increased smooth muscle tone or resistance (dynamic).

Question 3

what are the storage symptoms associated with BPH?

Answer 3

frequency, nocturia (current calls this irritative)

Question 4

what are the voiding symptoms associated with BPH?

Answer 4

hesitancy, intermittency, weak stream, dribbling

Question 5

What are the ddx for the lower urinary tract symptoms seen with BPH?

Answer 5

prostate cancer, UTI, neurogenic bladder, urethral stricture, renal disease, CV disease

Question 6

What are some other symptoms that may be present besides lower urinary tract symptoms seen with BPH?

Answer 6

hematuria, urinary retention, UTI, renal insufficiency

Question 7

This percentage of men suffer from LUTS between 45-80yo

Answer 7

90%. This is very common disease and it is progressive. It has a significant impact on the quality of life.

Question 8

What is the goal of therapy for BPH?

Answer 8

alleviate bothersome LUTS and alter disease progression (life style medication, medical treatment, surgical intervention)

Question 9

What is the patient questionnaire that could help you decide how to treat BPH?

Answer 9

AUA-SI (7 questions and a quality of life question)
mild = 0-7
mod = 8-19
severe = 20-35

Question 10

What are some modifiable factors for BPH?

Answer 10

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.

Question 11

What is the best indicator of who to start treatment on?

Answer 11

the QOL score.

Question 12

What are the two main drugs primarily used

Answer 12

alpha blockers and 5ARIs (anticholinergics are also used).

Question 13

What is combo therapy for BPH?

Answer 13

alpha blocker and 5ARI or alpha blocker and anticholinergic

Question 14

What are some of the SE of alpha blockers, and what do they required?

Answer 14

they require titration and blood pressure monitoring. the SE can be hypotension, dizziness, tiredness, retrograde ejaculation, and headache.

Question 15

What are the selective long acting alpha blockers?

Answer 15

terazosin, doxazosin, alfuzosin

Question 16

what are the alpha-1 selective receptor blockers?

Answer 16

tamsulosin and silodosin

Question 17

Alpha blockers should be stopped if there is a planned surgery for…

Answer 17

cataracts! (floppy iris syndrome)

Question 18

Describe 5ARIs

Answer 18

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.

Question 19

When should 5ARIs NOT be used?

Answer 19

If there is NO prostate enlargement, then DON’T use these drugs because they work by shrinking the prostate.

Question 20

Who are anticholinergics appropriate for?

Answer 20

men with LUTS secondary to BPH without an elevated post-void-residual and mainly irritative symptoms.

Question 21

How do anticholinergics work for BPH?

Answer 21

they target the m3 receptor. its found in the detrusor muscle cells, urothelial cells, and suburethelial cells, urothelial nerves.

Question 22

Has physiotherapy shown to be useful?

Answer 22

no, it has not shown to be useful in clinical studies

Question 23

What are some options for conventional surgical therapy for BPH?

Answer 23

TURP, TUIP, protatetectomy

Question 24

What are minimally invasive therapy options?

Answer 24

laser therapy, needle ablation, electrovaporization, hyperthemia

Question 25

what patients should be put on watchful waiting for treatment?

Answer 25

aua-si scores of 0-7.

Question 26

what is a good way to estimate the prostate on DRE?

Answer 26

1 finger breadth = 10-15 grams.

Question 27

what labs may be indicated if there is an enlarged prostate?

Answer 27

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).

Question 28

Should you biopsy if you feel an enlarged prostate?

Answer 28

AUA guidelines say yes

Question 29

When do you need to refer for BPH?

Answer 29

refractory to medical management, recurrent urinary retention, recurrent UTI, renal insuffiency, hematuria, bladder calculi.