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Gen Med Unit 5 > BPH > Flashcards

BPH Flashcards

1
Q

define BPH

A

Condition when prostate gland enlarges enough to compress the urethra and cause urinary obstruction

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2
Q

What causes lower urinary tract symptoms in BPH?

A

gland enlargement and increased smooth muscle tone

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3
Q

How evident is BPH in men at 50? at 80?

A

Clinically evident in 50% of men by age 50, in 90% by age 80

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4
Q

What is BPH characterized by?

A

Characterized by uncontrolled growth in deep mucosal glands of prostate and by proliferation of nearby stromal cells

May be due to androgens

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5
Q

What are the rsk factors for BPH?

A

Genetics

Black males

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6
Q

What is the pathophysiology of BPH?

A
  1. As men age, an androgen-estrogen imbalance occurs
    Androgen production decreases while estrogen production increases
    -The above combination is felt to stimulate prostatic growth
    -Cellular overgrowth begins in transition zone
  2. High levels of dihydrotestosterone:
    Main prostatic intracellular androgen
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7
Q

Where does BPH usually start?

A

!. transition zone

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8
Q

What is 5-alpha reductase and why is it important?

A

Converts testosterone to more potent dihydrotestosterone

Promotes stromal and basal prostate cell growth

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9
Q

How is blood flow and urine affected by BPH?

A

Growth of tissue causes areas of poor blood flow and tissue damage (necrosis)

Prostate hypertrophy
Decreases urine flow by distorting or compressing urethra

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10
Q

What are some complications of BPH?

A
  1. Urinary obstruction
    - Main complication
    - Can lead to UTI or calculi
  2. Incontinence
  3. Urethral stenosis
  4. Hydronephrosis
  5. Acute or chronic renal failure
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11
Q

What are the obstructive symptoms in BPH?

A 
Reduced urinary stream caliber and force
Hesitancy
Feeling of incomplete emptying
Double voiding (repeat < 2 hr)
Post-void dribbling
Straining to void
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12
Q

What are the irritative symptoms in BPH?

A

Urgency
Nocturia
Frequency

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13
Q

What are the abdominal signs of BPH?

A

Assess for distended bladder

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14
Q

What are the normal digital rectal exam signs?

A 
Prostate smooth 
Firm 
Enlarged 
Nontender 
No masses
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15
Q

Why are UA and urine C&S performed in BPH?

A

R/O UTI

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16
Q

When should CT abd/pelvis or renal us be performed?

A

If complicates suspected

17
Q

Digital rectal exam affects PSA in what way

A

Transiently elevated

18
Q

Why are alpha 1 blockers used in BPH? What are some examples?

A

Reduces smooth muscle tone in bladder neck, prostate, & arteries

Prazosin/Minipress 
Terazosin/Hytrin 
Doxazosin/Cardura
Siladosin/Rapaflo
Alfuzosin/Uroxatral
19
Q

What do you have to be careful about when using alpha 1 blockers?

A

Be careful of “first dose effect” with these drugs
First dose may produce an exaggerated hypotensive causing syncope
Dose low & slowly titrate up or give at hs

20
Q

Why are alpha 1-a adrenergic receptor antagonists used in BPH? What is an example?

A

Tamsulosin/Flomax
Relaxes smooth muscle in bladder neck & prostate only

Fewer systemic side effects than alpha 1 antagonists

21
Q

Why are 5 alpha reductase inhibitors used in BPH?

What are 2 examples?

A
  1. Antiandrogen effect
    A. Finasteride/Proscar (Propecia)
    B. Dutasteride/Avodart
  2. Blocks conversion of testosterone to dihydrotestosterone
  3. Results in ~20% reduction in prostate size
  4. Lowers PSA (Need baseline)
22
Q

What are the SE of 5 alpha reductase inhibitors used in BPH?

A 
Impotence
Decreased libido
Decreased ejaculate volume
Depression or anxiety
Gynecomastia
23
Q

What is phytotherapy and what are some examples?

A 
Use of plant extracts for medicinal purposes: 
Saw palmetto
Echinacea 
Soy 
Red Clover
24
Q

What are some ‘other’ medications used for BPH?

A

Tadalafil /Cialis

Dutasteride + tamsulosin / Jalyn

25
Q

What the percentages of the various BPH treatments?

A
  1. Watchful waiting: 4%
  2. TURP/TUIP: 62%
  3. Open prostatectomy: 1%
  4. Green light laser ablation (PVP): 22%
  5. TUMT: 5%
  6. TUNA: 3%
  7. Other: 3%
26
Q

Describe a TURP

A
  1. Transurethral Resection of the prostate
  2. Performed under spinal anesthesia by a Urologist
  3. Resectoscope removes the prostate tissue to create a larger channel for the patient to urinate
  4. 1 hour surgery and pt usually needs to stay 1-3 days
  5. Continuous irrigating catheter post-op
  6. Risk of retrograde ejaculation, ED
  7. Full recovery 4-6 wks
27
Q

Describe a TUIP

A
  1. Transurethral Incision of Prostate
  2. Widens the urethra by making small cuts in the prostate at bladder neck, rather than removing prostate tissue
  3. Used for mild-moderate BPH
  4. Less morbidity than TURP
  5. Shorter procedure
  6. Faster recovery - 1 day surgery
  7. Less risk of retrograde ejaculation
  8. Risk of urinary retention
  9. May need repeat procedure
28
Q

Describe Laser therapy

A
  1. Transurethral laser induced prostatectomy (TULIP)
  2. Performed under transrectal ultrasound guidance:
    Laser instrument placed in urethra and transrectal U/S directs the device as it is slowly pulled from bladder neck to apex
  3. No immediate visual change, coagulation necrosis
    Tissue sloughs up to 4. 3 mo, long term catheter
29
Q

Describe PVP

A
  1. Photovaporization of prostate (PVP)
  2. OP procedure
  3. High power laser surgery-vaporizes prostate tissue
  4. Recovery 2-3 days
  5. Immediate change seen similar to TURP
  6. Urethral mucosa spared
  7. Prostate tissue reabsorbed, not sloughed
  8. Catheter < 24 hr
  9. Risk of retrograde ejaculation
30
Q

Describe TUNA

A
  1. Transurethral needle ablation of prostate (TUNA)
  2. Specially designed urethral catheter is placed
  3. Interstitial radiofrequency needles are deployed from tip of catheter  pierces prostatic urethra
  4. Radiofrequencies heat tissue  coagulative necrosis
  5. Bladder neck and median lobe enlargement not well treated by TUNA
31
Q

Describe TUMT

A
  1. Minimally invasive
  2. Local anesthesia in office
  3. Microwave antenna within catheter emits microwaves to heat and destroy prostate tissue
  4. Full recovery < 5 days
  5. Foley catheter (or stent) left in place up to 2 weeks, edema expected
  6. Preferred over TURP
32
Q

Describe Open Prostatectomy

A
  1. Used when prostate too large (> 100 gm) to remove endoscopically
  2. Approach can be:
    A. Suprapubic (transvesical)
    -Operation of choice if concomitant bladder pathology
    -Urethral and suprapubic catheter
    B. Retropubic
    -Bladder is not entered
    -Transverse incision is made in surgical capsule of prostate
    -Allows direct visualization of gland
33
Q

Describe pt education for BPH

A
  1. Avoid antihistamines and anticholinergic medications
  2. Fluid restriction to prevent bladder distension
  3. Sitz baths after surgery
  4. Take meds as directed
  5. Catheter care

Gen Med Unit 5 (8 decks)

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