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Foundations III Exam 1 (Cholley) > BPH > Flashcards

BPH Flashcards

1
Q

What is benign prostatic hyperplasia?

A

enlarged prostate in absence of malignancy

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2
Q

BPH can impede…

A

passage of urine leaving bladder

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3
Q

How does BPH present?

A

Lower urinary tract sx

  • weak stream
  • hesitancy
  • stream intermittency
  • post void dribbling
  • nocturia
  • AUA sx score

Urinary retention

Hx of cytolithiasis

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4
Q

What should you include in your PE?

A

Genitourinary exam

DRE:
- Note size, consistency, & absence or presence of tenderness

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5
Q

What labs should be performed for BPH?

A

UA

PSA (if indicated)

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6
Q

What are examples of urologic testing?

A
  • Uroflow study
  • Post void residual
  • Cystoscopy: trabeculation, obstruction, “kissing lobes”
  • Urodynamic study (UDS)
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7
Q

How do you tx BPH?

A
  • watchful waiting
  • lifestyle modification
  • meds
  • surgery
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8
Q

What are lifestyle modifications for BPH?

A
  • avoid fluid intake & diuretics in evening to decrease nocturia
  • elevate legs to mobilize & eliminate fluid
  • avoid drinks/food that exacerbate sx
  • double void to empty bladder
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9
Q

What meds should be avoided in BPH?

A
  • Pseudoephedrine/ alpha agonists

- Caution w/ anticholinergics: can cause retention

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10
Q

What type of meds can you use to tx BPH?

A
  • Phytotherapy (Saw Palmetto)
  • Alpha blockers
  • 5 alpha reductase inhibitors
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11
Q

What is the MOA of alpha blockers?

A

block alpha 1 receptors of stroma & bladder neck –> relaxation of SM –> free passage of urine

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12
Q

What are examples of alpha 1 blockers?

A

Terazosin
Doxazosin
Alfuzosin

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13
Q

What are examples of alpha 1A blockers?

A

Tamsulosin

Silodosin

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14
Q

What type of meds are more specific at targeting urinary effects, while avoiding effects on BP & nasal passages?

A

Alpha 1A blockers

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15
Q

What are side effects of alpha blockers?

A
  • Dizziness
  • Asthenia
  • Congestion
  • Orthostatic hypotension/syncope
  • Retrograde ejaculation
  • Floppy iris syndrome
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16
Q

What is the MOA of 5 alpha reductase inhibitors?

A
  • Blocks conversion of testosterone to DHT –> lower DHT levels
  • Decrease prostate volume
  • Increase max urine flow
  • Improve AUA sx scores
  • Decreases risk of BPH progression
17
Q

How long does it take to see the effect of 5 alpha reductase inhibitors?

A

Can take 6 mos

18
Q

5 alpha reductase inhibitors decrease…

A

PSA by 50%

19
Q

5 alpha reductase inhibitors are most beneficial in…

A

larger volume prostates > 40 & PSAs > 1.4

20
Q

What are 2 examples of 5 alpha reductase inhibitors?

A

Finasteride

Dutasteride

21
Q

What are side effects of 5 alpha reductase inhibitors?

A
  • Impotence
  • Decreased libido
  • Lower ejaculatory volume
  • Gynecomastia
22
Q

What meds can you combine to tx BPH?

A

Alpha blocker & 5-ARI

  • Alpha blocker gives early response –> improved compliance while waiting for 5-ARI to take effect
  • Dutasteride + tamsulosin
23
Q

What PDE5-I is approved for BPH?

A

Only tadalafil

24
Q

What are surgery options for BPH?

A
  • TUMT
  • TUIP
  • Urolift
  • TURP
  • PVP
  • Open simple prostatectomy
  • HoLEP
25
Q

What occurs during transurethral microwave thermotherapy? (TUMT)

A
  • microwave device heats prostate & causes necrosis
  • minimally invasive, pt awake, outpatient
  • sloughed tissue passes during urination
26
Q

What occurs during transurethral incision of prostate? (TUIP)

A
  • cystoscopic incision made at 5 & 7 o’clock from bladder neck to superior verumontanum
  • smaller collar type prostate
  • prostate springs open
27
Q

Which surgical procedure has less chance of retrograde ejaculation?

A

TUIP

28
Q

What occurs during a urolift procedure?

A
  • permanent implant into prostate

- suture connected by 2 anchors (1 inside & 1 outside prostate) –> compression of tissue –> widening of urethra

29
Q

What surgical procedure is considered Gold standard?

A

TURP

30
Q

What occurs during transurethral resection of prostate? (TURP)

A

Electrocautery energy scoops out “chips” of prostatic tissue –> chips enter bladder & evacuated out –> sent to path

31
Q

What are complications of TURP?

A
  • Retrograde ejaculation
  • TUR syndrome
  • Hematuria
32
Q

What 4 sx are seen in TUR syndrome?

A
  • hyponatremia
  • confusion
  • HTN
  • visual changes
33
Q

What type of surgical procedure can be performed on an anticoagulated pt?

A

Photoselective vaporization of prostate (PVP)

34
Q

What occurs during open simple prostatectomy?

A
  • open suprapubic midline incision
  • prostatic capsule incised
  • glandular adenoma is enucleated
  • prostatic capsule closed
  • postop cath & CBI
35
Q

What surgical procedures are used for very large prostates > 80?

A
  • Open simple prostatectomy

- HoLEP (done transurethrally)

Foundations III Exam 1 (Cholley) (12 decks)

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