BPH Flashcards
What is benign prostatic hyperplasia?
enlarged prostate in absence of malignancy
BPH can impede…
passage of urine leaving bladder
How does BPH present?
Lower urinary tract sx
- weak stream
- hesitancy
- stream intermittency
- post void dribbling
- nocturia
- AUA sx score
Urinary retention
Hx of cytolithiasis
What should you include in your PE?
Genitourinary exam
DRE:
- Note size, consistency, & absence or presence of tenderness
What labs should be performed for BPH?
UA
PSA (if indicated)
What are examples of urologic testing?
- Uroflow study
- Post void residual
- Cystoscopy: trabeculation, obstruction, “kissing lobes”
- Urodynamic study (UDS)
How do you tx BPH?
- watchful waiting
- lifestyle modification
- meds
- surgery
What are lifestyle modifications for BPH?
- 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
What meds should be avoided in BPH?
- Pseudoephedrine/ alpha agonists
- Caution w/ anticholinergics: can cause retention
What type of meds can you use to tx BPH?
- Phytotherapy (Saw Palmetto)
- Alpha blockers
- 5 alpha reductase inhibitors
What is the MOA of alpha blockers?
block alpha 1 receptors of stroma & bladder neck –> relaxation of SM –> free passage of urine
What are examples of alpha 1 blockers?
Terazosin
Doxazosin
Alfuzosin
What are examples of alpha 1A blockers?
Tamsulosin
Silodosin
What type of meds are more specific at targeting urinary effects, while avoiding effects on BP & nasal passages?
Alpha 1A blockers
What are side effects of alpha blockers?
- Dizziness
- Asthenia
- Congestion
- Orthostatic hypotension/syncope
- Retrograde ejaculation
- Floppy iris syndrome
What is the MOA of 5 alpha reductase inhibitors?
- 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
How long does it take to see the effect of 5 alpha reductase inhibitors?
Can take 6 mos
5 alpha reductase inhibitors decrease…
PSA by 50%
5 alpha reductase inhibitors are most beneficial in…
larger volume prostates > 40 & PSAs > 1.4
What are 2 examples of 5 alpha reductase inhibitors?
Finasteride
Dutasteride
What are side effects of 5 alpha reductase inhibitors?
- Impotence
- Decreased libido
- Lower ejaculatory volume
- Gynecomastia
What meds can you combine to tx BPH?
Alpha blocker & 5-ARI
- Alpha blocker gives early response –> improved compliance while waiting for 5-ARI to take effect
- Dutasteride + tamsulosin
What PDE5-I is approved for BPH?
Only tadalafil
What are surgery options for BPH?
- TUMT
- TUIP
- Urolift
- TURP
- PVP
- Open simple prostatectomy
- HoLEP
What occurs during transurethral microwave thermotherapy? (TUMT)
- microwave device heats prostate & causes necrosis
- minimally invasive, pt awake, outpatient
- sloughed tissue passes during urination
What occurs during transurethral incision of prostate? (TUIP)
- cystoscopic incision made at 5 & 7 o’clock from bladder neck to superior verumontanum
- smaller collar type prostate
- prostate springs open
Which surgical procedure has less chance of retrograde ejaculation?
TUIP
What occurs during a urolift procedure?
- permanent implant into prostate
- suture connected by 2 anchors (1 inside & 1 outside prostate) –> compression of tissue –> widening of urethra
What surgical procedure is considered Gold standard?
TURP
What occurs during transurethral resection of prostate? (TURP)
Electrocautery energy scoops out “chips” of prostatic tissue –> chips enter bladder & evacuated out –> sent to path
What are complications of TURP?
- Retrograde ejaculation
- TUR syndrome
- Hematuria
What 4 sx are seen in TUR syndrome?
- hyponatremia
- confusion
- HTN
- visual changes
What type of surgical procedure can be performed on an anticoagulated pt?
Photoselective vaporization of prostate (PVP)
What occurs during open simple prostatectomy?
- open suprapubic midline incision
- prostatic capsule incised
- glandular adenoma is enucleated
- prostatic capsule closed
- postop cath & CBI
What surgical procedures are used for very large prostates > 80?
- Open simple prostatectomy
- HoLEP (done transurethrally)
