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F3 E1 Shea > BPH > Flashcards

BPH Flashcards

1
Q

Enlarged prostate in the absence of ____

A

Benign Prostatic Hyperplasia

  • malignancy
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2
Q

Benign Prostatic Hyperplasia

  • Growth of prostatic ____ into lumen of urinary tract can impede passage of urine leaving bladder
  • Increased ____ tone of prostatic stroma and at _____.
A
  • glandular tissue
  • smooth muscle / bladder neck
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3
Q

5 Lower Urinary Tract Sxs (LUTS)

A

SNUWP

  • Stream intermittency
  • Nocturia
  • Urinary hesitancy
  • Weak urinary stream
  • Post-void dribbling
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4
Q

What is the scoring system called?

A

AUA (American Urological Association) symptom score

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5
Q

3 components of the presentation of BPH

A
  • Urinary retention
  • recurrent UTIs
  • hx of lithiasis (cystolithiasis / other urolithiasis)
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6
Q

PE components for eval of BPH

  • Do a GU and DRE
  • Note what 3 prostatic findings?
A
  • Size
  • Consistency
    • indurated
    • firm
    • boggy = prostatitis
    • nodular = possible malignancy
  • Presence / absence of tenderness
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7
Q

2 labs for eval of BPH

A
  • UA
  • PSA if indicated (contraversial)
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8
Q

What are the 4 urologic tests?

A
  • Uroflow study
  • Post-void residual
  • Cystoscopy –> “kissing lobes”
  • Urodynamic study

(PUUC)

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9
Q

Which of the 4 urologic tests?

  • Voided volume, peak flow in mL/sec, Mean flow in mL/sec, low flow rate
A

Uroflow study

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10
Q

Which of the 4 urologic tests?

  • trabeculation, obstructive prostate encroaching into urinary outlet lumen, “kissing lobes”
A

Cystoscopy

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11
Q

Which of the 4 urologic tests?

  • May be indicated if —> low flow, elevated intravesical pressures
A

Urodynamic study

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12
Q

4 main tx options for BPH

A
  • watchful waiting
  • lifestyle modification
  • medication
  • surgery
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13
Q

Lifestyle modification / conservative management for BPH

  • avoid fluids/diuretics in evening to decrease nocturia
  • for LE edema, elevate legs in evenings
  • Avoid what foods/drinks?
  • _____ to completely empty bladder
  • Avoid what 2 meds?
  • Caution w/ what med bc it can cause retention?
A
  • caffeine, ETOH, acidic/spicy foods
  • double void
  • pseudoephedrine / alpha agonists
  • anticholinergics
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14
Q

What are the 3 meds to tx BPH?

A
  • Phytotherapy
  • Alpha-blockers
  • 5-alpha-reductase inhibitors (5-ARI)
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15
Q

Which med?

  • saw palmetto widely used
  • may have a therapeutic benefit
A

phytotherapy

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16
Q

Alpha Blockers for tx of BPH

  • Block stimulation of ____ of prostatic stroma and bladder neck
  • Cause ____ of smooth muscle that restricts the flow of urine
  • ____ of these muscle allows for free passage of urine
A
  • alpha 1 receptors
  • relaxation
  • relaxation
17
Q

What are the names of the two “older” Alpha 1 Blockers?

A
  • Terazosin
  • Doxazosin
18
Q

What are the names of the 3 newer Alpha 1 A Blockers which are less likely to cause lightheadedness?

A
  • Tamsulosin
  • Silodosin
  • Alfuzosin
19
Q

Alpha Blockers

  • Alpha 1-A blockers are more specific in targeting the ____ effects while avoiding effects on ___ and ____
A
  • urinary
  • blood pressure / nasal passages
20
Q

6 SE of alpha blockers

A

DANORI

  • Dizziness
  • Asthenia (abnormal physical weakness or lack of energy)
  • Nasal congestions
  • Orthostatic hypotension / syncope (rare)
  • Retrograde ejaculation
  • Intra-operative floppy iris syndrome
21
Q

Don’t start a patient on which med if they have a cataract surgery coming up soon. Pt needs to inform cataract surgeon in advance if he is taking ____.

A

Alpha Blockers

22
Q

5-Alpha Reductase Inhibitors

  • Block conversion of testosterone –> ___
  • Lower ___ levels
  • Decrease ____ volume
  • Increase ____ rates
  • Improve ___ scores
  • Decrease risk of ___ progression
A
  • DHT
  • DHT
  • prostatic glandular
  • max urinary flow
  • AUA sxs
  • BPH
23
Q

5-alpha-reductase inhibitors

  • “shrinks prostate”
  • Can take __ months to see effect (as opposed to weeks for alpha blockers)
  • Decreases ___ readings by 50%
  • May stop chronic ____ secondary to prostatic varices
  • Most beneficial in ____
A
  • 6
  • PSA
  • hematuria
  • larger volume prostates
24
Q

What are the 2 names of the 5-alpha-reductase inhibitors?

A
  • Finasteride
  • Dutasteride
25
Q

4 SE of 5-alpha-reductase inhibitors

A

GILE

  • Gynecomastia
  • Impotence
  • Ejaculatory volume lowered
  • Libido decreased
26
Q
  • What 2 types of meds are combined and what are their names?
  • Which med gives early response?
A
  • Alpha-blocker & 5-ARI
  • Dutasteride + Tamsulosin

(Alpha-blocker gives early response, which can improve compliance while waiting for 5-ARI to take effect)

27
Q
  • What is the only drug approved for BPH?
  • What else does this drug treat besides BPH?
A
  • PDE5-I (Tadalafil) - Cialis
  • ED
28
Q

Which surgery for BPH?

  • Device heats prostate and causes necrosis
  • Minimally invasive, outpatient, awake
  • Catheter like heating device placed _____
  • Temperature monitoring device placed _____
  • Prostatic tissue sloughs and passes per urethra when pt voids

(pt will get worse before they get better)

A

Transurethral Microwave Thermotherapy (TUMT)

  • transurethrally
  • transrectally
29
Q

Which surgery for BPH?

  • Cystoscopic incision made at __ o’clock and __ o’clock of the prostatic urethra, from bladder neck to just superior to verumontanum
  • Smaller _____ prostate
  • Prostate springs open
  • Is tissue removed?
  • Less chance of _____
A

Transurethral Incision of Prostate (TUIP)

  • 5 / 7
  • collar type
  • No
  • retrograde ejaculation
30
Q

Which surgery for BPH?

  • Permanent implant into prostate
  • Suture connected by __ anchoring devices
  • Where are the anchors located?
  • Permanent suture between the ____ compresses prostatic tissue, widening urethral lumen
A

Urolift

  • 2
  • Outside prostatic capsule & Inside prostate (prostatic urethra)
  • anchors
31
Q

What surgery is this?

What does it accomplish?

A

Urolift

Compress prostatic tissue, widens urethral lumen

32
Q

Which surgery for BPH?

  • Transurethral resectoscope
  • Under direct visualization, electrocautery energy scoops out “___” of prostatic tissue
  • ___ go into bladder, are evacuated out and sent to pathology
A

Transurethral Resection of Prostate (TURP)

  • chips
  • chips
33
Q

Which surgery is “GOLD STANDARD” for BPH?

A

TURP

(transurethral resection of prostate)

34
Q

What are the 3 SE / Complications from TURP?

A
  • Retrograde ejaculation
  • TUR syndrome
  • Hematuria
35
Q

What are the 4 sxs of TUR Syndrome?

(a complication of TURP surgery)

A
  • Hyponatremia
  • Mental confusion
  • Hypertension
  • Visual changes
36
Q

2 tx for hematuria related to TURP surgery

A
  • continuous bladder irrigation (CBI/CVI)
  • Transfusion
37
Q

Which surgery?

  • Green light
  • Can be done on ____ patient
A

Photoselective Vaporization of Prostate (PVP)

  • anticoagulated
38
Q

Which surgery?

  • Very large prostates (>80 cc)
  • TURP would have prolonged operating time on such a large prostate. Risk for TUR syndrome
  • Open suprapubic midline incision
  • Prostatic capsule incised
  • Glandular adenoma is enucleated (removed)
  • Prostatic capsule is ___
  • Post-op catheter and CBI (continuous bladder irrigation)
A

Open Simple Prostatectomy

  • closed
39
Q

Which surgery?

  • For large prostates (>80 g)
  • Previously could only be done with open surgery
  • Done transurethrally
A

Holmium Laser Enucleation of Prostate (HoLEP)

F3 E1 Shea (14 decks)

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