BPH Flashcards
Enlarged prostate in the absence of ____
Benign Prostatic Hyperplasia
- malignancy
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 _____.
- glandular tissue
- smooth muscle / bladder neck
5 Lower Urinary Tract Sxs (LUTS)
SNUWP
- Stream intermittency
- Nocturia
- Urinary hesitancy
- Weak urinary stream
- Post-void dribbling
What is the scoring system called?
AUA (American Urological Association) symptom score
3 components of the presentation of BPH
- Urinary retention
- recurrent UTIs
- hx of lithiasis (cystolithiasis / other urolithiasis)
PE components for eval of BPH
- Do a GU and DRE
- Note what 3 prostatic findings?
- Size
-
Consistency
- indurated
- firm
- boggy = prostatitis
- nodular = possible malignancy
- Presence / absence of tenderness
2 labs for eval of BPH
- UA
- PSA if indicated (contraversial)
What are the 4 urologic tests?
- Uroflow study
- Post-void residual
- Cystoscopy –> “kissing lobes”
- Urodynamic study
(PUUC)
Which of the 4 urologic tests?
- Voided volume, peak flow in mL/sec, Mean flow in mL/sec, low flow rate
Uroflow study
Which of the 4 urologic tests?
- trabeculation, obstructive prostate encroaching into urinary outlet lumen, “kissing lobes”
Cystoscopy
Which of the 4 urologic tests?
- May be indicated if —> low flow, elevated intravesical pressures
Urodynamic study
4 main tx options for BPH
- watchful waiting
- lifestyle modification
- medication
- surgery
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?
- caffeine, ETOH, acidic/spicy foods
- double void
- pseudoephedrine / alpha agonists
- anticholinergics
What are the 3 meds to tx BPH?
- Phytotherapy
- Alpha-blockers
- 5-alpha-reductase inhibitors (5-ARI)
Which med?
- saw palmetto widely used
- may have a therapeutic benefit
phytotherapy
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
- alpha 1 receptors
- relaxation
- relaxation
What are the names of the two “older” Alpha 1 Blockers?
- Terazosin
- Doxazosin
What are the names of the 3 newer Alpha 1 A Blockers which are less likely to cause lightheadedness?
- Tamsulosin
- Silodosin
- Alfuzosin
Alpha Blockers
- Alpha 1-A blockers are more specific in targeting the ____ effects while avoiding effects on ___ and ____
- urinary
- blood pressure / nasal passages
6 SE of alpha blockers
DANORI
- Dizziness
- Asthenia (abnormal physical weakness or lack of energy)
- Nasal congestions
- Orthostatic hypotension / syncope (rare)
- Retrograde ejaculation
- Intra-operative floppy iris syndrome
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 ____.
Alpha Blockers
5-Alpha Reductase Inhibitors
- Block conversion of testosterone –> ___
- Lower ___ levels
- Decrease ____ volume
- Increase ____ rates
- Improve ___ scores
- Decrease risk of ___ progression
- DHT
- DHT
- prostatic glandular
- max urinary flow
- AUA sxs
- BPH
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 ____
- 6
- PSA
- hematuria
- larger volume prostates
What are the 2 names of the 5-alpha-reductase inhibitors?
- Finasteride
- Dutasteride
4 SE of 5-alpha-reductase inhibitors
GILE
- Gynecomastia
- Impotence
- Ejaculatory volume lowered
- Libido decreased
- What 2 types of meds are combined and what are their names?
- Which med gives early response?
- Alpha-blocker & 5-ARI
- Dutasteride + Tamsulosin
(Alpha-blocker gives early response, which can improve compliance while waiting for 5-ARI to take effect)
- What is the only drug approved for BPH?
- What else does this drug treat besides BPH?
- PDE5-I (Tadalafil) - Cialis
- ED
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)
Transurethral Microwave Thermotherapy (TUMT)
- transurethrally
- transrectally
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 _____
Transurethral Incision of Prostate (TUIP)
- 5 / 7
- collar type
- No
- retrograde ejaculation
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
Urolift
- 2
- Outside prostatic capsule & Inside prostate (prostatic urethra)
- anchors
What surgery is this?
What does it accomplish?
Urolift
Compress prostatic tissue, widens urethral lumen
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
Transurethral Resection of Prostate (TURP)
- chips
- chips
Which surgery is “GOLD STANDARD” for BPH?
TURP
(transurethral resection of prostate)
What are the 3 SE / Complications from TURP?
- Retrograde ejaculation
- TUR syndrome
- Hematuria
What are the 4 sxs of TUR Syndrome?
(a complication of TURP surgery)
- Hyponatremia
- Mental confusion
- Hypertension
- Visual changes
2 tx for hematuria related to TURP surgery
- continuous bladder irrigation (CBI/CVI)
- Transfusion
Which surgery?
- Green light
- Can be done on ____ patient
Photoselective Vaporization of Prostate (PVP)
- anticoagulated
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)
Open Simple Prostatectomy
- closed
Which surgery?
- For large prostates (>80 g)
- Previously could only be done with open surgery
- Done transurethrally
Holmium Laser Enucleation of Prostate (HoLEP)
