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

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

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

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

BPH Flashcards by Megan Jacobson

Enlarged prostate in the absence of ____

Benign Prostatic Hyperplasia

malignancy

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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

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5 Lower Urinary Tract Sxs (LUTS)

SNUWP

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

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What is the scoring system called?

AUA (American Urological Association) symptom score

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3 components of the presentation of BPH

Urinary retention
recurrent UTIs
hx of lithiasis (cystolithiasis / other urolithiasis)

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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

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2 labs for eval of BPH

UA
PSA if indicated (contraversial)

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What are the 4 urologic tests?

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

(PUUC)

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Which of the 4 urologic tests?

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

Uroflow study

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Which of the 4 urologic tests?

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

Cystoscopy

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Which of the 4 urologic tests?

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

Urodynamic study

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4 main tx options for BPH

watchful waiting
lifestyle modification
medication
surgery

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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

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What are the 3 meds to tx BPH?

Phytotherapy
Alpha-blockers
5-alpha-reductase inhibitors (5-ARI)

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Which med?

saw palmetto widely used
may have a therapeutic benefit

phytotherapy

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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)