BPH Flashcards
What are 4 types of drugs used to manage LUTS
- Alpha blockers
- 5 alpha reductase inhibitors
- phosphodiesterase inhibitors
- anticholinergics
What is the mechanism of action and side effects of alpha blockers
MOA: relaxation of prostate smooth muscle and bladder neck
Side Effects: Retrograde ejaculation, hypotension, floppy iris syndrome
What is the mechanism of action and side effects of 5AR
MOA: inhibits the conversion of Testosterone to DHT impacting prostatic growth
Side Effects: decrease libido, breast tenderness/growth, erectile dysfunction
What is the mechanism of action and side effects of PDE
MOA: prevents the breakdown of cGMP to GMP which leads to vasodilation and smooth muscle relaxation
Side Effects: chest pain, dizziness, vision changes
Which alpha blocker drug or drugs are least likely to result in retrograde ejaculation? Why?
DAT
doxazosin, alfuzosin, terazosin because less selective affinity for alpha 1 receptor
Which alpha blocker is least likely to result in hypotension
Alfuzosin
what are some side effects to using Glycine as solution during TURP
hyperammonemia encephalopathy, retinal/optic nerve toxicity
What are the indications for surgical management of BPH?
- Renal failure/azotemia
- Acute urinary retention
- Bladder stones
- Recurrent UTI
- Recurrent hematuria (no other source)
- Failed medical management
what can be offered in those men who prefer to preserve ejaculatory function?
Urolift, TUIP, aqua ablation
According to AUA, which surgical treatments should not be offered for treatment of BPH?
TUNA and embolization
what are the LONG TERMside effects of surgical management of BPH?
ED, ejaculatory dysfunction, dysuria, frequency
What is the maximum uroflow rate that TURP is said to be helpful in the setting of BPH?
15 ml/sec
What is average uroflow rate for men?
< 45y/o: 21 ml/sec
46-65: 12 ml/sec
66-80: 9 ml/sec
