BPH and ED Flashcards
Sx of storage issues
- urgency
- freq.
- nocturia
- urg incontinence
Sx of voiding issues
- hestiancy
- poor flow
- intermmitency
- straining
- terminal dribble
post - voiding SX
- dribble
- incomplete emptying
etiology of LUTS
multi-factorial, but we’ll concentrate on prostate
what are clinical features of BPH (2)
results from outlet obstuction and compensatory chances in detrusotr function
- voiding Sx
- due to outflow obs - storage Sx
- due to detrusor overactivity
5 possible BPH complication
- retention
- incontinence
- hydronephrosis
- infection
- gross hematuria
6 parts of BPH work-up
- Hx and AUA score
- Phx - DRE
- urinalysis
- Cr to assess renal function
- PSA to rule out malig
- US for post-void resid
mgmt for mild Sx
watchful waiitng
- lifestyle changes
medical mgmt (3)
- a-blockers - -osins
- relaxes smooth muscle - 5-a reducase inhibs
- blocks conversion to DHT to reverse growth - tadalfl
when to refer
- baseline abnormalities on tests
- complications of BPH
- not responding to therapy
- pt pref
4 additional tests to do
- uroflowmetry
- cystoscopy
- urodynamics
- URT imaging
3 surgical Tx
- TURP
- open prostatectomy
- minimally invasive - laser
3 def. indications for surg
- refractory retention
- renal insufficiency
- intolerance/failure of meds
def. of ED
can’t get erection for 3 months
what is physiology of erection
stim>NO release> cGMP formation> smooth muscle relax> blood into sinusoids
3 major risks for ED
- age
- chronic disease
- heart
- diabetes
- meds - lifstyle
- SMOKING - impairment of smooth muscle relaxation
features of psycho erection
- sudden onset
- complete immediate loss
- AM present
- varies with ciricumstance
features of organi
- gradual onset
- etc
3 main vascualr causes
- atherosclerosis - same risk factors
- venous leaks
- trauma
6 neurogenic causes
- surgery
- cord injury
- MS or demylenating conditions
- DM
- mudendal nerve injurt
- stroke
3 hormonal causes
- hypogonadism
- thyroid
- pit.
6 types of meds
- antihypertensives
- SSRIs
- hormonal agents
- protease inhibs
- cytotoxic
- H2 agonists
5 parts of SHIM
- confidence
- firmness
- freq
- completion/maintenance
- satisfaction
4 first line therapies
- lifestye/drug mods
- psych
- androgen replacment
- oral therapy
4 types of androgen replacement
- trandermal pathc
- IM injections
- sub-cut implant
- oral
precautions for PDE-5s
- cardiac disease
- retinitis pigmentosa
- protease inhibs
- a-blockers
3 second line Tx
- vacuum
- muse
- caverject
3rd line
implant
