BPH, Erectile Dysfunction Flashcards
Benign Prostatic Hyperplasia: Lower urinary tract symptoms
- Weak stream
- Hesitancy
- Stream intermittency
- Post void dribbling
- Nocturia
BPH: complications
- urinary retention
- Recurrent UTI
What are the 2 scoring measures for BPH?
- Urinary Symptoms (AUA symptom score 0-35)
2. Impact on quality of life (Bother index 0-6)
What exam must be performed for a patient with BPH?
DRE (note size, consistency, +/- tenderness)
BPH: urologic testing (with expected findings)
- Urofow study (low flow rate)
- Post void residual (high residual)
- Cystoscopy (trabeculation, obstructive prostate into lumen)
- Urodynamic study (low flow, elevated pressure in bladder)
Name some conservative lifestyle modifications that can be done for mild BPH
- Avoid drinking too much water before bed
- If leg edema, elevate legs to help eliminate fluid before bed
- Avoid caffiene, and alcohol
- Double void to completely empty bladder
- Avoid pseudoephedrine/alpha agonist (causes sphincter to contract more forcefully)
BPH medications: phytotherapy
Saw palmetto
BPH medications: alpha blockers
cause relaxation of smooth muscle that restricts flow of urine
Alpha-1 blockers
Terazosin
Doxazosin
Alpha-1A blockers
Tamsulosin
Silodosin
Alfuzosin
(more specific and less likely to cause orthostatic hypotension)
Alpha-Blockers: ADEs
- Dizziness
- Nasal congestion
- Orthostatic hypotension
- Retrograde ejaculation
- Floppy iris syndrome*
5-alpha reductase inhibitors: MOA
- block conversion of testosterone to DHT
- Decrease prostate size/volume
- Increase urinary max flow rates
- Decrease risk of BPH progression
When would you tell your patient to expect results if you were starting them on a 5-alpha reductase inhibitor?
can take 6 months to see effect
alpha blockers are much quicker to give benefit
Which medication lowers PSA by 50% and is most beneficial in large prostates with PSA >1.4?
5 alpha reductase inhibitors
Name 2 examples of 5 alpha reductase inhibitors
- Finasteride
2. Dutasteride
5 alpha reductase inhibitors: ADE
- impotence
- Decreased libido
- Lower ejaculatory volume
- Gynecomastia
Which is the only PDE5-inhibitor that is approved for BPH and erectile dysfunction?
Tadalafil (cialis)
What is the gold standard surgery for BPH?
TURP - Transurethral Resection of Prostate
TURP complications/side effects
- Retrograde ejaculation
- TUR syndrome (Hyponatremia, confusion, hypertension, visual changes)
- Hematuria
What is the main benefit or reason why one would elect for a Photoselective Vaporization of Prostate proceedure?
-can be done safely on anticoagulation patient
Holmium Laser Enucleation of Prostate
Good for large prostates that previously could only be done with open surgery
What are some endocrine issues that could lead to erectile dysfunction?
Hyperprolactinemia*
Thyroid disorder
Hypogonadism
Name some medications that can cause ED?
Antihypertensives ** (beta blockers, thiazides, clonidine, methyldopa)
Antidepressants and antipsychotics (ex. TCAs, MAo-Is, Lithium)
Name the medications that can reduce testosterone (3)
- Cimetidine
- Spironolactone
- Ketoconizole
What can nocturnal penile tumescence help determine?
whether the ED is physiologic or psychologic
What is the best test to look for arterial insufficiency?
Penile duplex Doppler sonography
What is the best test to look for venous leak?
Cavernosometry/Cavernosography
Name some important initial measures for ED?
- Deterime if heart is healthy enough for sex
- Stop smoking
- Lose weight
- Moderate alcohol
- Change meds (if indicated)
What are contraindicated with phosphodiesterase-5 inhibitors?
nitrates
PDE-5 Inhibitors MOA
block PDE-5, allowing c-GMP to continue vasodilating
What is important to remember about using PDE-5 inhibitors and alpha blockers?
lowest dose of each, separate doses
PDE-5 side effects
- nasal congestion
- facial flushing
- headache
- dyspepsia
- back pain
- visual changes/loss of vision
What is important to remember about proper use of the VED
remove constricting ring after intercourse
Medicated urethral system for erection (MUSE)
Alprostadil
- prostaglandin E-1
- First dose under medical supervision (3% will have hypotension)
Penile injection
- Alprostadil or (Prostaglandin E1 + Phenotolamine + Papaverine)
- MAX of 3 per week
- First dose under medical supervision
Priaprism
> 4 hours
- Pain, stasis, hypoxia to cavernosal tissues, acidosis, fibrosis
- EMERGENCY!!
Priaprism: Tx
- Aspirate with 18 gauge needle
- Inject phenylephrine (vasoconstrictor)
Penile Prothesis: non-inflatable
- malleable or semi-rigid
- two rods that can be bent into and out of position of use
