BPH, Prostate, Bladder, and incontinence

Question 1

Where does prostate cancer originate?

Answer 1

In the peripheral zone of the prostate

Question 2

Where does BPH originate?

Answer 2

In the periurethral and transition zones

Question 3

What are some symptoms of BPH?

Answer 3

OBSTRUCTIVE such as low force and quality of stream, intermittent stream, hesitancy
IRRITATIVE such as frequency, urgency, nocturia

Question 4

What medications should you watch with BPH?

Answer 4

Allergy medications

Question 5

You detect uniform enlargement on a DRE. You patient has no sx. What is your next step?

Answer 5

No treatment

Question 6

Uniform enlargement with sx. What is your next step?

Answer 6

BUN/Cr, UA (r/o infection and hemauria), PSA (even if asymptomatic and greater than 40 years old)

Question 7

When do you image a person with BPH?

Answer 7

With more than mild to moderate symptoms or if they have mild to moderate with hemauria or if another urinary tract disease is suspected

Question 8

What tests may you use to assess BPH? What is used to guide efficacy of tx?

Answer 8

1) Uroflow, if second volume is more than 150 ml, it is considered positive
2) Post void residual urine measure (different from above) should be assessed and used to help guide efficacy of tx

Question 9

What test should be used to assess BPH only if diagnosis is uncertain?

Answer 9

cystourethroscopy

Question 10

What is the nonpharm tx for BPH?

Answer 10

avoid caffeine, cold and allergy meds

Question 11

What is the firstline medical treatment for BPH? What side effects?

Answer 11

alpha blockers:
Cardua (doxazoxin) and Hydrin (terazosin) (older meds)
TAMSULOSIN=FLOMAX .4 mg PO taken after a meal
Urozartral (afluzosin) 10 mg
Rapaflow (silodosin) 8 mg
stuffy nose, dizziness, retrograde ejaculation

Question 12

What is a the 2nd line medical tx for BPH?

Answer 12

type II 5-alpha reducase inhibitors (antiandrogens)
Proscar
Avodart
may cause breast tenderness, decreased libido, hair growth
take up to 9 months to work

Question 13

What should you used for acute tx of patient in retention?

Answer 13

try catheterization

Question 14

What is the gold standard of tx for BPH?

Answer 14

TURP

Question 15

radiofq needles in the prostate

Answer 15

TUNA, takes 6 weeks to see benefit

Question 16

What are 4 types of prostatitis?

Answer 16

Acute bacterial
chronic bacterial prostatitis
chronic prostatitis without infection
symptomatic inflammatory prostatitis

Question 17

What are signs and symptoms of prostatitis?

Answer 17

Dysuria, urgency, prequency, weak stream, perineal, suprapubic, testicle/scrotal pain, ED, +/- fever and chills in acute bacterial

Question 18

What are the most common causes of acute bacterial prostatitis?

Answer 18

E. Coli, Klebsiella, and Proteus

Question 19

Tx for acute prostatitis

Answer 19

for STD. Ceftriaxone IM with doxycycline BID x 10 days
Cipro BID 4-6 weeks or Levo QD 4-6 weeks
+/- alpha blocker

Question 20

What are the sx of chronic bacterial prostatitis?

Answer 20

typically none, possibly a low grade fever with a dull pain

Question 21

Focal nodules or indurations on DRE, PSA elevation

Answer 21

Prostate cancer

Question 22

Tx for prostate cancer

Answer 22

watchful waiting. radical prostatectomy, radiation or possibly androgen deprivation

Question 23

Men whose initial PSA level is greater than or equal to which should undergo annual testing? preventative tx?

Answer 23

2.5 ng/mL; 5 alpha-reductase inhibitors, DRE at 40!

Question 24

4 types of urinary incontinence

Answer 24

Urge: uncontrolled loss preceded by a strong, unexpected urge to void
Total: total loss of control all the time
Stress: a/w intra-abdominal pressure, do not leak in supine position (women)
Overflow: results from chronically distended bladder, causes dribbling

Question 25

Approach to incontinence:

Answer 25

PE: distended bladder, rectal exam
Labs: UA and cultures, cystoscopy to eval bladder anatomy

Question 26

Tx for urge incontinence:

Answer 26

Antimuscarinics:
Vesicare, Detrol, sanctura
ASK ABOUT NARROW ANGLE GLAUCOMA
SE of dry mouth and constipation

Question 27

Tx for stress incontinence

Answer 27

kegel exercises, then surgery

Question 28

Bladder CA

Answer 28

Men>women (7:1)

Cigarette smoking and dye exposure

Question 29

Presenting sx of bladder CA in 85-90% of pts

Answer 29

Hematuria, +/- hepatomegaly or supraclvicular lymphadenopathy OR LE lymphadenopathy

Question 30

Diagnostic findings of bladder CA

Answer 30

gross or microscopic hematuria, +/- anemia, urine cytology is useful in detecting disease

Question 31

diagnose and stage bladder CA

Answer 31

transurethral resection and cystoscopy

Question 32

hematuria being the common sign the differential goes as follows:

Answer 32

stones, heme disorders, infection, trauma (most likely not cancer)

Question 33

Your pt is on warfarin and notes blood in urine. Are you concerned?

Answer 33

Yes, check INR, do a workup with a CT urogram and urine cytology, refer to uro for CYSTOSCOPY

Question 34

Most likely age to develop testicular CA?

Answer 34

25-35, ESP WITH HISTORY OF CRYPTORCHISM

Question 35

Most common sx of test CA

Answer 35

painless enlargement of the testis, typically pts wait 3-6 months to seek tx

Question 36

Elevated lab findings in testicular CA

Answer 36

HCG, alpha-fetoprotein, LDH

Question 37

What images are indicated if you suspect testicular CA?

Answer 37

scrotal U/S to distinguish from epidermoid cyst (benign) in 25% of diagnoses
staging: chest film and CT of pelvis

Question 38

One take home from testicular CA

Answer 38

NEVER LET THE SUN SET ON A TESTES MASS

get a stat testicular U/S and immediate URO consult