BPH, Prostate, Bladder, and incontinence Flashcards
Where does prostate cancer originate?
In the peripheral zone of the prostate
Where does BPH originate?
In the periurethral and transition zones
What are some symptoms of BPH?
OBSTRUCTIVE such as low force and quality of stream, intermittent stream, hesitancy
IRRITATIVE such as frequency, urgency, nocturia
What medications should you watch with BPH?
Allergy medications
You detect uniform enlargement on a DRE. You patient has no sx. What is your next step?
No treatment
Uniform enlargement with sx. What is your next step?
BUN/Cr, UA (r/o infection and hemauria), PSA (even if asymptomatic and greater than 40 years old)
When do you image a person with BPH?
With more than mild to moderate symptoms or if they have mild to moderate with hemauria or if another urinary tract disease is suspected
What tests may you use to assess BPH? What is used to guide efficacy of tx?
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
What test should be used to assess BPH only if diagnosis is uncertain?
cystourethroscopy
What is the nonpharm tx for BPH?
avoid caffeine, cold and allergy meds
What is the firstline medical treatment for BPH? What side effects?
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
What is a the 2nd line medical tx for BPH?
type II 5-alpha reducase inhibitors (antiandrogens)
Proscar
Avodart
may cause breast tenderness, decreased libido, hair growth
take up to 9 months to work
What should you used for acute tx of patient in retention?
try catheterization
What is the gold standard of tx for BPH?
TURP
radiofq needles in the prostate
TUNA, takes 6 weeks to see benefit
What are 4 types of prostatitis?
Acute bacterial
chronic bacterial prostatitis
chronic prostatitis without infection
symptomatic inflammatory prostatitis
What are signs and symptoms of prostatitis?
Dysuria, urgency, prequency, weak stream, perineal, suprapubic, testicle/scrotal pain, ED, +/- fever and chills in acute bacterial
What are the most common causes of acute bacterial prostatitis?
E. Coli, Klebsiella, and Proteus
Tx for acute prostatitis
for STD. Ceftriaxone IM with doxycycline BID x 10 days
Cipro BID 4-6 weeks or Levo QD 4-6 weeks
+/- alpha blocker
What are the sx of chronic bacterial prostatitis?
typically none, possibly a low grade fever with a dull pain
Focal nodules or indurations on DRE, PSA elevation
Prostate cancer
Tx for prostate cancer
watchful waiting. radical prostatectomy, radiation or possibly androgen deprivation
Men whose initial PSA level is greater than or equal to which should undergo annual testing? preventative tx?
2.5 ng/mL; 5 alpha-reductase inhibitors, DRE at 40!
4 types of urinary incontinence
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
Approach to incontinence:
PE: distended bladder, rectal exam
Labs: UA and cultures, cystoscopy to eval bladder anatomy
Tx for urge incontinence:
Antimuscarinics:
Vesicare, Detrol, sanctura
ASK ABOUT NARROW ANGLE GLAUCOMA
SE of dry mouth and constipation
Tx for stress incontinence
kegel exercises, then surgery
Bladder CA
Men>women (7:1)
Cigarette smoking and dye exposure
Presenting sx of bladder CA in 85-90% of pts
Hematuria, +/- hepatomegaly or supraclvicular lymphadenopathy OR LE lymphadenopathy
Diagnostic findings of bladder CA
gross or microscopic hematuria, +/- anemia, urine cytology is useful in detecting disease
diagnose and stage bladder CA
transurethral resection and cystoscopy
hematuria being the common sign the differential goes as follows:
stones, heme disorders, infection, trauma (most likely not cancer)
Your pt is on warfarin and notes blood in urine. Are you concerned?
Yes, check INR, do a workup with a CT urogram and urine cytology, refer to uro for CYSTOSCOPY
Most likely age to develop testicular CA?
25-35, ESP WITH HISTORY OF CRYPTORCHISM
Most common sx of test CA
painless enlargement of the testis, typically pts wait 3-6 months to seek tx
Elevated lab findings in testicular CA
HCG, alpha-fetoprotein, LDH
What images are indicated if you suspect testicular CA?
scrotal U/S to distinguish from epidermoid cyst (benign) in 25% of diagnoses
staging: chest film and CT of pelvis
One take home from testicular CA
NEVER LET THE SUN SET ON A TESTES MASS
get a stat testicular U/S and immediate URO consult
