BPH, Prostate,Bladder,Test CA Flashcards
Obstructive vs Restrictive BPH sx
Obstructive: decreased force of urinary stream, intermittent, and urinary hesitancy. CAREFUL WHEN USING ALLERGY MEDS WITH BPH (Antihistamines are decongestants - alpha 1 causes urinary retention)
Restrictive sx: requency, urgency and NOCTURIA (lots like UTI)
BPH
80% of men over 80 yr have it
ORIGINATES IN THE PERIURAL (around urethra) and TRANSITION ZONES
CA ORIGINATE IN THE PERIPHERAL ZONE of prostate
Which medication should you be careful using in BPH pts
Allergy meds are alpha 1 agonists (?) and increase urinary retention
What would DRE digital rectal exam reveal?
If both lobes enlarged (uniform) - classic BPH
If focal - may be BPH, may be CA
DRE reveals either uniform (both sides) or focal (1 side)
If focal - need further eval; want to worry about CA especially if SMOOTH AND RUBBERY (like tip of nose)
What determines BPH tx?
Sx rather than size!!!!
Don’t tx if no sx
Which labs must be performed?
UA always to RO infection and hematuria
If hematuria - do PSA (prostate specific antigen) to see if CA
BUN/Creat - may do to asses kid fx (post renal failure is most common cause of obstruction or vs? Obstruction could lead to post renal failure so it’s a good idea to do BUN/Cr to asses kid fx)
Offer PSA to
asx man > 40 yo with life expectancy of 10 year
if less than 10 yrs with chronic dz - dont need PSA bc CA is slow growing
What imaging studies should be ordered in BPH?
Not nec UNLESS HEMATURIA or UPPER UR tract Dz is suspected (pyelonephritis)
UroFlow eval - may be useful (total volume in bladder must be >150 ml for test to be reliable)
which is the most important test in BPH?
POST VOID REsidual urine measurement - !! should be assessed and used to help duide tx and response to tx !!
What BPH test MUST be performed if Dx uncertain and there is hematuria?
CystoUrethroScopy - invasive but always must be done when Dx is uncertain and there is blood and BPH sx
DDx
urethral strictures due to STDs
bladder calculi (stones)
UTI and nuerologic dz
Non pharm and Med tx
Non-pharm : avoid caffein, cold and ALLERGY MEDS
Med: ALPHA BLOCKER! “ZOSINS”
Cardura or Hytrin
Flomax
Uroxatral
RapaFlo
Proscar (type II5 Alpha reductase inh) Avodart SE: decreased libido, breast tender, hair growth - take up to 9 months - dont use for ACUTE TX
!!!Must discuss SE with pt: stuffy nose, dizziness, retrograde ejaculation
What Side effects of BPH Tx must be discussed with pt?
Stuffy nose, dizziness, retrograde ejaculation
Which drugs not to use for acute tx of BPH?
Type II alpha reductase inh’s - Avodart, Proscar: use if need to slow growth of prostate
Start with alpha blockers (ZOSINS)
TURP surgery transurethral resection of prostate
GOLD in BPH but complications: incontinence, and retro ejaculation.
(also green light laser is new - but can’t get tissue for pathology)
TUNA TransUrethral Needle Ablation
radiofrequency needles thru urethra and lateral lobes of prostate - causing heat induced coagulation necrosis. - takes 6 wks before benefit
Know for primary care ab BPH
BPH can be tx’d in PC
If pt presents with urinary retention - refer to urology
Hospital F/Us for urinary retention - make sure they are on ALPHA BLOCKER
If see a pt in PCP office for hospital follow up of urinary retention
Make sure they are on ALPHA blocER
4 types of prostatitis
Acute Bacterial
Chronic bacterial
Chronic prostatitis without infection
Symptomatic inflamm prostatitis
Prostatis Sx
DYSURIA (only diff from BPH), uregency, frequency, weak stream: like BPH
if have;
suprapubic pain, testicle/scrotal pain, erectile dysfx : more ass’d with prostatitis than BPH
If fever - acute bacterial
Acute Bacterial pros
infected prostate often caused by same bacteria: Coli, Kleb, Proteus
(maybe aquired as STD - but will spread to prostate)
Risk factors that allow for Acute Bacterial prost
Phimosis (unable to retract skin in uncircumsized male) anal sex UTI acute epididymitis transurethral surgery (TUNA OR TERC)
Tx of acute prostatitis
Cipro min 30 days (4-6 weeks bc difficult to reach prost)
May need alpha blocker to assist with urination
Supportive Tx
What are the sx of chronic bacterial inf?
No sx, sometimes low grade fever, CBC with high WBC
follow up on Acute bacterial inf
uncommon
