BPH, Prostate,Bladder,Test CA

Question 0

Obstructive vs Restrictive BPH sx

Answer 0

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)

Question 1

BPH

Answer 1

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

Question 2

Which medication should you be careful using in BPH pts

Answer 2

Allergy meds are alpha 1 agonists (?) and increase urinary retention

Question 3

What would DRE digital rectal exam reveal?

Answer 3

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)

Question 4

What determines BPH tx?

Answer 4

Sx rather than size!!!!

Don’t tx if no sx

Question 5

Which labs must be performed?

Answer 5

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)

Question 6

Offer PSA to

Answer 6

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

Question 7

What imaging studies should be ordered in BPH?

Answer 7

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)

Question 8

which is the most important test in BPH?

Answer 8

POST VOID REsidual urine measurement - !! should be assessed and used to help duide tx and response to tx !!

Question 9

What BPH test MUST be performed if Dx uncertain and there is hematuria?

Answer 9

CystoUrethroScopy - invasive but always must be done when Dx is uncertain and there is blood and BPH sx

Question 10

DDx

Answer 10

urethral strictures due to STDs
bladder calculi (stones)
UTI and nuerologic dz

Question 11

Non pharm and Med tx

Answer 11

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

Question 12

What Side effects of BPH Tx must be discussed with pt?

Answer 12

Stuffy nose, dizziness, retrograde ejaculation

Question 13

Which drugs not to use for acute tx of BPH?

Answer 13

Type II alpha reductase inh’s - Avodart, Proscar: use if need to slow growth of prostate
Start with alpha blockers (ZOSINS)

Question 14

TURP surgery transurethral resection of prostate

Answer 14

GOLD in BPH but complications: incontinence, and retro ejaculation.
(also green light laser is new - but can’t get tissue for pathology)

Question 15

TUNA TransUrethral Needle Ablation

Answer 15

radiofrequency needles thru urethra and lateral lobes of prostate - causing heat induced coagulation necrosis. - takes 6 wks before benefit

Question 16

Know for primary care ab BPH

Answer 16

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

Question 17

If see a pt in PCP office for hospital follow up of urinary retention

Answer 17

Make sure they are on ALPHA blocER

Question 18

4 types of prostatitis

Answer 18

Acute Bacterial
Chronic bacterial
Chronic prostatitis without infection
Symptomatic inflamm prostatitis

Question 19

Prostatis Sx

Answer 19

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

Question 20

Acute Bacterial pros

Answer 20

infected prostate often caused by same bacteria: Coli, Kleb, Proteus
(maybe aquired as STD - but will spread to prostate)

Question 21

Risk factors that allow for Acute Bacterial prost

Answer 21

Phimosis (unable to retract skin in uncircumsized male)
anal sex
UTI
acute epididymitis
transurethral surgery (TUNA OR TERC)

Question 22

Tx of acute prostatitis

Answer 22

Cipro min 30 days (4-6 weeks bc difficult to reach prost)
May need alpha blocker to assist with urination
Supportive Tx

Question 23

What are the sx of chronic bacterial inf?

Answer 23

No sx, sometimes low grade fever, CBC with high WBC
follow up on Acute bacterial inf
uncommon

Question 24

Chronic prostatitis w/o infection AKA

Answer 24

AKA chronic pelvic pain syndrome
condition with recurrent pelvic, testicle, or rectal pain without evidence of bladder infection. May have DYSURIA, or painful ejac, and erectile dysfx.
Cause not known
Normal CBC, UA, but perotoneal prostate pain

Question 25

PROSTATE CA

Answer 25

Most common CA in men
FOCAL nodules, or INDURATION on DRE
ASX most often, may have LOW BACK PAIN (mets to bone)
20% lose wgt (sign of CA when lose wgt always)

Question 26

Tx of prostate CA

Answer 26

watchful waiting
radical prostatectomy - remove prostate, big complications
radiation or poss androgen deprivation ( to decrease testosterone -> leads to CA)

Question 27

What will PSA show in prostate CA

Answer 27

Elevation

Question 28

Urinary incontinance

Answer 28

when urine leaks involuntary and is one of 4 groupls:
Urge incont - uncontrolled loss of urine preceeded by strong, unexpected urge to void
TOTAL incont - pt loses ALL urine ALL the time (no tone in bladder - neurogenic bladder)
STRESS INCONTINENCE - loss of urine due to increased intra-abldominal pressure (COUGH, sneeze or exercise) ::::: pt DO NOT leak in the supine posn !!!!! Caused by LAXITY in the muscles of pelvic floor, mostly in multiparous women or in pts with perlvic surgery
OVERFLOW incont - chronic distention of bladder receiving addl urine sot hat intravesical pressure exceeds outlet pressure cuasing the patient to dribble (what??)

Question 29

Clin findings in incontinence

Answer 29

Hx is most impt

PE to RO neuro abnormalities (urge), distended bladder (overflow), rectal exam (stress/total)

Question 30

Dx of incont

Answer 30

UA and cultures impt to exclude UTI

Can detect residual urine