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Final Notes > FN: BPH > Flashcards

FN: BPH Flashcards

1
Q

Epi

A

70% @ 60 yrs

90% @ 80yrs

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2
Q

Epi

A

70% @ 60 yrs

90% @ 80yrs

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3
Q

Path

A
  1. Benign nodular or diffuse hyperplasia of stromal and epithelial cells
  2. Affects inner (transitional) layer of prostate (cf. Ca) - urethral compression
  3. DHT produced from testosterone in stromal cells by 5alpha reductase enzyme
  4. DHT-induced GFs - raised stromal cells and reduced epithelial cell death
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4
Q

Presentation

A

Storage symptoms

Voiding symptoms

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5
Q

Storage symptoms

A

Nocturia
Freqeuncy
Urgency
Overflow incontinence

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6
Q

Voiding symptoms

A 
Hesitancy
Straining
Poor stream/flow + terminal dribbling
Strangury (urinary tenesmus)
Incomplete emptying: pis en doux
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7
Q

Other symptoms

A

Bladder stones secondary to stasis

UTI secondary to stasis

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8
Q

Examination

A

PR

  • smoothly enlarged prostate
  • Definable median sulcus

Bladder not usually palpable unless acute on chronic obstruction

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9
Q

Investigations

A 
Blood: U+E, PSA (after PR)
Urine: dip, MC+S
Imaging: transrectal US ± biopsy
Urodynamics: pressure/flow cstometry
Voiding diary
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10
Q

Mx conservatuce

A

reduced caffeine, EtOH
Double voiding
Bladder trainingL hold on - raised time between voiding

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11
Q

Mx medical

A

Useful in mild disease and while awaiting TURP
1st - alpha-blockers
2nd - 5alpha - reductase

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12
Q

Alpha-blockers

A
  • Tamsulosin, doxazosin

- Relax prostate smooth muscle

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13
Q

Alpha blockers SE

A

Drowsiness, reduced BP, depression m EF, increased wt, extra-pyramidal signs

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14
Q

5 alpha reductase

A

Finasteride
Inhibit conversion of testosterone - DHT
Preferred if significantly enlarged prostate

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15
Q

5 alpha reductase SE

A

Excreted in semen (use condoms), ED

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16
Q

Surgical Mx indications

A

Symptoms affect QoL

Complciatino sof BPH

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17
Q

Surgical MX

A

TURP - cystoscopic resectino of lateral and middle lobes

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18
Q

Transurethral incisions of prestate (TUIP)

A
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19
Q

Tranurethral electrovaporisation of prostate

A

Electric current - tissue vaporisation

20
Q

Laser prostatectomy

A

reduced ED and retrograde ejaculation

Similar efficiacy as TURP

21
Q

Open retropubic prostatectomy

A

Used for very large prostates >100g

22
Q

TURP complciations immediate

A

TUR syndrome - absorption of large quality of fluids - reduced NA
Haemorrhage

23
Q

TURP complications early

A

Haemorrhage
Infection
Clot retention: requires bladder irrigation

24
Q

LAte complications of TURP

A

Retrograde ejaculation: common
ED 10%
Incontinence

25
Q

Path

A
  1. Benign nodular or diffuse hyperplasia of stromal and epithelial cells
  2. Affects inner (transitional) layer of prostate (cf. Ca) - urethral compression
  3. DHT produced from testosterone in stromal cells by 5alpha reductase enzyme
  4. DHT-induced GFs - raised stromal cells and reduced epithelial cell death
26
Q

Presentation

A

Storage symptoms

Voiding symptoms

27
Q

Storage symptoms

A

Nocturia
Freqeuncy
Urgency
Overflow incontinence

28
Q

Voiding symptoms

A 
Hesitancy
Straining
Poor stream/flow + terminal dribbling
Strangury (urinary tenesmus)
Incomplete emptying: pis en doux
29
Q

Other symptoms

A

Bladder stones secondary to stasis

UTI secondary to stasis

30
Q

Examination

A

PR

  • smoothly enlarged prostate
  • Definable median sulcus

Bladder not usually palpable unless acute on chronic obstruction

31
Q

Investigations

A 
Blood: U+E, PSA (after PR)
Urine: dip, MC+S
Imaging: transrectal US ± biopsy
Urodynamics: pressure/flow cstometry
Voiding diary
32
Q

Mx conservatuce

A

reduced caffeine, EtOH
Double voiding
Bladder trainingL hold on - raised time between voiding

33
Q

Mx medical

A

Useful in mild disease and while awaiting TURP
1st - alpha-blockers
2nd - 5alpha - reductase

34
Q

Alpha-blockers

A
  • Tamsulosin, doxazosin

- Relax prostate smooth muscle

35
Q

Alpha blockers SE

A

Drowsiness, reduced BP, depression m EF, increased wt, extra-pyramidal signs

36
Q

5 alpha reductase

A

Finasteride
Inhibit conversion of testosterone - DHT
Preferred if significantly enlarged prostate

37
Q

5 alpha reductase SE

A

Excreted in semen (use condoms), ED

38
Q

Surgical Mx indications

A

Symptoms affect QoL

Complciatino sof BPH

39
Q

Surgical MX

A

TURP - cystoscopic resectino of lateral and middle lobes

40
Q

Transurethral incisions of prestate (TUIP)

A
41
Q

Tranurethral electrovaporisation of prostate

A

Electric current - tissue vaporisation

42
Q

Laser prostatectomy

A

reduced ED and retrograde ejaculation

Similar efficiacy as TURP

43
Q

Open retropubic prostatectomy

A

Used for very large prostates >100g

44
Q

TURP complciations immediate

A

TUR syndrome - absorption of large quality of fluids - reduced NA
Haemorrhage

45
Q

TURP complications early

A

Haemorrhage
Infection
Clot retention: requires bladder irrigation

46
Q

LAte complications of TURP

A

Retrograde ejaculation: common
ED 10%
Incontinence

Final Notes (196 decks)

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