L 67 - Disease of the Male GU Tract

Question 1

BPH symptoms

Answer 1

LUTS

Obstructive: hesitancy, weak stream, incomplete emptying, retention

Irritative: Urgency, Frequency, Nocturia, Urge Incontinence

Question 2

2 mechanisms in which the prostate can lead to obstructed urinary outflow

Answer 2

Mechanical: Tissue Bulk

Dynamic: Smooth Muscle Tone is too tight and it doesn’t relax enough to allow for urine flow

Question 3

what is the hormonal driver behind prostate enlargement?

what enzyme is a potential target for treatment?

Answer 3

DHT

5 alpha reductase: cnverts testosterone to DHT

Question 4

Treatment options for BPH

what is the first option?

Answer 4

Alpha blockers – first option

5 alpha reductase Inhibition

Surgical Treatment Options

Minimally Invasive Treatment Options

Question 5

how do alpha blockers help with BPH? how long do they take to make a difference?

name two 5 alpha reductase inhibitors (how are they different)

Answer 5

Alpha blockers:
Mechanism – relaxation of the smooth muscle
- quick acting, (2 days); works in all prostate sizes

5alpha Reductase inhibitors:
- Finasteride: blocks 5AR type 2

• Dutasteride: blocks 5AR type 1&2

Question 6

Finasteride vs Dutasteride

Answer 6

inasteride: Blocks only 5AR type 2

Dutasterinde: Blocks 5AR type 1 and 2

Question 7

Surgical Treatment Options

vs

Minimally Invasive Treatment Options (what is the logical for these)

Answer 7

TURP
Lasers

Minimally invasive – adenoma has the worse blood supply. therefore can use Thermotherapy, Microwave therapy, Radio therapy to cut off that blood supply, necrose the adenoma but not the capsule

Question 8

what % of men over 70 have microscopic prostate cancer

Answer 8

80%

Question 9

treatment options for prostate cancer

Answer 9

Radical Prostatectomy

Brachytherapy

External Beam Radiation

Hormonal Therapy

Question 10

defintion of ED

Most common etiology

Risk factors

Answer 10

-inability to get or maintain erection

Venous leakage is the most common cause of ED

Age, HTN, DM, Drugs, trauma, psychological

Question 11

treatment for ED

Answer 11

PDE 5 Inhibitors

inhibition of PDE 5; therefore maintenance of cGMP

Question 12

common presenting symptom for testicular cancer

Answer 12

Painless Testis Mass

Question 13

best way to differentiate between testicular cnacer and other testricular enlargement process

Ddx of scrotal mass:

Answer 13

ultrasound

DDx: 
cancer
hydrocele 
epididymla cyst 
Varicocele
Hernia

Question 14

Ddx for scrotal pain:

Answer 14

Testicular Torsion

Epididymitis

Question 15

most at risk age range for testicular cancer:

prognosis for testicular cancer

Answer 15

Age: puberty to 40

Highly Curable (mortality 10-15%)

Sensitive to Chemotherapy