L66

Question 1

TESTQ: What kind of symptoms cause men with BPH to seek treatment?

Answer 1

Irritative > obstructive symptoms

• Urgency
• Freq
• Nocturia
• Incontinence

Question 2

2 risk factors for BPH

Answer 2

Nocturnal emission pre-20 yo

Long sex

Question 3

2 medicines to treat BPH

Answer 3

Alpha blockers = terazosin, tamsulosin

5 alpha reductase inhibitors

Question 4

Mechanism of the alpha blockers

Answer 4

Relax smooth muscle

Question 5

TESTQ: what hormone/molecules causes prostate enlargement/growth?

Answer 5

DHT = dihydro-testosterone

Question 6

Mechanism of 5 alpha reductase I

Answer 6

Testosterone + 5 alpha R = DHT

No androgens to maintain prostate

Question 7

Name the two 5 alpha reductase I

Answer 7

Dutasteride

Finasteride

Question 8

SE 5 alpha R-Is

Answer 8

Takes 6-12 mo to work
Sexual dysfxn
Gynecomastia, painful nipples
↑Hair

Question 9

4 surgical options for BPH

Answer 9

1. Laser - burn off superficial layers, less impotence, SE retrograde ejac
2. Thermotherapy - microwave adenoma (central), capsule protected b/c better BF
3. TUNA - needle lesions to push open
4. Urolift = sutures anchored on outside prostate to hold open

Question 10

What is stage 1/2 vs 3 vs 4 for prostate cancer? Prognosis?

Answer 10

1/2 confined
3 local invasion
4 distant mets
3 + 4 = not curable

Question 11

What does PSA tell you about cancer?

Answer 11

Screen for tumors too small to be palpated on PE aka earlier stage
Question is - would this have ever really become your issue

Question 12

Causes of ↑PSA

Answer 12

Cancer 10x BPH
Prostatitis
Infarct, retention

Question 13

When do you do a PSA?

Answer 13

1/yr AA > 40, men 55-70

Do as pt of dx eval when pt presenting with urinary symptoms/abnormalities

Question 14

5 treatment options for prostate cancer

Answer 14

1. Remove entire prostate
2. Brachy = radioactive particles, less invasive + incontinence
3. External beam radiation
4. Cryosurg - if fialed brachy/radio, argon gas
5. Hormonal - block testosterone

Question 15

What is ED? Possible cause?

Answer 15

Consistently can’t get a boner
Vs premature ejac - do you ejaculate before you lose your boner?
May be cause by hypo-gonadism

Question 16

How do testosterone levels effect sexual activity?

Answer 16

Low testosterone doesn’t change your ability to get a boner

Changes how often you get one and what you do with it

Question 17

What pt penis gets hard?

Answer 17

Corpus cavernosum
+ Arterial blood
↓Venous outflow

Question 18

ED medication + mechanism

Answer 18

PDE-5 inhibitors = sildenafil
PDE 5 breaks down cGMP
cGMP is needed to relax arterial SM
Nerve stim -> arginine -> NO -> GC -> ↑cGMP -> SM relax -> vasodilate -> erection

Question 19

Which pts are CI for PDE 5 I?

Answer 19

Cardiac pts on NITRATES

Net vasodilation - pool blood - ↓return to heart - ↓CO

Question 20

4 treatments for impotence

Answer 20

1. PDE-5 I
2. • Prostaglandin intra-urethral
3. Injection
4. Suction
5. Implant

Question 21

DDX for swelling + pain of scrotum

Answer 21

Torsion - acute

Epididymus - few days

Question 22

Presentation of testicular cancer

Answer 22

Painless testicular mass - 1 ball feels heavier than other
(vs choriocarcinoma = painful)
Young pts - puberty -> 40
Sensitive to treatment