Lecture 8 BPH

Question 1

BPH is characterized by hyperplasia, aka an increase in what?

Answer 1

number of glands and stroma

also increase in size, of the prostate in general

Question 2

what part of the prostate is typically involved in BPH

Answer 2

periurethral glands and surrounding stroma

Question 3

most important risk factor for development of BPH

Answer 3

age (also male gender)

Question 4

it is thought that ____ binds to androgen receptors, causing hyperplasia

Answer 4

DHT

Question 5

DHT is made from ____. what enzyme is responsible for this?

Answer 5

testosterone; 5 alpha reductase

Question 6

____ enhances DHT action

Answer 6

estradiol

Question 7

is BPH associated with cancer?

Answer 7

no (ie not premalignant)

Question 8

clinical manifestations are termed ____ or “___”

Answer 8

prostatism, LUTS (Lower urinary tract symptoms)

Question 9

symptoms include increased ____ of urination, ___turia, difficulty ___ and _____, ___uria

Answer 9

frequency, noc;
stopping and starting;
dys

Question 10

increased urinary ____ can cause ___ and renal insufficiency

Answer 10

retention, UTI

Question 11

what is more important, symptoms or pathology, when determining significance of BPH?

Answer 11

symptoms

ie LUTS

Question 12

the _____ score looks at obstructive and irritative symptoms, and the “bother score”

Answer 12

international prostatic symptom

Question 13

on digital rectal exam, the prostate will feel _____, elastic, and with a ____ ____ enlargement

Answer 13

smooth, firm nodular

Question 14

3 general options for treatment of BPH

Answer 14

watchful waiting, medication, surgery

Question 15

BPH complications:

distention and ____ of bladder, leading to increased risk of ____. ____, UTI

Answer 15

hypertrophy, diverticuli;

hydronephrosis

Question 16

2 general categories of medical therapy:

Answer 16

alpha blockers, 5 alpha reductase inhibitors

combo is best

Question 17

5alpha reductase inhibitors cause significant shrinkage of ____ hyperplasisa, but minimal shrinkage of _____.

Answer 17

glandular, stromal

Question 18

alpha blockers cause significant shrinkage of ____ hyperplasia, but minimal shrinkage of ____

Answer 18

stromal, glandular

Question 19

finasteride and dutasteride mechanism of action:

2 most common side effects:

Answer 19

5 alpha reductase inhibtors;

impotence, decreased ejaculate

Question 20

which work faster, alpha blockers or 5 alpha reductase inhibitors?
which affects progression of disease?

Answer 20

alpha blockers (days to weeks vs months);
5 alpha reductase inhibitors

Question 21

2 alpha blockers mentioned in FA

Answer 21

terazosin, tamsulosin

Question 22

alpha blockers cause ____ relaxation without impairing bladder ____

Answer 22

smooth muscle (outlet), contraction

Question 23

tamsulosin (flomax) can cause this weird-ass side effect:

Answer 23

retrograde ejaculation

Question 24

What is the gold standard of surgical treatment?

Answer 24

Transurethral resection of the prostate (TURP)

Question 25

most common complication of TURP?

Answer 25

post op UTI

Question 26

what works best for small prostates?

Answer 26

transurethral incision of prostate (TUIP)

Question 27

what should be done for very large prostates?

Answer 27

open prostatectomy

Question 28

what laser treatment has shown to be most effective?

Answer 28

HoLEP

laser enucleation of prostate