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SM_242: BPH Flashcards

1
Q

____ zone of prostate is where BPH arises

A

Transitional zone of prostate is where BPH arises

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2
Q

This is a ____

A

This is a normal prostate acinus and surrounding stroma

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3
Q

Describe the 3 anatomic / physiologic zones of the lower urinary tract

A

3 anatomic / physiologic zones of the lower urinary tract

  • Zone 1: supra-trigonal bladder
  • Zone 2: bladder neck, prostate, and prostatic urethra
  • Zone 3: membranous urethra surrounded by UGC
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4
Q

Prostate growth and differentiation is ___

A

Prostate growth and differentiation is a complex interaction between the epithelial / stromal components, hormones, and growth factors

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5
Q

___ may promote prostate cell proliferation

A

Estrogens may promote prostate cell proliferation

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6
Q

BPH has ___ with ___ and ___ on histology

A

BPH has nodular cell proliferation with glandular epithelial cells and stromal cells

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7
Q

BPH can compress the ____

A

BPH can compress the prostatic urethra

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8
Q

BPH results in ____

A

BPH results in bladder wall thickening / trabeculation reflecting increased detrusor collagen deposition

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9
Q

BPH usually begins at ___ histologically and increases with ___

A

BPH begins at age 30 histologically and increases with age

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10
Q

Describe phases of BPH

A

BPH phases

  1. Histologic
  2. Clinical
  3. Symptomatic
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11
Q

PSA is a surrogate marker of ___

A

PSA is a surrogate marker of prostate volume

  • Specifically [-2]proPSA
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12
Q

Describe presentation of BPH

A

BPH presentation

  • Obstructive: decreased force of stream, hesitancy, intermittency, straining, feeling of incomplete bladder emptying
  • Irritative: frequency of urination, urgency
  • Nocturia
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13
Q

BPH is a ___ diagnosis

A

BPH is a clinical diagnosis

  • No biopsy required
  • Diagnosed by a combination of subjective and objective paramters
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14
Q

Prostate volume ____ with age and ____ with PSA

A

Prostate volume increases with age and increases with PSA

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15
Q

Urinary flow rate ____ with age

A

Urinary flow rate decreases with age

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16
Q

Post void residual urine is ___

A

Post void residual urine is amount of urine not emptied during voiding

  • Increases in elderly men due to blockage and weakening of the bladder muscle
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17
Q

BPH involves detrusor ____

A

BPH involves detrusor areflexia

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19
Q

Describe behavioral therapy for BPH

A

BPH behavioral therapy

  • Double voiding
  • Timed voiding
  • Avoidance of caffeine, alcohol, and other diuretics
  • Night-time fluid restriction
  • Increasing level of physical activity: leads to decreased body size, decreased sympathetic nervous system, decreased levels of systemic inflammation, and improved sleep quality
20
Q

There is ____ evidence for use of herbal therapies in BPH

A

There is NO objective evidence for use of herbal therapies in BPH

21
Q

Describe medical treatment of BPH

A

Medical treatment of BPH

  • Alpha antagonists
  • 5-alpha reductase inhibitors
  • Combination therapy
  • Antimuscarinics
  • Beta-3 adrenergic agonist
  • Phosphodiesterase-5 inhibitors
22
Q

____ is a potential complication associated with use of a1 blockers for BPH

A

Intraoperative Floppy Iris Syndrome is a potential complication associated with use of a1 blockers for BPH

23
Q

5a-reductase inhibitors ___ in treatment of BPH

A

5a-reductase inhibitors decrease likelihood of surgery and acute urinary retention in treatment of BPH

24
Q

Combination therapy with a1 blocker and 5-alpha reductase inhibitor is used for treatment of BPH in patients with ____, ____, ____, and ____

A

Combination therapy with a1 blocker and 5-alpha reductase inhibitor is used for treatment of BPH in patients with moderate-severe symptoms, prostates above 40 mL, higher PSA, and advanced age

25
Anticholinergics block ACh signal at \_\_\_\_, leading to \_\_\_\_
Anticholinergics block ACh signal at NMJ of detrusor muscle, leading to inhibition of detrusor contractions * Target detrusor overactivity
26
Anticholingergic side effects are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Anticholingergic side effects are dry mouth, constipation, and blurry vision * Dementia
27
Mirabegron (B3 agonist) is used to treat BPH due to \_\_\_\_
Mirabegron (B3 agonist) is used to treat BPH due to B3 activation and possible a1 blockade leading to relaxation of urethral smooth muscle * Same rate of adverse events as placebo
28
PDE-5 inhibitors function by \_\_\_\_, leading to \_\_\_\_
PDE-5 inhibitors function by blocking the breakdown of cGMP to GMP by phosphodiesterase, leading to vasodilation * Sildenafil, tadalafil, vardenafil * Useful for treating lower urinary tract symptoms and ED
29
\_\_\_\_, \_\_\_\_, and ____ are adverse effects of PDE-5 inhibitors
Headache, dyspepsia, and flushing are adverse effects of PDE-5 inhibitors
30
Describe indications for surgery for BPH
BPH surgery indications * Acute urinary retention * Bladder calculi * Azotemia * Recurrent UTI * Recurrent hematuria * Worsening lower urinary tract symptoms refractory to medical therapy
31
Describe surgical options for BPH
BPH for surgical options * Minimally invasive technologies * Transurethral resection of the prostate * Transurethral incision of the prostate * Laser therapies * Open simple prostatectomy * Robotic-assisted laparoscopic simple prostatectomy
32
\_\_\_\_ is better for larger prostates in BPH
Bipolar transurethral resection of prostate (bTURP) is better for larger prostates in BPH
33
Transurethral incision of the prostate is most suitable for ____ in BPH and ____ retrograde ejaculation
Transurethral incision of the prostate is most suitable for small prostates with an obstructing bladder neck in BPH and decreases retrograde ejaculation
34
HoLEP (Holmium laser for BPH) requires \_\_\_\_
HoLEP (Holmium laser) for BPH requires morcellation of the specimen * Adds to complexity and length of operative time
35
Simple prostatectomy for BPH involves \_\_\_
Simple prostatectomy for BPH involves enucleation of the transitional zone within the capsule * Generally reserved for prostates larger than 80 mL and/or in patients with large bladder diverticula or bladder stones requiring concomitant procedures
36
Robotic assisted simple prostatectomy is \_\_\_, \_\_\_, and \_\_\_
Robotic assisted simple prostatectomy is good for large glands, minimizes blood volume and hospital time, and leads to quicker recovery
37
BPH originates from ____ of prostate
BPH originates from transition zone of prostate
38
\_\_\_ cells are primarily responsible for production of type 2 5a-reductase in the prostate
Stromal cells cells are primarily responsible for production of type 2 5a-reductase in the prostate
39
Describe stages of BPH
BPH stages * Stage 1: abnormal transition zone histology, normal DRE, no LUTS * Stage 2: abnormal transition zone, enlarged prostate, no LUTS * Stage 3: abnormal transition zone, enlarged prostate, increased LUTS
40
\_\_\_\_ of men ages 60-69 are affected by symptoms of BPH
70% of men ages 60-69 are affected by symptoms of BPH
41
Components of initial evaluation of a patient with presumed BPH are \_\_\_, \_\_\_, \_\_\_, and \_\_\_
Components of initial evaluation of a patient with presumed BPH are history, DRE and focused physical exam, urinalysis, and PSA in selected patients
42
\_\_\_\_ adrenergic receptors are linked to smooth muscle contraction in the prostate
a-1A adrenergic receptors are linked to smooth muscle contraction in the prostate
43
Recurrent episodes of gross hematuria with clot retention in BPH are an absolute indication for \_\_\_
Recurrent episodes of gross hematuria with clot retention in BPH are an absolute indication for surgical management

Repro / GU (46 decks)

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