Urology Flashcards
Signs and symptoms LUTS
Storage: urgency, frequency, incontinence, nocturia
Obstruction: hesitancy, weak stream, intermittence, straining
Post-micturition: dribbling, incomplete void, retention
Erectile or ejaculatory dysfunction
Labs for LUTS investigations
Urinalysis - UTI, hematuria, glucosuria, proteinuria
PSA - pros and cons
Lifestyle recommendations for BPH
Recommend if IPSS <7:
Fluid restriction, especially before bedtime
Avoid irritating foods - coffee, spice, ETOH
Avoid irritation meds - TCA, diuretics, decongestants, antihistamines
Timed voiding
Pelvic floor exercises
Urethral milking for dribble
Avoid constipation
Examples and use of alpha blockers in BPH
Tamsulosin
Use for small gland and low PSA
Reduce symptoms but not prostate size or progression
Side effects of alpha blockers
Hypotension - more common with non-selective
Erectile dysfunction - more comment with selective ones
Selective better tolerated
Examples and use of 5-alpha reductase inhibitors in BPH
Finasteride
Dutasteride
Use for large gland and high PSA
Alters natural history, shrinks prostate
Side effects of 5-alpha reductase inhibitors
ED, decreased libido, ejaculatory disorder
Most effective treatment regime for BPH
Combined therapy with a-blocker and 5-ari. Can stop a-blocker after 6 monthd. Best evidence for LUTS.
Use of antimuscarinics and b3-agonists in BPH and examples
Tolterodine
Mirabegron
Can be used for storage symptoms. Caution if bladder obstruction or large post residual volume.
Indications for surgery of BPH
Patient preference
Recurrent or refractory urinary retention
Recurrent UTI
Bladder stones
Recurrent hematuria
Renal dysfunction secondary to BPH
Symptoms deterioration despite medical therapy
Types of surgery for BPH with specific indications and efficacy
- Monopolar-Transurethral resection of the prostate (M-TURP). For mod-severe LUTS w prostate volume 30-80cc.
- B-TURP - small indication
- Prostatectomy if prostate > 80 cc
Risks of surgery for BPH
Risks hematuria, TUR syndrome, urinary retention, infection, incontinence, ED, retrograde ejaculation*, possible need for repeat.
Definition of erectile dysfunction
Persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for atleast 3 months
Causes of ED
Psychogenic
Vascular - post stroke, PVD
Medication/Substancesss - anti-HTNs, opiates, antidepressanrs, hormones, ilicit drugs.
Psychological
Neurological - spinal cod injury, MS, parkinson’s, alzheimers
Hormonal - hypogonadism, hyperprolac, thyroid, addisions
Investigations in ED
CBC
Lipids
A1c
TSH
ECG
Can consider:
Urinalysis
LFTS
Cr
Prolactin
Testosterone
