Urology 2.0

Question 1

What are the LUTS symptoms seen in BPH

Answer 1

• Hesitancy
• poor flow
• intermittency
• incomplete emptying
• Frequency
• urgency
• urge incontinence
• nocturia

Question 2

Main investigations to do for BPH

Answer 2

• MSU
• Creatinine
• PSA
• IPSS: international prostate symptom score Mil;1-7, mod:8-19, severe:20-35
• Flow rate + post voidal volume: can show outflow obstruction

Question 3

Tx of BPH

Answer 3

Often watching waiting

• Alpha blockers: most useful for ipss 8-20, shows a 50% reduction for ~50% of patients
  
  • doxazosin: (alpha1 selective)
  • Tamulosin: more selective, less systemic side effects
• 5-alpha reductase inhibitors: block test → dihydrotestosterone
  
  • Finasteride: for big prostates to be used in conjunction with alpha blocker
• Type 5 phosphodiesterase inhibitors (PDE5): improve lower urinary tract symptoms as well as erectile dysfunction.
  • Taladafil
• SURGERY IS ONLY FOR SEVERE IPSS >20 ((TURP)))

Question 4

Cause of erectile dysfunction

Answer 4

• Psychosocial
• Neurological conditions: spinal cord injury, ms, diabetes
• Medication

Question 5

How do you get an erection?

Answer 5

Visual, imaginatory and tactile stimuli are co-ordinated in the medial preoptic and paraventricular areas of the brain. Neural impulses travel down the spinal cord to the sacral segments and then via the pelvic plexus and cavernosal nerve to the penis.

Question 6

The key mediator of an erection in the cavernosal tissue is?

Answer 6

Nitrous oxide

Causes SM relaxation, occluding the emissary veins and penile engorgement follows

Question 7

Treatment of Erectile Dysfunction

Answer 7

• Lifestyle factors: weight, exercise, stress
• Treat underlying cause
• Oral PDE-5 inhibators: sildenafil, vardenafil and taladafil prevent degredation of penile peptide
  
  • 80% respond
• Also vacuum pump and intracavernosal injections

Question 8

Side effects of PDE-5 inhibitors?

Answer 8

10-20% get facial flushing and indigestion

Do NOT use in conjuction with nitrate for worry of severe hypotension

Question 9

What things an alter PSA levels

Answer 9

• Vigorous exercise, ejaculation, and digital rectal examination: delayed for 48 hours
• Acute prostatitis or UTI: delay for a month
• Instrumentation
• BPH

Question 10

Side effects of alpha-1 antagonists

Answer 10

e. g. tamsulosin, alfuzosin
* decrease smooth muscle tone (prostate and bladder)
* considered first-line, improve symptoms in around 70% of men
* adverse effects: dizziness, postural hypotension, dry mouth, depression

Question 11

Side effects of 5-alpha reductase inhibitors

Answer 11

eg; finasteride

• block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
• adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia