Urology CC Flashcards
BPH occurs in the __ zone which surrounds ___
as men age, inc amount of __/ ____
BPH Obstructive sx
WISE
BPH irritative sx
FUND
Presents w B
L
P
transition, the urethra
stroma/ alpha 1 receptors
weak stream, intermittency, straining, emptying poor
freq, urgerncy, nocturia, dysuria
Bladder outlet obstruction
lower urinary tract sx
prostatism
International Prostate Symptom Score AKA \_\_\_ Standardized \_\_\_ 0-7 is \_\_\_ 8-19 is \_\_ 20-35 is \_\_
Med management w __ to work on __ receptors
helps to ___ smooth muscle in bladder
A1A in P, B, S, V
A1B in B
A1D in N, B, S
this is ___ therapy
can lead to
AUA sx score questionairre mildly sx moderate sx severely sx
alpha blockers, A1 adrenergic
relax
prostate, bladder neck, seminal vesicles, vas deferens
blood vessels
nasal passages, bladder, spinal cord
first line
trouble passing urine
BPH nonselective A blockers med management
Need __
T, D, A
Selective for ___
T and S
less ___, dont have to __
Alpha blockers work __
as quick as __, may take _w
SE D F N O R
titration
terazosin, doxazosin, alfuzosin
A1A adrenergic receptor
tamsulosin, silodosin
systemic SE, titrate
acutely
8hrs
2-4 wks
dizziness fatigue nasal congestion ortho hypoTN retrograde ejaculation
BPH management
5A reductase inhibitors
5AR converts __ to ___
reduces ___
includes __ and __
takes __ to notice beneficial effects
Reduces \_\_\_ inc \_\_ improve \_\_\_ reduces risk of \_\_ and need for \_\_\_ reduces \_\_\_ decreases \_\_ over 1 yr
T to DHT
DHT
finasteride, dutasteride
6-9m
prostate volume max flow rate IPSS scores urinary retention, BPH surgery progression PSA
BPH surgical treatment
__ (TURP) gold standard
___ prostate endoscopic
SE
R__ w ___, irreversible
__ syndrome w __, __ overload from absorption of ___
Other options T\_\_ U\_\_\_ which tacks \_\_ open M/N \_\_\_ Simple \_\_\_
transurethral resection of prostate
core out
retrograde ejac, open bladder neck
TUR, hypoNa, fluid, hypotonic fluid
transurethral laser surgery
urolift, lobes of prostate
microwave/needle ablation
prostatectomy
BPH is a common cause of __, must rule out ___
Dizziness may require ___ of med or ___
Pt who fails therapy have possible ___ or need __
___ is not indicated for BPH
hematuria, cancer
discontinuation, reduction
neuro cx, surgery
open radical prostatectomy
Erectile fxn is __ event w __ and ___ modualtion
sex stimulation leads to ___ release of NO
eventual ___ of sm in arterioles
inc ___ w __ expansion
SM in ___ relaxes, filling/expanding ___
causes compression of ___ bw erectile tissues overlying ___, stopping __
PNS leads to inc ___ w dec __
neurovasc, psych/hormonal
PNS NT
relaxation
blood flow, cavernosal
sinusoidal system, corporal bodies
venous complexes, tunica, venous outflow
inc blood flow, venous outflow
Erectile fxn major NT ___
inc ___ leads to __ and erection
__ of cGMP by __ leads to detumescence
NO
cGMP, sm relaxation
hydrolysis, PDE5
Common causes of ED
Pyschogenic
Neurogenic
Jormonal
Vasc
Med induced
disorders, problem
performance anx/depression
dec libido/NO, overinhib
stroke, SC injury, diabetic retinopathy
lack of nerve impulse/dec trans
hypogonad, hyperprolactin
dec NO
athero, HTN
impaired arterial/venous flow
antiHTN, antidepressants, etoh/cigs
central suppression, vasc insufficiency
ED can occur in ___ or ___ or __ or __ or ___ or ___
new onset ED leads to __ inc risk for __, __, __, __
Possible tx oral \_\_\_\_ inhibs, like \_\_\_ \_\_ device \_\_\_ or other \_\_ injections intraurethral \_\_ admin surgical placement of \_\_ \_\_ supplementation
DM, CAD, hyperlipid, hyperTN, sc dz, pituitary tumor
MI, stroke, angina, mini-stroke
PDE. sildenafil vacuum constriction PG E1, intracavernosal PG E1 penile prosthesis testosterone
PDE5 inhibitors
__ first line tx for ED
inhibit breakdown of ___, enhancing ___
imrpove response to __, but do not cause __
Most men __
Others: T, A, S, V
SE H/F N B Impaired \_\_\_ bc \_\_ in retina
higher in __ and __
low in __ and __ (dec aff for __)
sildenafil
cGMP, NO
sexual stimulation, auto erections
respond
tadalafil, avanafil, sildenafil, vardenafil
HA, flushing
nasal congestion
blurry vision
color vision, PDE6
sildenafil/vardenafil
tadalafil/avanafil, PDE6
Avoid PDE5 inhibs w
Resting ___ or __
__ or inherited disorders of ___
____
absolute contraindication __
should not be taken w/in 4hrs of ___
RF for ED S D/H/H Prolonged \_\_ V Trauma to \_\_\_/\_\_\_ Pelvic \_\_/\_\_
hypoTN (90/50), HTN (170/110)
retinitis pigmentosa, retinal PDE6
CV dz
nitrates
alpha blockers
smoking DM/HTN/hypercholesterolemia bike riding vasc dz penis/perineum surgery/radiation
PG E1 injection in __
directly relaxes ___
no __ needed for errection
if no errection, pt has __ from severe ___ or __ from leak in ___ mech of penis
option is ___ w pump to inflate ___ in ___
penis
penile arterioles
neural input
inflow, PVD
outflow prob, veno-occlusive
surgical device, tubes, corpora
Phimosis
inability to __
only emergent if ___
can tx w ___ as outpt
may include __ in tx
other options
D/C
retract foreskin
cant void
steroid cream
antifungal
dorsal slit
circumsision
Paraphimosis
can result in __
due to ___
manage w ___
compress ___
dunk glands past ___
+/- ___
__ if cant reduce
necrosis of glans
circumferential constriction
emergent reduction
edema
constricting ring
penile block
dorsal slit
