2022 - BPH over 80 Flashcards
(32 cards)
What challenges are involved in the medical management of BPH in elderly men?
Multiple comorbidities, polypharmacy, adverse effects, drug-drug interactions, limited data on medications for those over 80, and specific concerns regarding alpha blockers.
What is FORTA classification, and how is it used in treating BPH in elderly men?
FORTA (Fit fOR The Aged) classification categorizes the safety and efficacy of medications for BPH in men over 65. It helps in selecting the right medication, considering factors like side effects and interactions.
What are the key considerations in using alpha blockers in the management of BPH in elderly patients?
Alpha blockers like alfuzosin, doxazosin, tamsulosin, and silodosin are commonly used. Considerations include FORTA classification, side effects like orthostatic hypotension, intraoperative floppy iris syndrome (IFIS), interaction with cataract surgery, and sexual side effects.
Figure. Treatment algorithm for the elderly male with BPH. OAB, overactive bladder. OSA, obstructive sleep apnea
What factors must be considered for an individualized approach to BPH in men over 80?
Comorbidities, operative risk, polypharmacy, living environment, resources, and mental acuity.
Why is understanding the living environment crucial in older patients with BPH?
To assess toileting abilities, fall risks, caregiver support, and choose the best treatment path.
What diagnostic tools are important in understanding BPH issues in older men?
Voiding diaries, urodynamics, cystoscopy.
What is the typical first-line therapy for BPH?
Medications, considering comorbidities, polypharmacy, and the FORTA classification.
What should be considered when prescribing alpha blockers for BPH in the elderly?
Side effects like orthostatic hypotension, IFIS, and QTc prolongation. Only silodosin and tamsulosin are acceptable in the FORTA classification.
What are the advantages and classification of 5ARIs in BPH treatment for the elderly?
Reduction of prostate volume, lack of adverse cognitive and cardiovascular effects, 3-4 months for symptom change, FORTA B classification.
What is the role of PDE-5s in BPH treatment?
Treats both LUTS and ED, tadalafil FDA-approved for daily use, FORTA-C classification.
What is the role and considerations of anticholinergics in BPH treatment for the elderly?
Reduces nerve impulses in bladder muscles, significant side effects in some types, fesoterodine preferred, FORTA classification varies.
Describe the role and effects of beta-3 agonists like mirabegron in BPH treatment.
Causes detrusor relaxation, well-tolerated with low adverse effects, hypertension, and urinary tract infection as common effects.
What are the combination therapies for BPH, and how effective are they?
Alpha Blocker and 5-ARI, Alpha Blocker and Anticholinergic; effective in reducing symptoms and progression.
What are the roles of testosterone replacement and antiandrogens in BPH treatment?
Testosterone improves quality of life but risks prostate growth (mitigated with 5ARIs); antiandrogens for rapid reduction in prostate size.
What are the special considerations for elderly patients undergoing BPH surgery?
Anesthetic risks, polypharmacy, anticoagulation, comorbidities, social factors, recovery components, frailty, and potential catheter use.
What are MISTs, and what makes them attractive for frail men?
Low-risk office-based procedures like prostatic urethral lift, water vapor thermotherapy; may require anesthesia or sedation. Advantages and disadvantages listed in table 3.
How is PAE used in BPH treatment, especially for frail older men?
Reasonable and safe treatment, beneficial for refractory/recurrent hematuria, concerns about contrast load and prolonged treatment times.
What are the key considerations regarding anesthesia in elderly BPH surgery?
Hemodynamic and cognitive risks, limiting duration, regional approaches, risk of neurotoxicity, pressure ulcers, limited mobility, and traumatic fractures.
What are the surgical approaches and potential modifications for elderly BPH patients?
: Avoiding monopolar TUR, laparoscopic, robotic, and open surgery; preferring laser procedures; modifying techniques like channel bipolar TUR; considering short-term hormonal therapy for untreated prostate cancer.
What are the critical postoperative considerations for elderly men after BPH surgery?
Managing fluid intake, constipation, voiding symptoms, recurrent hematuria, potential catheter or suprapubic tube trials, antibiotics, consideration of 5ARIs or antiandrogens.
What is the importance of assessing frailty in elderly patients undergoing BPH surgery?
Increased risk of complications, length of hospital stay, mortality; assessment tools like frailty phenotype and frailty index; lack of consensus on optimization; geriatric assessment advised.
What are the concluding thoughts on treating BPH in older men?
Requires full assessment and thoughtful approach, considering voiding issues, treatment risks, patient frailty, living environment; tailored treatment options with multiple choices.
What is the FORTA classification system for medical therapies used to treat BPH in men ≥65, and how are the medications classified?
FORTA A (Absolutely): None
FORTA B (Beneficial): Dutasteride, Finasteride (5ARI); Fesoterodine, Oxybutynin extended release, Solifenacin, Tolterodine, Trospium (Anticholinergic); Tadalafil (Phosphodiesterase inhibitor)
FORTA C (Careful/Caution): Darifenacin, Mirabegron (Anticholinergic); Alfuzosin, Doxazosin, Silodosin, Tamsulosin, Terazosin (Alpha blocker)
FORTA D (Do Not Recommend): Oxybutynin immediate release (Anticholinergic); Propiverine (Anticholinergic)
