242 - BPH Flashcards Preview

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Flashcards in 242 - BPH Deck (21)
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1

Which medications are proven to decrease prostate volume by ~20%?

Finasteride, dutasteride

(5-alpha-reductase inhibitors)

Also decreases PSA by 50%

But takes up to 6 months

2

Which lymph nodes drain the prostate?

Obturator nodes

(Hypogastric lymph nodes)

3

List the 3 stages of BPH

What size and symptoms occur at each stage?

  • Stage 1 = Histologic
    • Normal size
    • No symptoms
    • Histologic changes only
  • Stage 2 = Clinical (can discover on exam)
    • Enlarged
    • No lower urinary tract sx (LUTS)
  • Stage 3 = Symptomatic (pt has sx)
    • Enlarged
    • LUTS

 

4

Which structures make up the 1st, 2nd, and 3rd anatomic/physiologic zones of the lower urinary tract?

Which receptors predominate in each zone?

  • Zone 1
    • Bladder (above the trigone)
    • M3 (pelvic nerve), Beta-3 (hypogastic nerve)
  • Zone 2
    • Trigone to prostate
    • Bladder neck, prostate, prostatic urethra
    • Alpha-1 (pudendal nerve)
  • Zone 3
    • Membranous urethra
    • Nicotinic ACh receptors (pudendal nerve)

 

5

When would surgical managment be preferred over medical for BPH?

  • High AUR schore
  • Bladder caliculi
  • Large bladder diverticulum w/narrow neck + stasis
  • Recurrent UTI
  • Recurrent gross hematuria
  • Overflow incontinence (bilateral hydronephrosis, azotemia)
  • Lower urinary tract sx refractory to medical mangement

 

 

6

What is the half life of PSA?

2-3 days

7

What form of sexual dysfunction is associated with tamsulosin?

Retrograde ejaculation

 

Tamuslosin = Selective alpha-1A blocker, relaxes bladder neck

Semen can get into the bladder during ejaculation

Usually it is just peed out, no complaints

I guess only a problem if trying to conceive?

8

List the behavioral modifications that might be useful for mildy symptomatic pts with BPH (5)

  • Double voiding
  • Timed voiding (based on diary)
  • Avoid caffein, EtOH, diruetics
  • Night time fluid restriction
  • Exercise

 

 

9

What ophthalmologic problem is associated with alpha-blockers?

Intra-operative floppy iris syndrome

Not a contra-indication, but ophthalmologist needs to know before surgery

Higher rates of iris trauma, posterior capsule rupture during cataract surgery

10

WWhat are the standard components of a BPH workup? (6)

  • History
  • Focused physical exam
  • Digital rectal exam
  • Urinalysis
  • Creatinine
  • PSA (in select pts)

 

11

Which type of enzyme is PSA?

What is its function?

Serine protease

Liquifies semen

12

What is the major advantage of laser prostatectomy over conventional TURP?

Less bleeding

-> better hemostasis in an anticoagulated pt

 

 

13

Which herbal treatments work to treat BPH?

NONE of them have proven efficasy

14

For which patients would combined pharamcologic therapy for BPH be most helpful?

(alpha-blocker + 5-alpha reductase inhibitor)

Moderate-severe sx

Prostate volume >40mL

Higher PSA

Advanced age

15

Which two types of drugs will work best for irratiative symptoms of BPH?

What needs to be monitored when patients take these medications?

M2/M3 blocker or beta-3 agonist

Goal is to prevent detrusor contraction or promote relaxation

 

Monitor post-void residual volume to avoid urinary retention

16

Which phosphodiesterase enzymes are located in the prostae? (3)

4

5

11

 

PDE-5 inhibitors can help with ED and BPH

17

Which cells of the prostate produce PSA?

Adlumina/secretory cells

18

Which two cellular compartments expand in BPH?

Epithelial

Stromal

19

Which cells types make up the prostatic acinus? (3)

Adluminal/secretory

Basal

Neuroendocrine

20

Which drug class would be best to treat a patinet with BPH and erectile dysfunction?

PDE-5 inhibitors

(Sildinafil)

 

Age increases risk of both ED and BPH

21

Which embryonic structure is the prostate derived from?

Pelvic part of the UG sinus