Benign Prostate Disease Flashcards
(32 cards)
where do most prostate cancers arise
peripheral zone - acinar tissue, posterior surface
where does BPH occur
transition zone - surrounds urethra
what is BPH
benign prostatic hyperplasia
proliferation of epithelial and smooth muscle cells within the transition zone of prostate.
what is a nonmalignant adenomatous overgrowth of periurethral prostate gland
BPH
what are the symptoms of BPH
bladder outlet obstruction: weak stream, hesitancy, urinary frequenzy, urgency, urge or overflow incontinence
how is BPH diagnosed
DRE and symptoms
cytoscopy
transrectal US
urodynamics or other imaging
what are the tx options of BPH
5-alpha-reductase inhibitors
alpha blockers
tadalafil
surgery
what are lower urinary tract symptoms (LUTS)
often progressive:
urinary frequency
urgency
nocturia
hesitancy
intermittency
what can straining to void cause with BPH
congestion of superficial veins of prostatic urethra and trigone, which may rupture and cause hematuria
Acutely: vasovagal syncope
Chronically: dilation of hemorrhoidal veins or inguinal hernias
what causes urinary retention
prolonged attempts to postpone voiding
immobilization
exposure to cold
use of anesthetics, anticholinergics, sympathomimetics, opioids or alcohol
what are behavioral modifications for the tx of BPH
decreased fluid intake
decreased caffeine intake
void in seated position
double voiding
examine/modify med list if possible - long list of meds can cause urinary retention
voiding diary (include ins and outs)
what is the first line medical management of BPH treatment
alpha blockers.
how do alpha blockers work
relax the smooth muscle in the prostate to facilitate urine flow through the prostatic portion of the urethra
what are the main side effects of alpha blockers
dizziness, fatigue
what are the common alpha blockers
terazosin, doxazosin, *tamsulosin, alfuzosin, silodosin
what is the MOA of 5ARI drugs
decreased production of DHT (Dihydrotestosterone) which causes growth of acinar cells. usually used in combo with alpha blockers
what is the use of 5ARI
reduce risk of urinary retenetion and need for future prostate surgery
what are the 5ARI meds
finasteride, dutasteride
what are the sexual side effects of 5ARI meds
reduction in ejaculatory volume, decrease in libido
what type of drug is tadalafil (Cialis)
PDE5i (phosphodiesterase - 5 inhibitors)
what is the standard surgical treatment of BPH
transurethral resection of prostate (TURP)
what is the most common cause of urethritis
n.gonorrheae and c trachomatis
what is the presentation of urethritis
urethral discharge (purulent or mucopurulent), dysuria, pain at meatus
what labs are done with urethritis
urethral swab (or urine testing)
