Benign Prostatic Hypertrophy Flashcards
Benign prostatic hyperplasia (BPH) is a hyperplastic process, meaning what?
there is an increased number of cells
BPH is the most common benign tumor in men and its incidence is age related.
(a) At age 55 years, approximately ___ % of men report obstructive voiding symptoms
(b) At age 75, ___% of men report decrease in the force and caliber of the urinary stream.
a) 25%
b) 50%
Symptoms for BPH can be related either what two responses?
the obstructive component of the prostate
OR
the secondary response of the bladder to the outlet resistance (irritative).
These S/S are attributed to what component or response to BPH?
(a) Hesitancy
(b) Decreased force and caliber of stream
(c) Sensation of incomplete bladder emptying
(d) Double voiding (urinating a second time within 2 hours)
(e) Straining to urinate
(f) Postvoid dribbling(a) Urgency
(b) Frequency
(c) Nocturia
Obstructive
These S/S are attributed to what component or response to BPH?
(a) Urgency
(b) Frequency
(c) Nocturia
Irritative symptoms
What is the most important tool used in the evaluation of patients with BPH.
— Should be calculated for all patients before starting therapy.
American Urological Association (AUA) symptom index
American Urological Association (AUA) symptom index
Answers to seven questions quantitate the severity of obstructive or irritative complaints on a scale of ____-____.
0-5
What physical examp components should you do for suspected BPH?
(a) Digital rectal exam
–Smooth firm elastic enlargement of the prostate
–Induration should alert you to the possibility of cancer
(b) Neurologic exam
(c) Abdominal exam -Assess for a distended bladder
Induration of the prostate durring a DRE should alert you to the possibility of what?
cancer
DDx for BPH
(1) Urethral stricture
(2) Bladder neck contracture
(3) Bladder stones
(4) Prostate cancer
(5) Urinary tract infection
(6) Bladder carcinoma
(7) Neurogenic bladder
Laboratory considerations for BPH
-Urinalysis
(a) To exclude infection or hematuria
-Prostate specific antigen test (PSA)
When is upper tract imaging recommended for suspected BPH?
only in the presence of concomitant urinary tract disease or
complications of BPH
(hematuria, UTI, Chronic kidney disease, history of stone
disease)
Treatment of BPH
–Patients with mild symptoms (AUA scores 0-7)
Watchful waiting waiting only.
-Men with symptomatic disease, progression is not inevitable some men undergo spontaneous improvement or resolution of their symptoms.
Medical Therapy for BPH
–Alpha-blockers
–5-alpha-reductase inhibitors
–Phosphdiesterase-5 inhibitors
What medication
Used in patients with erectile dysfunction with mild or moderate symptoms
– Improve lower urinary tract symptoms
Phosphdiesterase-5 inhibitors
