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Flashcards in BPH Deck (17)
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1

BPH symptoms

Irritative --> frequency, urgency, nocturia
Obstructive --> hesitancy, dribbling, fullness
Complications --> CKD, hematuria, UTI, etc

2

Anatomy

Transitional zone
Epithelial = grows by androgens
Stromal = smooth muscle contracts with alpha receptors

3

Physiology

Test/Androstenedione --> DHT via 5 alpha reductase
5alpha reductase II --> increased prostate growth
Normal stromal:epithelial 2:1. BPH 5:1

4

Static vs Dynamic

Static = 5AR, Androgens, Epithelial growth
Dynamic = A1, SM contraction, Urine obstruction

5

Medications causing BPH

Anticholinergics
TCA
Phenothiazines

6

Static medication & MOA

Finasteride --> 5 alpha reductase inhibitor

7

Finasteride ADE

ED, libido, ejaculatory dysfxn, gynecomastia
PSA decreases by 50%

8

Finasteride pro/con

Pro: good for enlarged >40g, delays progression
Con: takes 3-6 months

9

Dynamic medication & MOA

A1A blockers:
Doxazosin, Tansulosin, Alfuzosin, (Tadalafil)

10

A1A blocker ADE

1. Doxazosin: syncope, hypotension, dizzy
2. Tamsulosin: NO CV ADE
3. Alfuzosin: FEWER CV ADE
All: Floppy iris syndrome

11

A1A monitoring

BP & HR

12

A1A pros

Onset at 1-6 weeks
Decreases voiding symptoms
Good for interm measure

13

Symptomatic relief (Meds & MOA)

Oxybutynin & Mirabegron --> relax detrusor muscle
Oxybutynin: Anticholinergic
Mirabegron: B adrenergic agonist

14

Oxybutynin monitoring/ADE

1. Mental status
2. Bowel habits
3. Ability to urinate
ADE: Tachycardia & ED

15

Mirabegron monitoring/ADE

1. BP
2. Bowel habits
ADE: HTN, decreased cognition

16

Surgical indications

Severe, no response from meds, complications of BPH

17

Surgical options

1. TURP: can do bx
2. Greet light: CANT do bx