Flashcards in L66 Deck (22)
TESTQ: What kind of symptoms cause men with BPH to seek treatment?
Irritative > obstructive symptoms
2 risk factors for BPH
Nocturnal emission pre-20 yo
2 medicines to treat BPH
Alpha blockers = terazosin, tamsulosin
5 alpha reductase inhibitors
Mechanism of the alpha blockers
Relax smooth muscle
TESTQ: what hormone/molecules causes prostate enlargement/growth?
DHT = dihydro-testosterone
Mechanism of 5 alpha reductase I
Testosterone + 5 alpha R = DHT
No androgens to maintain prostate
Name the two 5 alpha reductase I
SE 5 alpha R-Is
Takes 6-12 mo to work
Gynecomastia, painful nipples
4 surgical options for BPH
1. Laser - burn off superficial layers, less impotence, SE retrograde ejac
2. Thermotherapy - microwave adenoma (central), capsule protected b/c better BF
3. TUNA - needle lesions to push open
4. Urolift = sutures anchored on outside prostate to hold open
What is stage 1/2 vs 3 vs 4 for prostate cancer? Prognosis?
3 local invasion
4 distant mets
3 + 4 = not curable
What does PSA tell you about cancer?
Screen for tumors too small to be palpated on PE aka earlier stage
Question is - would this have ever really become your issue
Causes of ↑PSA
Cancer 10x BPH
When do you do a PSA?
1/yr AA > 40, men 55-70
Do as pt of dx eval when pt presenting with urinary symptoms/abnormalities
5 treatment options for prostate cancer
1. Remove entire prostate
2. Brachy = radioactive particles, less invasive + incontinence
3. External beam radiation
4. Cryosurg - if fialed brachy/radio, argon gas
5. Hormonal - block testosterone
What is ED? Possible cause?
Consistently can't get a boner
Vs premature ejac - do you ejaculate before you lose your boner?
May be cause by hypo-gonadism
How do testosterone levels effect sexual activity?
Low testosterone doesn't change your ability to get a boner
Changes how often you get one and what you do with it
What pt penis gets hard?
+ Arterial blood
ED medication + mechanism
PDE-5 inhibitors = sildenafil
PDE 5 breaks down cGMP
cGMP is needed to relax arterial SM
Nerve stim -> arginine -> NO -> GC -> ↑cGMP -> SM relax -> vasodilate -> erection
Which pts are CI for PDE 5 I?
Cardiac pts on NITRATES
Net vasodilation - pool blood - ↓return to heart - ↓CO
4 treatments for impotence
1. PDE-5 I
2. + Prostaglandin intra-urethral
DDX for swelling + pain of scrotum
Torsion - acute
Epididymus - few days