BPH

Question 1

Enlarged prostate in the absence of ____

Answer 1

Benign Prostatic Hyperplasia

• malignancy

Question 2

Benign Prostatic Hyperplasia

• Growth of prostatic ____ into lumen of urinary tract can impede passage of urine leaving bladder
• Increased ____ tone of prostatic stroma and at _____.

Answer 2

• glandular tissue
• smooth muscle / bladder neck

Question 3

5 Lower Urinary Tract Sxs (LUTS)

Answer 3

SNUWP

• Stream intermittency
• Nocturia
• Urinary hesitancy
• Weak urinary stream
• Post-void dribbling

Question 4

What is the scoring system called?

Answer 4

AUA (American Urological Association) symptom score

Question 5

3 components of the presentation of BPH

Answer 5

• Urinary retention
• recurrent UTIs
• hx of lithiasis (cystolithiasis / other urolithiasis)

Question 6

PE components for eval of BPH

• Do a GU and DRE
• Note what 3 prostatic findings?

Answer 6

• Size
• Consistency
  
  • indurated
  • firm
  • boggy = prostatitis
  • nodular = possible malignancy
• Presence / absence of tenderness

Question 7

2 labs for eval of BPH

Answer 7

• UA
• PSA if indicated (contraversial)

Question 8

What are the 4 urologic tests?

Answer 8

• Uroflow study
• Post-void residual
• Cystoscopy –> “kissing lobes”
• Urodynamic study

(PUUC)

Question 9

Which of the 4 urologic tests?

• Voided volume, peak flow in mL/sec, Mean flow in mL/sec, low flow rate

Answer 9

Uroflow study

Question 10

Which of the 4 urologic tests?

• trabeculation, obstructive prostate encroaching into urinary outlet lumen, “kissing lobes”

Answer 10

Cystoscopy

Question 11

Which of the 4 urologic tests?

• May be indicated if —> low flow, elevated intravesical pressures

Answer 11

Urodynamic study

Question 12

4 main tx options for BPH

Answer 12

• watchful waiting
• lifestyle modification
• medication
• surgery

Question 13

Lifestyle modification / conservative management for BPH

• avoid fluids/diuretics in evening to decrease nocturia
• for LE edema, elevate legs in evenings
• Avoid what foods/drinks?
• _____ to completely empty bladder
• Avoid what 2 meds?
• Caution w/ what med bc it can cause retention?

Answer 13

• caffeine, ETOH, acidic/spicy foods
• double void
• pseudoephedrine / alpha agonists
• anticholinergics

Question 14

What are the 3 meds to tx BPH?

Answer 14

• Phytotherapy
• Alpha-blockers
• 5-alpha-reductase inhibitors (5-ARI)

Question 15

Which med?

• saw palmetto widely used
• may have a therapeutic benefit

Answer 15

phytotherapy

Question 16

Alpha Blockers for tx of BPH

• Block stimulation of ____ of prostatic stroma and bladder neck
• Cause ____ of smooth muscle that restricts the flow of urine
• ____ of these muscle allows for free passage of urine

Answer 16

• alpha 1 receptors
• relaxation
• relaxation

Question 17

What are the names of the two “older” Alpha 1 Blockers?

Answer 17

• Terazosin
• Doxazosin

Question 18

What are the names of the 3 newer Alpha 1 A Blockers which are less likely to cause lightheadedness?

Answer 18

• Tamsulosin
• Silodosin
• Alfuzosin

Question 19

Alpha Blockers

• Alpha 1-A blockers are more specific in targeting the ____ effects while avoiding effects on ___ and ____

Answer 19

• urinary
• blood pressure / nasal passages

Question 20

6 SE of alpha blockers

Answer 20

DANORI

• Dizziness
• Asthenia (abnormal physical weakness or lack of energy)
• Nasal congestions
• Orthostatic hypotension / syncope (rare)
• Retrograde ejaculation
• Intra-operative floppy iris syndrome

Question 21

Don’t start a patient on which med if they have a cataract surgery coming up soon. Pt needs to inform cataract surgeon in advance if he is taking ____.

Answer 21

Alpha Blockers

Question 22

5-Alpha Reductase Inhibitors

• Block conversion of testosterone –> ___
• Lower ___ levels
• Decrease ____ volume
• Increase ____ rates
• Improve ___ scores
• Decrease risk of ___ progression

Answer 22

• DHT
• DHT
• prostatic glandular
• max urinary flow
• AUA sxs
• BPH

Question 23

5-alpha-reductase inhibitors

• “shrinks prostate”
• Can take __ months to see effect (as opposed to weeks for alpha blockers)
• Decreases ___ readings by 50%
• May stop chronic ____ secondary to prostatic varices
• Most beneficial in ____

Answer 23

• 6
• PSA
• hematuria
• larger volume prostates

Question 24

What are the 2 names of the 5-alpha-reductase inhibitors?

Answer 24

• Finasteride
• Dutasteride

Question 25

4 SE of 5-alpha-reductase inhibitors

Answer 25

**GILE** * Gynecomastia * Impotence * Ejaculatory volume lowered * Libido decreased

Question 26

* What 2 types of meds are combined and what are their names? * Which med gives early response?

Answer 26

* Alpha-blocker & 5-ARI * Dutasteride + Tamsulosin (Alpha-blocker gives early response, which can improve compliance while waiting for 5-ARI to take effect)

Question 27

* What is the only drug approved for BPH? * What else does this drug treat besides BPH?

Answer 27

* PDE5-I (Tadalafil) - Cialis * ED

Question 28

**Which surgery for BPH?** * Device heats prostate and causes necrosis * Minimally invasive, outpatient, awake * Catheter like heating device placed \_\_\_\_\_ * Temperature monitoring device placed \_\_\_\_\_ * Prostatic tissue sloughs and passes per urethra when pt voids *(pt will get worse before they get better)*

Answer 28

**Transurethral Microwave Thermotherapy (TUMT)** * transurethrally * transrectally

Question 29

**Which surgery for BPH?** * Cystoscopic incision made at __ o'clock and __ o'clock of the prostatic urethra, from bladder neck to just superior to verumontanum * Smaller _____ prostate * Prostate springs open * Is tissue removed? * Less chance of \_\_\_\_\_

Answer 29

**Transurethral Incision of Prostate (TUIP)** * 5 / 7 * collar type * No * retrograde ejaculation

Question 30

**Which surgery for BPH?** * Permanent implant into prostate * Suture connected by __ anchoring devices * Where are the anchors located? * Permanent suture between the ____ compresses prostatic tissue, widening urethral lumen

Answer 30

**Urolift** * 2 * Outside prostatic capsule & Inside prostate (prostatic urethra) * anchors

Question 31

What surgery is this? What does it accomplish?

Answer 31

Urolift Compress prostatic tissue, widens urethral lumen

Question 32

**Which surgery for BPH?** * Transurethral resectoscope * Under direct visualization, electrocautery energy scoops out "\_\_\_" of prostatic tissue * ___ go into bladder, are evacuated out and sent to pathology

Answer 32

**Transurethral Resection of Prostate (TURP)** * chips * chips

Question 33

Which surgery is **"GOLD STANDARD"** for BPH?

Answer 33

**TURP** | (transurethral resection of prostate)

Question 34

What are the 3 SE / Complications from TURP?

Answer 34

* Retrograde ejaculation * TUR syndrome * Hematuria

Question 35

**What are the 4 sxs of TUR Syndrome?** *(a complication of TURP surgery)*

Answer 35

* Hyponatremia * Mental confusion * Hypertension * Visual changes

Question 36

2 tx for hematuria related to TURP surgery

Answer 36

* continuous bladder irrigation (CBI/CVI) * Transfusion

Question 37

**Which surgery?** * Green light * Can be done on ____ patient

Answer 37

**Photoselective Vaporization of Prostate (PVP)** * anticoagulated

Question 38

**Which surgery?** * Very large prostates (\>80 cc) * TURP would have prolonged operating time on such a large prostate. Risk for TUR syndrome * Open suprapubic midline incision * Prostatic capsule incised * Glandular adenoma is enucleated (removed) * Prostatic capsule is \_\_\_ * Post-op catheter and CBI (continuous bladder irrigation)

Answer 38

**Open Simple Prostatectomy** * closed

Question 39

**Which surgery?** * For large prostates (\>80 g) * Previously could only be done with open surgery * Done transurethrally

Answer 39

Holmium Laser Enucleation of Prostate (HoLEP)