BPH and ED

Question 1

Sx of storage issues

Answer 1

• urgency
• freq.
• nocturia
• urg incontinence

Question 2

Sx of voiding issues

Answer 2

• hestiancy
• poor flow
• intermmitency
• straining
• terminal dribble

Question 3

post - voiding SX

Answer 3

• dribble

- incomplete emptying

Question 4

etiology of LUTS

Answer 4

multi-factorial, but we’ll concentrate on prostate

Question 5

what are clinical features of BPH (2)

Answer 5

results from outlet obstuction and compensatory chances in detrusotr function

1. voiding Sx
   - due to outflow obs
2. storage Sx
   - due to detrusor overactivity

Question 6

5 possible BPH complication

Answer 6

1. retention
2. incontinence
3. hydronephrosis
4. infection
5. gross hematuria

Question 7

6 parts of BPH work-up

Answer 7

1. Hx and AUA score
2. Phx - DRE
3. urinalysis
4. Cr to assess renal function
5. PSA to rule out malig
6. US for post-void resid

Question 8

mgmt for mild Sx

Answer 8

watchful waiitng

- lifestyle changes

Question 9

medical mgmt (3)

Answer 9

1. a-blockers - -osins
   - relaxes smooth muscle
2. 5-a reducase inhibs
   - blocks conversion to DHT to reverse growth
3. tadalfl

Question 10

when to refer

Answer 10

• baseline abnormalities on tests
• complications of BPH
• not responding to therapy
• pt pref

Question 11

4 additional tests to do

Answer 11

1. uroflowmetry
2. cystoscopy
3. urodynamics
4. URT imaging

Question 12

3 surgical Tx

Answer 12

1. TURP
2. open prostatectomy
3. minimally invasive - laser

Question 13

3 def. indications for surg

Answer 13

1. refractory retention
2. renal insufficiency
3. intolerance/failure of meds

Question 14

def. of ED

Answer 14

can’t get erection for 3 months

Question 15

what is physiology of erection

Answer 15

stim>NO release> cGMP formation> smooth muscle relax> blood into sinusoids

Question 16

3 major risks for ED

Answer 16

1. age
2. chronic disease
   - heart
   - diabetes
   - meds
3. lifstyle
   - SMOKING - impairment of smooth muscle relaxation

Question 17

features of psycho erection

Answer 17

• sudden onset
• complete immediate loss
• AM present
• varies with ciricumstance

Question 18

features of organi

Answer 18

• gradual onset

- etc

Question 19

3 main vascualr causes

Answer 19

1. atherosclerosis - same risk factors
2. venous leaks
3. trauma

Question 20

6 neurogenic causes

Answer 20

1. surgery
2. cord injury
3. MS or demylenating conditions
4. DM
5. mudendal nerve injurt
6. stroke

Question 21

3 hormonal causes

Answer 21

1. hypogonadism
2. thyroid
3. pit.

Question 22

6 types of meds

Answer 22

1. antihypertensives
2. SSRIs
3. hormonal agents
4. protease inhibs
5. cytotoxic
6. H2 agonists

Question 23

5 parts of SHIM

Answer 23

1. confidence
2. firmness
3. freq
4. completion/maintenance
5. satisfaction

Question 24

4 first line therapies

Answer 24

1. lifestye/drug mods
2. psych
3. androgen replacment
4. oral therapy

Question 25

4 types of androgen replacement

Answer 25

1. trandermal pathc 2. IM injections 3. sub-cut implant 4. oral

Question 26

precautions for PDE-5s

Answer 26

- cardiac disease - retinitis pigmentosa - protease inhibs - a-blockers

Question 27

3 second line Tx

Answer 27

1. vacuum 2. muse 3. caverject

Question 28

3rd line

Answer 28

implant