Benign Prostatic Hyperplasia

mbch4kz2's version from 2016-04-16 12:10


Question Answer
Occlusion of the urethra by BPH occurs through what 2 mechanisms?1. An increase in benign prostatic tissue 2. An increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors
Name 5 symptoms of BPHFrequency, urgency, nocturia, weak stream, hesitancy, intermittency, straining, imcomplete emptying, post-void dribbling
What tests would you order?Urinalysis (pus would suggest UTI), PSA, Volume charing, US, CT, Cytoscopy, Uroflowmetry
How would you differentiate from prostatisis?Presence of fever, suprapubic or lower back pain, tender prostate. Elevated white count, abnormal urinary sediment, possible elevation of PSA
How would you differentiate from prostate cancer?Abnormal DRE with prostate nodules, elevated PSA for age, low free PSA
How would you differentiate from bladder cancer?Haematuria, suprapubic pain, blader spasms, historory of tobacco use, abnormal findings on cystoscopy
How would you tray a patient with an IPSS 0-7 with significant bother?1. Alpha blockers, PDE-5 inh, NSAIDs
How would you treat moderate and severe (IPSS 8-35)1. Alpha blocker, PDE-5, NSAID
If prostate is >80g how would you treat?Open prostatectomy
If prostate <80gTURP or TUVP
What are behavioural management programmes?Decrease symptoms and improve QOL- libation of fluids, bladder training on times and complete voiding, treatment of constipation
Name 2 long acting alpha-1 blockers?Terazosin and doxasin
Why are these titrated when beginningTo avoid first-dose hypotension and syncopeTumulosin and solodosin (both are psotate selective with minimal vascular effects in patients at risk for orthostasis)
Name 2 modified release alpha-blockers (selective)Tamulosin and solidosin (prostate selective with minimal vascular effects in patients at risk of hypotension)
Name a common side effect with modified a-blockersEjeculatory dysfunction (more common in silodosin)
What question should always be asked when putting a patient on prostate therapies?Floppy iris syndromes- patients should be questioned about any eye surgery prior to initiating therapy
Name 3 PDE-5 inhibitorsSildenafil ,Tadalafil, Vardenafil
Name 2 NSAIDs used in prostate treatmentCelecoxib and Tenoxicam