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26 Cards in this Set
- Front
- Back
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What is the prevalence of BPH
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ALL men, just not all are symptomatic
prevalence of symptomatic BPH increases with age |
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What is the most common symptom of BPH
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frequency
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What are the symptoms of BPH
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nocturia
hesitancy urgency weak strain frequency stop/start incomplete emptying |
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Are the symptoms of BPH specific for the diagnosis?
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no
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How are symptoms related to the size of the prostate?
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they are NOT
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What is used to determine whether BPH related urinary symptoms in men need to be managed
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American Urological Association Urinary Symptom Score
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What is the treatment cut off for AUA Symptom scale?
What do you do if below the threshold? |
>/= 8 - manage
</= 7 - watchful waiting |
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What is the most common of the differentials for BPH
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urethral stricture - fairly common
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What are the DD for BPH
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urethral strictures
bladder neck contrx carcinoma of bladder or prostate bladder calculi neurogenic bladder UTI prostatitis |
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Who gets referred for BPH symptoms
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<50
h/o pelvic surgery / radiation neuro disease / injury / meds that affect function of bladder lower abd pain as main symp discrepancy btw symptoms and findings diabetics who may have neuropathy hematuria rapidly developing symptoms suspicious/abnormal DRE PSA > 10 (>3 if over 65yo) |
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When is PSA of concern
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<65 yo - >3mcg
>65 yo - >10mcg |
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When do you measure the Free: Total PSA ratio
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between 3-10mcg
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At what PSA Free:Total ratio is there suspicion for prostate cancer
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<0.15 - increased probability of cancer
<0.07 - basically assume cancer |
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When is it appropriate to watch and wait
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early identified condition
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What are the treatment options for BPH
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1. watchful waiting
2. medication 3. TUNA 4. outpt treatments: microwaves, stents, lasers 5. TURP (Open not done) |
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What are the medication options for BPH
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1. a-blockers
2. 5a-reductase inhibitors |
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What is the best med regimen for BPH
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COMBO of a-blker and 5a-reductase inhib
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What a-blockers do for BPH
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cause smooth muscle relaxation in prostate and bladder neck
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What 5a-reductast inhibitors do in BPH
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manipulate androgens
shrink prostate |
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What medication would you use if the prostate was not markedly enlarged (on DRE or US) and the PSA is less than 1.5
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a-blocker
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What are the minimally invasive treatment options for BPH
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TUNA
microwaves lasers stents |
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For which patients would you use TUNA?
Why? What is the downside? |
sicker, older, anticoagulated pt
only local sedation, not invasive, less bleeding risk less efficacious |
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What class of med is Flomax
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a-blocker
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What does TUNA stand for
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Transurethral Noninvasive Ablation
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What does TURP stand for
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Transurethral Resection of the Prostate
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Why use TURP
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gold standard
local anesthesia only 2-3 days inpt very good outcomes: more cost-effective and efficacious than medications |
