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15 Cards in this Set
- Front
- Back
What causes benign prostatic hyperplasia?
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BPH is a nonmalignant enlargement of the prostate. It is due to excessive cellular growth of both glandular and stromal elements of the prostate. BPH may be related to dihydrotestosterone (DHT) and aging.
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What are the symptoms of BPH?
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The symptoms reflect bladder irritation:
1. urinary frequency 2. urinary urgency 3. dribbling 4. retention |
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What are important conditions to rule out when a man has symptoms of BPH?
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1. prostatitis
2. urethral stricture 3. infection 4. prostate cancer 5. bladder cancer |
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How can I gauge the severity of my patient's BPH?
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1. Use the AUA (American Urologial Association) symptom index.
2. Peak urine flow (normal should be greater than 15 ml/sec) and postvoid residual (normal less than 100mL) are useful to gauge disease severity. 3. Remember, prostate size does not correlate well with symptom severity or degree of obstruction |
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Besides symptoms, are there any other serious problems associated with BPH?
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Longstanding BPH can lead to urinary retention, renal insufficiency, UTI, gross hematuria and bladder stones. If these occur, surgery is generally indicated.
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How do I decide when to treat BPH?
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The patient's perception of symptom severity (AUA Symptom Score) is a major determinant in making treatment decision.
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How do you treat BPH?
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If the AUA score is mild: watchful waiting.
If the AUA score is moderate to severe, you review the risks/benefits of options and proceed per patient preference. 1. watchful waiting 2. medications (alpha-blocker or finasteride) 3. surgery TURP |
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What medications are used to manage BPH?
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2 classes of medication and one herbal remedy improves BPH symptoms
- alpha adrenergic blockers (doxazosin, terazosin, tamsulosin) - finasteride - saw palmetto |
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How do alpha-adrenergic blockers work to combat BPH?
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They block alpha1-adrenergic receptors in the bladder neck and prostate that constrict outflow
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What are side effects of alpha-adrenergic blockers?
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5-10% of patients get orthostatic hypotension and weakness
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How does finateride work to combat BPH?
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It decreases prostatic DHT and shrinks prostate size by about 20%. Over 6-12 months, finasteride reduces urinary retention symptoms and need for surgery.
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What are the side effects of finasteride?
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Decreased libido and impotence in 3-4%, but it has fewer side effects tha alpha blockers
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How well does saw palmetto work?
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It is at least as effective as finasteride in relieving symptoms of prostate obstruction with minimal side effects.
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When should invasive or surgical interventions be considered?
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When medical therapy fails
But risks include impotence, incontinence, blood loss requiring transfusion, and infection. |
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What does TURP stand for?
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transurethral resection of the prostate
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