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15 Cards in this Set

  • Front
  • Back
What causes benign prostatic hyperplasia?
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.
What are the symptoms of BPH?
The symptoms reflect bladder irritation:
1. urinary frequency
2. urinary urgency
3. dribbling
4. retention
What are important conditions to rule out when a man has symptoms of BPH?
1. prostatitis
2. urethral stricture
3. infection
4. prostate cancer
5. bladder cancer
How can I gauge the severity of my patient's BPH?
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
Besides symptoms, are there any other serious problems associated with BPH?
Longstanding BPH can lead to urinary retention, renal insufficiency, UTI, gross hematuria and bladder stones. If these occur, surgery is generally indicated.
How do I decide when to treat BPH?
The patient's perception of symptom severity (AUA Symptom Score) is a major determinant in making treatment decision.
How do you treat BPH?
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
What medications are used to manage BPH?
2 classes of medication and one herbal remedy improves BPH symptoms

- alpha adrenergic blockers (doxazosin, terazosin, tamsulosin)
- finasteride
- saw palmetto
How do alpha-adrenergic blockers work to combat BPH?
They block alpha1-adrenergic receptors in the bladder neck and prostate that constrict outflow
What are side effects of alpha-adrenergic blockers?
5-10% of patients get orthostatic hypotension and weakness
How does finateride work to combat BPH?
It decreases prostatic DHT and shrinks prostate size by about 20%. Over 6-12 months, finasteride reduces urinary retention symptoms and need for surgery.
What are the side effects of finasteride?
Decreased libido and impotence in 3-4%, but it has fewer side effects tha alpha blockers
How well does saw palmetto work?
It is at least as effective as finasteride in relieving symptoms of prostate obstruction with minimal side effects.
When should invasive or surgical interventions be considered?
When medical therapy fails

But risks include impotence, incontinence, blood loss requiring transfusion, and infection.
What does TURP stand for?
transurethral resection of the prostate