Ipapburke Gu Test 2- Bph

Front 1

MC benign tumor in men

Back 1

BPH

Front 2

What are LUTS?

Back 2

lower urinary tract infection

Front 3

Histologically what type of hyperplasia causes BPH?

Back 3

stromaglandular hyperplasia

Front 4

What does BPE stand for?

Back 4

Benign Prostatic Enlargement-- anatomic enlargement of the gland

Front 5

What is BOO?

Back 5

Bladder Outlet Obstruction---compression of the urethra with obstruction of urinary flow

Front 6

What are risk factors for BPH?

Back 6

age over 40, genetic predisposition, racial differences

Front 7

What are the two necessary factors for BPH?

Back 7

aging and dihydrotestosterone

Front 8

What system controls BPH?

Back 8

endocrine control

Front 9

What does microscopic eval in BPH show?

Back 9

a nodular growth pattern consisting of varying amounts if stroma or epithelium

Front 10

What zone does hyperplasis occur in?

Back 10

transitional zone

Front 11

What are the two things that the symptoms of BPH be related to?

Back 11

obstructive component of the prostate or to secondary response to the bladder outlet resistance

Front 12

What two subdivisions are there in the obstructive component of BPH?

Back 12

mechanical obstruction and dynamic obstruction

Front 13

Is there correlation between the prostatic size on DRE and BPH symptoms?

Back 13

poor correlation

Front 14

What is occult or subclinical BPH?

Back 14

patients with BPH with no symptoms/complaints

Front 15

MC obstructive complaints in BPH

Back 15

hesitancy and decreased force of stream and caliber of stream

Front 16

MC Irritative complaints in BPH

Back 16

frequency, urgency, nocturia

Front 17

Onset of obstructive and irritative symptoms in BPH

Back 17

insidious and gradual over years

Front 18

What is the most important tool in BPH evaluation?

Back 18

AUA Symptoms Index questionnaire for BPH

Front 19

What causes the irritative voiding symptoms in BPH?

Back 19

secondary response of the bladder to the increased outlet resistance

Front 20

If the prostate is asymmetrical or indurated on PE, what is necessary?

Back 20

further work up to rule out cancer

Front 21

What is typically found on exam of prostate in BPH?

Back 21

usually smooth, firm, elastic enlargement noted

Front 22

Why is UA done in BPH patient?

Back 22

looking for hematuria and to rule out infection

Front 23

What should be considered if a patient is at risk for bladder cancer?

Back 23

urine cytology

Front 24

When should you do a serum PSA?

Back 24

when starting a pt on 5 Alpha Reductase Inhibitor or when needing to R/O prostate cancer

Front 25

What is the scale for BPH questionnaire?

Back 25

0-35 (higher score= more symptoms)

Front 26

When is upper tract imaging like IVP, CT, renal US done?

Back 26

only in the presence of concomitant UTI or BPH complication (hematuria, UTI, renal insufficiency, PMH of urinary stones)

Front 27

When would you consider uroflow or PVR?

Back 27

score greater than or equal to 8 on AUA

Front 28

Why is abdominal exam on BPH exam?

Back 28

there may be bladder retention that is causing palpable bladder retention

Front 29

When is cytoscopy recommended?

Back 29

when patient has a history of urethritis, prolonged catheterization, trauma, or to rule out strictures

Front 30

How should patients with AUA score 0-7 and mild symptoms be treated?

Back 30

watchful waiting--> may spontaneously resolve--> annual follow up

Front 31

What patients usually start BPH medical treatment?

Back 31

AUA score 8-18 with moderate symptoms

Front 32

If a patient has AUA score of 19-35 with S/S of obstructive uropathy or renal failure, what should be done?

Back 32

ADMIT them

Front 33

What is an absolute surgical indication in BPH?

Back 33

refractory urinary retention, or renal insufficiency, recurrent UTI, recurrent gross hematuria, or bladder stones

Front 34

Most widely used meds for BPH

Back 34

Alpha blockers

Front 35

What are the alpha 1 receptor specific drugs for BPH?

Back 35

Tamsulosin (Flomax) and Alfuzosin (Uroxatral)

Front 36

What is the MOA for 5 alpha reductase inhibitors?

Back 36

block conversion of testosterone to dihydrotestosterone

Front 37

What patients will benefit most from 5 alpha reductase inhibitors?

Back 37

patients with larger prostate (greater than 40 cc)

Front 38

What is the minimum tx time for patient on 5 Alpha reductase inhibitor?

Back 38

minimum for 6 mths and reeval

Front 39

What are the 5 alpha reductase inhibitors used for BPH? ?

Back 39

Proscar and Avodart

Front 40

What drugs are used in combo for BPH?

Back 40

alpha blocker and 5 alpha reductase inhibitor

Front 41

OTC treatments for BPH

Back 41

saw palmetto, African plum, rye pollen, pumpkin seeds, South African saw grass

Front 42

What is the gold standard in surgical therapy for BPH?

Back 42

Transurethral resection of the prostate (TURP)

Front 43

Where is the focus of TURP?

Back 43

transitional zone

Front 44

What are the two outpatient therapies that can be done for BPH?

Back 44

Transurethral Needle Ablation (TUNA) and Transurethral Microwave Thermotherapy (TUMT)

Front 45

How long can irritative voiding last after TUNA or TUMT?

Back 45

several weeks

Front 46

Describe TUNA (outpatient procedure)

Back 46

radiofrequency waves heat prostate and create thermal necrosis

Front 47

What is the basic goal of Transurethral Incision of the Prostate?

Back 47

remove just a minimum amount of probate tissue to allow adequate flow through the prostate (done by making a simple cut or incision along the entire length of the prostate)

Front 48

What may have to be the follow up to a TUIP a few years following?

Back 48

an additional or a TURP

Front 49

When is an open simple prostatectomy done?

Back 49

when the prostate is too large to remove endoscopically (done with suprapubic or retropubic approach)