Mcphs Benign Prostatic Hyperplasia

Front 1

This is a proliferation of epithelial and/or stromal cells of the prostate.

Back 1

Benign Prostatic Hyperplasia

Front 2

What two zones of the prostate does BPH usually develop?

Back 2

Periurethral and Transitional Zones

Front 3

This is the most common benign tumor in men.

Back 3

BPH

Front 4

BPH prevalence increases with what?

Back 4

Age

Front 5

What are the two things that contribute to the pathogenesis of BPH?

Back 5

Age and Genetics

Front 6

How does age contribute to BPH?

Back 6

May inhibit apoptosis

Increase in estrogen/androgen ratio

Front 7

How does genetics contribute to BPH?

Back 7

Possible autosomal dominant transmission

Front 8

What are the five obstructive clinical presentations associated with BPH?

Back 8

1. Straining to urinate
2. Hesitancy
3. Decreased flow rate
4. Postvoid dribbling
5. Sensation of incomplete bladder emptying

Front 9

What are the four irritative clnical presentations associated with BPH?

Back 9

1. Urgency
2. Frequency
3. Nocturia
4. Double voiding

Front 10

What can actually occur with BPH that can become an emergency in men?

Back 10

Acute urine retention

Front 11

History taking for BPH:

What do you look for in the chief complaint with BPH?

Back 11

Progressive vs. acute urinary retention

Front 12

History taking for BPH:

What do you look for in the PMH/PSH in BPH?

Back 12

DM
Neurologic Conditions
Neurogenic bladder
CVA
Parkinsons
Prior urologic instrumentation
UTIs

Front 13

History taking for BPH:

What medications do you look for in the history?

Back 13

Alpha adrenergic agonists

Anticholinergics

Front 14

History taking for BPH:

What do you look for in the social history?

Back 14

Alcohol/Tobacco

Front 15

History taking for BPH:

What do you look for in the ROS?

Back 15

Fever/chills
Nausea/vomiting
Weight loss
Night sweats
Suprapubic pain
Low back pain
Hematuria

Front 16

What are the things that the American Urological Association International Symptom Prostate Score use to rate BPH?

Back 16

Incomplete bladder emptying
Frequency
Intermittency (hesitency)
Urgency
Weak Urinary Stream
Straining
Nocturia

Front 17

AUA symptom score for BPH:

0-7 ?
8-19 ?
20-35 ?

Back 17

0-7 Mild

8-19 Moderate

20-35 Severe

Front 18

Response to Tx for BPH

5 point reduction ?
>5-10 reduction ?
>10 point reduction ?

Back 18

5 point reduction = modest relief

>5-10 point reduction = moderate relief

>10 point reduction = large relief

Front 19

Physical examination for BPH:

What three things are included in the physical exam for BPH?

Back 19

Abdominal examination:
Bladder Palpation

Prostate/DRE (digital rectal exam):
Prostate size and consistency
Nodules, tenderness, induration, asymmetric enlargement

Neurological examination:
Sphincter tone

Front 20

What are the five diagnostic studies used to diagnose BPH?

Back 20

Urinalysis:
Hematuria, pyuria, bacteriuria, glucose

Serum Creatinine:
Assess renal function

Serum Prostate Specific Antigen (PSA):
Free PSA

Post Void Residual Volume

Urine Flow Study

Front 21

What are the readings for a PSA in caucasians?

Age:
0-49 ?
50-59 ?
60-69 ?
70-79 ?

Back 21

0-49 = 0-2.5
50-59 = 0-3.5
60-69 = 0-4.5
70-79 = 0-6.5

Front 22

What are the readings for a PSA in African Americans?

Age:
0-49 ?
50-59 ?
60-69 ?
70-79 ?

Back 22

0-49 = 0-2.0
50-59 = 0-4.0
60-69 = 0-4.5
70-79 = 0-5.5

Front 23

This alone does not necessitate medical Tx in BPH.

Back 23

Enlarged prostate

Front 24

What four factors do you consider when you are deciding to treat BPH medically?

Back 24

Severity of symptoms

Will Tx cause noticeable relief of symptoms

How long will effects of Tx last

Do the benefits of Tx outweigh the risks of complications of Tx

Front 25

What are the four management options for BPH?

Back 25

Watchful waiting

Pharmacologic management

Minimally invasive procedures

Invasive procedures (surgery)

Front 26

Periodic evaluation for symptom progression or complications without medical or surgical intervention in BPH?

Back 26

Watchful Waiting Option

Front 27

What are two situations in which men are well suited for the watchful waiting option?

Back 27

Appropriate for men who are not experiencing any symptoms

Also appropriate for men with mild symptoms and may not want Tx: 0-7 AUA symptomatic score

Front 28

What is the goal of pharmacotherapy in BPH?

Back 28

Relax the smooth muscle in the stromal cells.

Front 29

What are the three main pharmacologic TXs for BPH?

Back 29

Alpha blockers
5-Alpha Reductase Inhibitors
Alternative/Complimentary medicine

Front 30

These drugs relax smooth muscle of the prostate and bladder neck.

Back 30

Alpha blockers

Front 31

What drugs can be used to treat both BPH and hypertension?

Back 31

Long acting alpha 1 blockers

Front 32

What are the three long acting alpha 1 blockers?

Back 32

Doxazosin
Terazosin

Front 33

What are the side effects of long acting alpha 1 blockers?

Back 33

orthostatic hypotension, dizziness

Front 34

What are the long acting alpha 1a blockers?

Back 34

Tamsulosin (flomax)
Alfuzosin (Uroxatrel)

Front 35

These block the conversion of testosterone to DHT

Decrease volume of the prostate - epithelial component

May reduce PSA level by half

Back 35

5-Alpha-Reductase Inhibitors

Front 36

What are the two 5-Alpha-Reductase Inhibitors?

Back 36

Finasteride (Proscar)
Dutasteride (Avodart)

Front 37

What are the side effects of 5-Alpha-Reductase Inhibitors?

Back 37

Decrease libido, decrease volume of ejaculate, erectile dysfunction

Front 38

What are the plant based or herbal supplements used to treat BPH?

Back 38

Saw Palmetto

Pygeum Africanum

Neither are FDA approved

Front 39

What are the seven minimally invasive procedures to Tx BPH?

Back 39

Catheterization
Stenting
Laser Therapy
High Intensity Focused Ultrasound (HIFU)
Transurethral electroevaporation of the prostate
(TUVP or TVP)
Transurethral microwave thermotherapy of the prostate (TUMT)
Transurethral radio frequency needle ablation of the prostate (TUNA)

Front 40

What are the six signs that surgery (invasive procedures) may be needed for BPH?

Back 40

Medical therapy fails
Evidence of kidney failure
Urinary retention
Recurrent urinary tract infections
Recurrent or persistent urethral bleeding
Bladder stones

Front 41

What are the three invasive procedures for BPH?

Back 41

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP)

Open Prostatectomy

Front 42

This is the most common surgical procedure for BPH. It is the removal of the inner portion of the prostate.

Back 42

Transurethral resection of the prostate (TURP)

Front 43

This procedure widens the urethra with several small cuts in the bladder neck.

Back 43

Transurethral incision of the prostate (TUIP)

Front 44

This is performed when transurethral procedures can not be performed, or when the prostate is too large to be removed through the penis.

Back 44

Open Prostatectomy

Front 45

What are the sexual functions after BPH surgery?

Back 45

1. Erections - surgery rarely causes loss of erection. Surgery can not restore prior loss of function.

2. Retrograde Ejaculation - As high as 75% with TURP

3. Orgasm - usually no change