Renal Module - Bph And Ui

Front 1

In order, what are the top 3 prostatatic problems?

Back 1

1) benign prostate hypertrophy
2) prostate cancer
3) prostatitits

Front 2

What area of the prostate is BPH most commonly found?

Back 2

transition zone and periuretral zone

Front 3

What region of the prostate is prostate cancer most likely to be found?

Back 3

peripheral zone

Front 4

How does benign prostate hyperplasia usually present itself (7)

Back 4

1) lower urinary tract symptoms (LUTS)
2) urinary retention
3) utrinary tract infection
4) urinary incontinence
5) gross hematuria
6) bladder stones
7) renal insufficiency

Front 5

What are LUTS (lower urinary tract symptoms)?

Back 5

lower urinary tract symptoms attributable to voiding disturbances:
1) voiding (obstructive) Sx
2) storage (irritative) Sx

Front 6

70%-80% men undergoing prostatectomy for benign prostate hypertrophy develop this....

Back 6

retrograde ejaculation

Front 7

What are the 7 elements of the American Urologists Association (AUA) Symptom Index?

Back 7

1) Frequency
2) Hesitancy
3) Intermittency
4) Urgency
5) Nocturia
6) Incomplete Voidings
7) Weak Stream

(Frequent Hesitation during Intermittent Urgency Nocturia IncompleteVoiding is WeakStream.)

Front 8

Which medications would be used for immediate treatment for BPH symptoms?

Back 8

alpha1 adrenergic receptor antagonists:
terazosin (non-specific)
doxazosin (non-specific)
tamsulosin (specific)
alfuzosin (specific)

Front 9

Which medications should be used for long-term maintenence of BPH?

Back 9

5-alpha-reductase inhibitors

finasteride
dutasteride

Front 10

What drug class do terazosin and doxazosin belong to?

Back 10

non-selective alpha1 adrenergic receptor blockers

Front 11

What class of drugs do tamsulosin and alfuzosin belong to?

Back 11

specific alpha1a adrenergic reeptors

Front 12

What class of drugs do finasteride and dutasteride belong to?

Back 12

5-alpha-reductase inhibitors (induces apoptosis)

Front 13

Where are alpha1 receptors located in the lower urinary tract?

Back 13

1) trigone of bladder (a1d)
2) neck of the bladder (a1d)
3) urethra (a1d)
4) smooth muscle cells of prostate gland (a1a)

Front 14

What are indications for prostate surgery in a BPH patient?

Back 14

1) refractory urinary retention
2) recurrent UTI's
3) recurrent gross hematuria
4) renal insufficiency
5) bladder stones
6) large bladder diverticula due to BOO (bladder outlet obstruction)

Front 15

What are the 2 components to BOO (bladder outlet obstruction?)

Back 15

1) Dynamic or physiologic (increased tone due to stimulation of alpha 1 adrenergic receptors)

2)Fixed or structural component (enlarged prostate and its effect on the bladder neck and prostatic urethra)

Front 16

What are the therapeutic options for BPH?

Back 16

1) Watchful waiting
2) Medical Therapy (alpha1 adrenergic antagonists, 5-alpha reductase inhibitors or combined)
3) minimally invasive therapies (TUNA, TUMT)
4) surgical therapies (TURP, Laser, open prostatectomy)
5) emerging therapies

Front 17

How are alpha-1a and alpha-1d receptors distributed in the lower urinary tract?

Back 17

1) alpha-1d in the bladder and bladder neck
2) alpha-1a in the prostate

Front 18

What is the most significant side effect of terazosin or doxazosin on BPH patients?

Back 18

hypotension

Front 19

What is the reationale for treatment of BPH patients with 5-alpha reductase inhibitors?

Back 19

Block the catalytic activity of 5-alpha reductase in conversion of testosterone to dihyrotestosterone (DHT), a compound which increases prostate size. Requires treatment for at least 6 mos. before improvement of Sx.

Front 20

What is the generic name for PROSCAR?

Back 20

finasteride

Front 21

What are the main side effects of 5-alpha reductase inhibitors?

Back 21

1) decreased libido
2) erectile dysfunction

Front 22

What has been the primary treatment for BPH and BOO patients?

Back 22

Transurethral Resection Prostate (TURP)

Front 23

What forms the border between the upper and lower urinary tracts?

Back 23

uretal vesicle junction

Front 24

How is the lower urinary tract of men different from women?

Back 24

1) longer urethra
2) presence of prostate gland

Front 25

What muscles are involved in control of micturation? What nerves innervate them?

Back 25

1) detrusor m. (bladder)
- sympathetic (hypopgastric n.= T10-S2, alpha1)
- parasympathetic (pudendal n.=S1-S3, muscarinic M2,M3)

2) pelvic floor m. (levator ani)/external urinary sphincter m.'s
- pudendal nerve (S2,3,4 nAchR)

Front 26

What nerves provide sympathetic innervation to the bladder smooth muscle?

Back 26

hypogastric nerves (T10-L2)

Front 27

What nerves provide parasympathetic innervation to the bladder smooth muscle?

Back 27

pelvic nerves (S2,3,4)

Front 28

Which branch of the autonomic nervous system leads to voiding of the bladder?

Back 28

parasympathetic :
- pelvic nerves (S1,2,3)
- m2,m3 cholinergic receptors

Front 29

Which branch of the nervous system helps to maintain storage of urine in the bladder?

Back 29

sympathetic
- hypogastric nerves (T10-S2)
- alpha1: incr. outlet tone
- beta2: bladder detrusor muscle relaxation

Front 30

Are men more prone to urinary incontinence or urinary retention and why?

Back 30

urinary retention, as due to anatomical differences (e.g. longer urethra, prostate) men experience greater outlet resistance.

Front 31

What are the distribution and results of activating the following receptors in the lower urinary system:
a) m3
b) m2
c) B2
d) a1
e) nAchR

Back 31

a) m3 - detrusor SMC contraction

b) m2 - inhibit sympathetically mediated detrusor muscle relaxation (for release)

c) B2 - relaxation of detrusor muscle (for storage)

d) a1 - contraction of bladder trigone, neck and urethra

d) nAchR - contract pelvic floor muscles (levator ani, external urethral sphincter)

Front 32

What are the 4 types of voiding dysfunctions?

Back 32

1) Urge Incontinence

2) Stress (Exercise-Related) Incontinence

3) Bladder Outlet Obstruction Retention (anatomic/fixed and/or physiologic/increased alpha tone)

4) Failure of Bladder to Contract leading to urinary retention (could be neurologic- check rectal tone: S2,S3,S4)

Front 33

Name differential diagnoses for urgency?

Back 33

1) bladder stones
2) bladder tumors
3) foreign objects
4) UTI
5) suburethral diverticulum with stone

stimulate receptors in bladder wall and cause reflexive involuntary detrusor contraction and urine loss.

Front 34

What are 3 signs of an overactive bladder (OAB)?

Back 34

1) urinary urgency
2) urinary incontinence
3) urinary frequency

Front 35

What are the 2 different types of OAB and which is the more common of the two?

Back 35

1) wet OAB- w/leakage
2) dry OAB- w/o leakage, more common (2/3 of OAB patients)

Front 36

What are urodynamics?

Back 36

invasive measurement of bladder pressure and urinary sphincter activity during the micturition cycle

Front 37

What are the 4 different subtype classifications of urinary incontinence and what causes them?

Back 37

1) urge incontinence - increased bladder pressure

2) stress incontinence - decreased outlet resistance

3) mixed incontinence - urge and stress

4) overflow incontinence - elevated outlet resistance

Front 38

How can an overactive bladder (OAB) be controlled?

Back 38

1) behavioral
- pelvic muscle rehab (biofeedback, electrical stim)
- bladder training

2) pharmacological

- anticholinergics, antimuscarinics (oxybutynin chloride, tolterodine tartrate-less side effects)

- Antispasmodics (dicyclomine HCl/ocybutynin chloride)

- tricylic antidepressants (imipramine, doxepine, desipramine, nortriptyline)

Front 39

If a voiding dysfunction is suspected, what tests might be performed to further diagnose the patient?

Back 39

1) post void residual
2) urinalysis
3) urodynamics
4) cystoscopy

- history
- medical and neurological Hx
- meds
- physical and pelvic exam