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49 Cards in this Set
- Front
- Back
MC benign tumor in men
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BPH
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What are LUTS?
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lower urinary tract infection
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Histologically what type of hyperplasia causes BPH?
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stromaglandular hyperplasia
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What does BPE stand for?
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Benign Prostatic Enlargement-- anatomic enlargement of the gland
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What is BOO?
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Bladder Outlet Obstruction---compression of the urethra with obstruction of urinary flow
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What are risk factors for BPH?
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age over 40, genetic predisposition, racial differences
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What are the two necessary factors for BPH?
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aging and dihydrotestosterone
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What system controls BPH?
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endocrine control
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What does microscopic eval in BPH show?
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a nodular growth pattern consisting of varying amounts if stroma or epithelium
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What zone does hyperplasis occur in?
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transitional zone
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What are the two things that the symptoms of BPH be related to?
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obstructive component of the prostate or to secondary response to the bladder outlet resistance
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What two subdivisions are there in the obstructive component of BPH?
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mechanical obstruction and dynamic obstruction
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Is there correlation between the prostatic size on DRE and BPH symptoms?
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poor correlation
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What is occult or subclinical BPH?
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patients with BPH with no symptoms/complaints
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MC obstructive complaints in BPH
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hesitancy and decreased force of stream and caliber of stream
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MC Irritative complaints in BPH
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frequency, urgency, nocturia
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Onset of obstructive and irritative symptoms in BPH
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insidious and gradual over years
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What is the most important tool in BPH evaluation?
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AUA Symptoms Index questionnaire for BPH
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What causes the irritative voiding symptoms in BPH?
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secondary response of the bladder to the increased outlet resistance
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If the prostate is asymmetrical or indurated on PE, what is necessary?
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further work up to rule out cancer
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What is typically found on exam of prostate in BPH?
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usually smooth, firm, elastic enlargement noted
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Why is UA done in BPH patient?
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looking for hematuria and to rule out infection
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What should be considered if a patient is at risk for bladder cancer?
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urine cytology
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When should you do a serum PSA?
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when starting a pt on 5 Alpha Reductase Inhibitor or when needing to R/O prostate cancer
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What is the scale for BPH questionnaire?
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0-35 (higher score= more symptoms)
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When is upper tract imaging like IVP, CT, renal US done?
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only in the presence of concomitant UTI or BPH complication (hematuria, UTI, renal insufficiency, PMH of urinary stones)
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When would you consider uroflow or PVR?
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score greater than or equal to 8 on AUA
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Why is abdominal exam on BPH exam?
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there may be bladder retention that is causing palpable bladder retention
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When is cytoscopy recommended?
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when patient has a history of urethritis, prolonged catheterization, trauma, or to rule out strictures
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How should patients with AUA score 0-7 and mild symptoms be treated?
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watchful waiting--> may spontaneously resolve--> annual follow up
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What patients usually start BPH medical treatment?
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AUA score 8-18 with moderate symptoms
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If a patient has AUA score of 19-35 with S/S of obstructive uropathy or renal failure, what should be done?
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ADMIT them
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What is an absolute surgical indication in BPH?
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refractory urinary retention, or renal insufficiency, recurrent UTI, recurrent gross hematuria, or bladder stones
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Most widely used meds for BPH
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Alpha blockers
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What are the alpha 1 receptor specific drugs for BPH?
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Tamsulosin (Flomax) and Alfuzosin (Uroxatral)
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What is the MOA for 5 alpha reductase inhibitors?
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block conversion of testosterone to dihydrotestosterone
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What patients will benefit most from 5 alpha reductase inhibitors?
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patients with larger prostate (greater than 40 cc)
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What is the minimum tx time for patient on 5 Alpha reductase inhibitor?
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minimum for 6 mths and reeval
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What are the 5 alpha reductase inhibitors used for BPH? ?
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Proscar and Avodart
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What drugs are used in combo for BPH?
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alpha blocker and 5 alpha reductase inhibitor
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OTC treatments for BPH
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saw palmetto, African plum, rye pollen, pumpkin seeds, South African saw grass
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What is the gold standard in surgical therapy for BPH?
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Transurethral resection of the prostate (TURP)
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Where is the focus of TURP?
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transitional zone
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What are the two outpatient therapies that can be done for BPH?
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Transurethral Needle Ablation (TUNA) and Transurethral Microwave Thermotherapy (TUMT)
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How long can irritative voiding last after TUNA or TUMT?
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several weeks
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Describe TUNA (outpatient procedure)
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radiofrequency waves heat prostate and create thermal necrosis
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What is the basic goal of Transurethral Incision of the Prostate?
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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)
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What may have to be the follow up to a TUIP a few years following?
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an additional or a TURP
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When is an open simple prostatectomy done?
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when the prostate is too large to remove endoscopically (done with suprapubic or retropubic approach)
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