Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
In order, what are the top 3 prostatatic problems?
|
1) benign prostate hypertrophy
2) prostate cancer 3) prostatitits |
|
What area of the prostate is BPH most commonly found?
|
transition zone and periuretral zone
|
|
What region of the prostate is prostate cancer most likely to be found?
|
peripheral zone
|
|
How does benign prostate hyperplasia usually present itself (7)
|
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 |
|
What are LUTS (lower urinary tract symptoms)?
|
lower urinary tract symptoms attributable to voiding disturbances:
1) voiding (obstructive) Sx 2) storage (irritative) Sx |
|
70%-80% men undergoing prostatectomy for benign prostate hypertrophy develop this....
|
retrograde ejaculation
|
|
What are the 7 elements of the American Urologists Association (AUA) Symptom Index?
|
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.) |
|
Which medications would be used for immediate treatment for BPH symptoms?
|
alpha1 adrenergic receptor antagonists:
terazosin (non-specific) doxazosin (non-specific) tamsulosin (specific) alfuzosin (specific) |
|
Which medications should be used for long-term maintenence of BPH?
|
5-alpha-reductase inhibitors
finasteride dutasteride |
|
What drug class do terazosin and doxazosin belong to?
|
non-selective alpha1 adrenergic receptor blockers
|
|
What class of drugs do tamsulosin and alfuzosin belong to?
|
specific alpha1a adrenergic reeptors
|
|
What class of drugs do finasteride and dutasteride belong to?
|
5-alpha-reductase inhibitors (induces apoptosis)
|
|
Where are alpha1 receptors located in the lower urinary tract?
|
1) trigone of bladder (a1d)
2) neck of the bladder (a1d) 3) urethra (a1d) 4) smooth muscle cells of prostate gland (a1a) |
|
What are indications for prostate surgery in a BPH patient?
|
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) |
|
What are the 2 components to BOO (bladder outlet obstruction?)
|
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) |
|
What are the therapeutic options for BPH?
|
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 |
|
How are alpha-1a and alpha-1d receptors distributed in the lower urinary tract?
|
1) alpha-1d in the bladder and bladder neck
2) alpha-1a in the prostate |
|
What is the most significant side effect of terazosin or doxazosin on BPH patients?
|
hypotension
|
|
What is the reationale for treatment of BPH patients with 5-alpha reductase inhibitors?
|
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.
|
|
What is the generic name for PROSCAR?
|
finasteride
|
|
What are the main side effects of 5-alpha reductase inhibitors?
|
1) decreased libido
2) erectile dysfunction |
|
What has been the primary treatment for BPH and BOO patients?
|
Transurethral Resection Prostate (TURP)
|
|
What forms the border between the upper and lower urinary tracts?
|
uretal vesicle junction
|
|
How is the lower urinary tract of men different from women?
|
1) longer urethra
2) presence of prostate gland |
|
What muscles are involved in control of micturation? What nerves innervate them?
|
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) |
|
What nerves provide sympathetic innervation to the bladder smooth muscle?
|
hypogastric nerves (T10-L2)
|
|
What nerves provide parasympathetic innervation to the bladder smooth muscle?
|
pelvic nerves (S2,3,4)
|
|
Which branch of the autonomic nervous system leads to voiding of the bladder?
|
parasympathetic :
- pelvic nerves (S1,2,3) - m2,m3 cholinergic receptors |
|
Which branch of the nervous system helps to maintain storage of urine in the bladder?
|
sympathetic
- hypogastric nerves (T10-S2) - alpha1: incr. outlet tone - beta2: bladder detrusor muscle relaxation |
|
Are men more prone to urinary incontinence or urinary retention and why?
|
urinary retention, as due to anatomical differences (e.g. longer urethra, prostate) men experience greater outlet resistance.
|
|
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 |
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) |
|
What are the 4 types of voiding dysfunctions?
|
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) |
|
Name differential diagnoses for urgency?
|
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. |
|
What are 3 signs of an overactive bladder (OAB)?
|
1) urinary urgency
2) urinary incontinence 3) urinary frequency |
|
What are the 2 different types of OAB and which is the more common of the two?
|
1) wet OAB- w/leakage
2) dry OAB- w/o leakage, more common (2/3 of OAB patients) |
|
What are urodynamics?
|
invasive measurement of bladder pressure and urinary sphincter activity during the micturition cycle
|
|
What are the 4 different subtype classifications of urinary incontinence and what causes them?
|
1) urge incontinence - increased bladder pressure
2) stress incontinence - decreased outlet resistance 3) mixed incontinence - urge and stress 4) overflow incontinence - elevated outlet resistance |
|
How can an overactive bladder (OAB) be controlled?
|
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) |
|
If a voiding dysfunction is suspected, what tests might be performed to further diagnose the patient?
|
1) post void residual
2) urinalysis 3) urodynamics 4) cystoscopy - history - medical and neurological Hx - meds - physical and pelvic exam |