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Flashcards in Prostate Disorders Deck (58)
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1

Disorder of the Prostate

Benign prostatic hyperplasia (BPH)
Acute bacterial prostatitis
Chronic bacterial prostatitis
Non-bacterial prostatitis
Prostadynia

2

Define Benign Prostatic Hyperplasia

Most common benign tumor

3

Risk Factors for BPH

Poorly understood
Maybe some genetic predisposition
maybe some racial factors

4

Pathophysiology of Benign Prostatic Hyperplasia

Growth begins in periurethral glandular tissue
Surgical capsule forms around adenomatous hyperplasia
Increased resistance to urine flow
Bladder hypertrophy
Increased risk of infection
Highly vascular & predisposed to bleeding
Painless hematuria

5

Clinical Presentation of Benign Prostatic Hyperplasia

Hesitancy
Weak stream
Decrease caliber of stream
Incomplete bladder emptying
Straining
Post void dribble
Frequency
Nocturia
Urgency

6

Diagnosis of BPH

Almost entirely on history

7

Physical Exam of BPH

Good physical exam
DRE
Neurological exam
Labs

8

DRE For BPH

Size & consistency should be noted
Consistency: smooth, firm, elastic enlargement
Induration: possibility of cancer

9

Neurological Exam for BPH

Sphincter tone
Reflexes

10

Labs for BPH

UA
Creatinine
PSA (+/-)

11

Imaging of BPH

PVR
Renal ultrasound
TRUS

12

Indications for Imaging in BPH

UTIs
Hematuria
Renal insufficiency
Hx of stones

13

Goals of BPH Therapy

Relieve symptoms
Delay further prostate enlargement

14

Symptoms to Relieve in BPH

Incomplete bladder emptying
Feelings of urgency to urinate
Weak urinary stream
Having to push or strain to start urinating
Nocturia

15

Medications for BPH Management

Alpha-1 adrenergic antagonists
5-alpha-reuctase inhibitors
Anticholinergic agents
Phosphodiesterase-5 (PDE5) inhibitors
Herbal

16

Benefits of Alpha-blockers

Primarily for symptomatic relief

17

Benefits of 5-alpha-reductase Inhibitors

Reduces prostate size

18

Benefits of Anticholinergics

Reduces irritative voiding symptoms

19

Benefits of PDE-5 Inhibitors

Symptomatic relief and Erectile Dysfunction

20

Herbal Therapy

Saw palmetto

21

1st Line Treatment for BPH

Limit fluid before bed
Avoid decongestants
Double void
Void frequently

22

2nd Line Treatment for BPH

Alpha blocker
5-alpha-reductase inhibitor

23

3rd Line Treatment for BPH

Combination therapy of alpha blocker & 5-alpha-reductase inhibitor

24

Surgical Options for BPH

TURP
Transurethral Incision of the Prostate (TUIP)
Transurethral laser surgery (PVP)
Simple Prostatectomy

25

Indications for a Prostatectomy

Refractory acute retention
Hydronephrosis
Repeated UTIs due to obstruciton
Recurrent or refractory gross hematuria
Elevated Cr level that responds to a period of bladder decompression with catheter drainage

26

Transurethral Resection of the Prostatectomy (TURP)

Most common surgical procedure
Associated with incontinence, erectile dysfunction, & retrograde ejaculation

27

Transurethral Incision of the Prostate (TUIP)

Better choice for young men with smaller prostates
Reduces risk for retrograde ejaculation & subsequent infertility

28

Transurethral Laser Surgery (PVP)

Less bleeding

29

Simple Prostatectomy

Large prostates too big for TURP
Patients with BPH & bladder stones
Longer stay in hospital & higher chance of blood loss

30

Urinary Retention in BPH

Progress over time with symptoms
Can be acute & painful