BPH (benign prostate enlargement) is believed to result from hormonal changes with aging. Which hormone tends to lower and which one tends to increase as a result?
How can the increased hormone lead to cell growth?
- Lowered = Testosterone
- Elevated = Estrogen
Higher estrogen increases DHT that promotes cell growth.
List irritative symptoms of BPH (associated with inflammation or infection) (5)
- 1. Nocturia
- 2. Urinary Frequency
- 3. Dysuria
- 4. Bladder pain
- 5. Incontinence
List obstructive symptoms of BPH (due to urinary retention) (4)
- 1. Decrease in caliber and force of urinary stream
- 2. Difficulty in initiating voiding
- 3. Intermittency: stopping and staring several times
- 4. Dribbiling in between and at the end of urination
List some complications of BPH (5)
- 1. Acute urinar retention
- 2. UTI - associated with incomplete bladder empty (residual urine)
- 3. Calculi d/t alkalization of residual urine
- 4. Renal failure caused by distention of pelvis)
- 5. Pyelonephritis with delayed acute urinary retention
What is indication of DRE?
Digital Rectal Exam can be done for BPH. It is done for males >50 y/o.
What is PSA?
Prostate-specific antigen: done to rule out prostate cancer. Slightly elevated with BPH.
List things patients need to avoid with BPH
- Avoid anticholinergics and decongestants
- Dietary changes such as decrease caffeine intake
- Restrict evening fluid intake
How can 5alpha reductase inhibiors (Finasteride (Proscar)) help with BPH?
How long does it take to be effective?
It blocks the enzyme 5alpha reductase which converts testosterone to DHT. DHT promotes cell growth
It takes 6 months to be effective.
What is Dutasteride (Avodart) used to treat?
In men, it is used to treat signs of enlarged prostate (BPH)
What are indications for these 4 drugs:
These are alpha-adrenergic receptor blockers: they promote smooth muscle relaxation in the prostate and helps with urine flow.
This tx for BPH is done as an outpatient, also causing tissue death of prostate using low-wave radiofrequency.
a. Transuretheral microwave thermotherapy
b. Transuretheral needle ablation
What are its complications?
b. Transuretheral needle ablation
Complications: urinary retention, UTI, irritative voiding, and often hematuria (RBCs in urine) for a week.
This BPH tx is done as an outpatient. It raises the temperature of the prostate tissue with a probe to 113 deg F causing tissue death.
a. Transurethral microwave thermotherapy
b. Transurethral needle ablation
Who is it contraindicated with?
Contraindicated for men with rectal problems
T or F: Before a patient is to receive a transrethral microwave thermotherapy tx for BPH, he should stop anticoagulant therapy (aspirin) for 5 days prior.
False: 10 days
T or F: Patients who receive a laser prostatectomy for BPH don't have to stop anticoagulants beforehand.
True: it has minimal bleeding and fast recovery
List preoperative and postoperative care for TURP (Transuretheral Resection of the Prostate)
- Preoperative: restore urinary drainage - may need a cath insert (10mL of sterile water with lidocaine)
- Postoperative: Bladder irrigation either anually or CBI (continuous bladder irrigation).
- - Drainage will be light pink with no clots
- - Cleanse meatus daily
What do you want to tell the patient to avoid after a TURP procedure?
- Avoid heavy lifting
- Refrain from driving or sexual activity
Prostate cancer can present signs of pain at this location
Pain in lumbosacral area that radiates down to hips or legs due to metastasis. This severe leg pain is due to compression on spinal cord and destruction of bone
This tx for prostate cancer places a radioactive seed implant into the prostate gland, it is a one-time outpatient
What is the most common s/e?
- Most common s/e: Urinary irritative problems
List tx and therapy for Prostatitis
- abx for 4 weeks for bacterial prostatitis (cipro, cephalexin, doxycycline)
- Pain management (tamsulosin been effective in reducing discomfort
- Cath insertion for acute urinary retention (contraindicated if urethera is inflamed)
- Adequate fluids
- Fever management
Match: Uretheral meatus is located on the ventrical surface; surgery indicated if there is chordee (painful down curve of penis during erection)
A. surgery may be also for cosmetic or emotional well-being
Match: tightness or constriction of the foreskin around the head of the penis
- caused by edema or inflammation of the foreskin d/t poor hygiene
Match: tightness of foreskin resulting in the ability to pull forward from a retrated position, preventing normal return over glans.
What are its tx?
- Tx: abx, warm soaks, and possible circumcision
What are common causes of Priapism? (3)
- sickle cell dz
- spinal cord trauma
- cocaine use
T or F: cancer of the penis is a higher risk for men who were not circumcised as an infant
What is epididymitis and its tx?
What is the most common cause?
- Acute and painful inflammatory process of the epididymis d/t infectious process, trauma, or urinary reflux
- Tx: abx for BOTH partners if the cause is through sexual contact.
the most common cause is STD
T or F: If the cause of epididiymitis is caused by an STD, both partners have to be treated with abx
What is Phosphodiesterase type 5 inhibitor indicated for? How should it be taken?
What is the suffix of these drugs?
Generally a safe and effective tx for ED. It should be used 30-60 mins prior to sexual activity and not to be used more than once/day.
Oral Erectogenic drugs end with -afil (Example: Sidnafil, ardenafil, Tadalafil)
What are contraindications for PDE5 (ED drugs)?
Contraindicated if patient is taking nitrates that can result in hypotension