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SURGERY

Prostate

QuestionAnswer
fxn of the prostate to produce the ejaculate, which serves as a vehicle for spermatozoa
Sx's of BPH (6) 1. frequency of urination of small amnts, 2. feeling of incomplete voiding with subsequent attempts to urinate to achieve the feeling of bladder emptying, 3. slow urinary flow, 4. nocturia, 5. hesitancy, 6. complete urinary retention
Differential of BPH (other things that can mimic sx's of BPH) - 5 1. urethral stricture, 2. URI, 3. prostatitis, 4. prostate CA, 5. neurologic bladder dysfxn
When should you bx prostate when pt complains of urinary retention? when there is nodularity of the prostate or an elevation in the PSA
w/u for prostatism (4) 1. ROS for neuro abnl, 2. UA (UTI; hematuria --> tumor), 3. labs (serum Cr to r/o severe prostatism w renal compromise, PSA), 4. DRE (size, nodularity -->CA)
In pts with sx's of prostatism, what would require urgent urologic intervention? (5) 1. evidence of renal compromise, 2. elevated Cr, 3. urinary retention, 4. small voids with incomplete emptying, 5. palpable bladder
tx of BPH 1. meds 2. TURP
Meds for BPH 1. alpha1 antag , 2. 5-alpha reductase inhib (block enzyme that converts testosterone to DHT)
How do alpha1 antag help BPH? What are some examples of agents? relaxation of the prostate smooth muscle --> increasing functional diameter of urethra (terazosin, doxazosin, tamsulosin)
How does finasteride help BPH? What are some examples of agents? 5-alpha reductase inhib --> block production of DHT --> involution of prostate glandular tissue and reduce prostate size
Describe a TURP. Describe f/u. transurethral resection of the prostate. Monitor for response to therapy with interval PSA since residual glandular tissue will continue to grow.
72-yo man with lower abd mass constantly dribble urine - what does he have and what is the management? overflow incontinence (bladder filled to capacity); immediate urinary drainage via Foley and hospitalization
side effect of alpha1 antagonists originally for BP control; relaxes arterial smooth muscle --> dec BP --> dizziness/syncope; some require nighttime dosing
How does a DRE prior to PSA testing affect PSA levels? mild elevations in PSA after DRE. Should repeat PSA several days to one week after DRE.
In which pts is PSA testing most useful? pts who have had tx for prostate CA to detect recurrence
Does PSA screening impact mortality? not definitively, but some still advise screening after age 50
PSA screening after what age? 50
No physiologic relationship between BPH and prostate CA? None, but age of onset for these two entities overlap
Distinguishing characeristics of prostate CA firm, hard, misshapen prostate gland on DRE and/or elevated or elevating PSA
Can same pt have BPH and prostate CA? yes
How to dx prostate ca? transrectal bx of prostate
Created by: christinapham
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