26- Urology Explaains Flashcards
What is the prevalence of BPH in men over the age of 60?
BPH is present in 50% of men over the age of 60.
What is the prevalence of BPH in men by the age of 90?
BPH is present in nearly 90% of men by the age of 90.
Where does BPH occur in the prostate?
BPH occurs as a result of hyperplasia of the periurethral glands in the transitional zone of the prostate.
What are the two main groups of lower urinary tract symptoms (LUTS) associated with BPH?
The two main groups of LUTS associated with BPH are obstructive symptoms (hesitancy, poor stream, straining, etc.) and irritation symptoms (pain during bladder filling, frequency, urgency, etc.).
What role do androgens play in the development and progression of BPH?
Androgens play a role in the development and progression of BPH. Testosterone diffuses into prostatic and stromal cells and binds to the androgen receptor, leading to stimulation and proliferation.
What is the end result of the proliferative activity in BPH?
The proliferative activity in BPH results in varying degrees of obstruction and lower urinary tract obstructive symptoms.
What are the components of the clinical diagnosis of BPH?
The clinical diagnosis of BPH includes a degree of lower urinary tract symptoms, palpable prostatic enlargement, and evidence of impaired voiding on urodynamic assessment.
How do alpha adrenergic antagonists work in the management of BPH?
Alpha adrenergic antagonists block the action of noradrenaline on prostatic smooth muscle, causing relaxation and improved bladder emptying.
What are the conservative management options for BPH?
Conservative management options for BPH include alpha adrenergic antagonists and 5 alpha reductase inhibitors.
How do 5 alpha reductase inhibitors work in the management of BPH?
5 alpha reductase inhibitors, like Finasteride, inhibit the conversion of testosterone to dihydroxytestosterone (DHT), reducing intracellular activity and decreasing prostatic volume.
What is the gold standard surgical treatment for BPH?
Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for BPH. In some cases, an open retropubic prostatectomy may be considered for a large gland.
What is the failure rate of vasectomy?
1 in 2000
What type of anesthesia is typically used during a vasectomy?
Local anesthesia
What are the success rates of vasectomy reversal if performed within 10 years of the procedure?
Approximately 55%
How is the vasectomy procedure typically performed?
Small bilateral incisions and formal dissection of the vas
What is the “no scalpel” technique for vasectomy?
A technique involving the use of haemostats for skin puncture
Is it necessary to send the vas for histology after a vasectomy?
No, it is not necessary to routinely send the vas for histology
Who should be cautious about undergoing a vasectomy?
Childless, single men under the age of 30
What are the risks associated with vasectomy?
Chronic scrotal pain (reported by 12-52% of men), haematomas, and sperm granulomas
When should clearance for contraception be granted after a vasectomy?
After a negative sperm sample is available, usually taken 12-16 weeks post-procedure
Under what conditions may “special clearance” to stop contraception be given after a vasectomy?
When less than 10,000 non-motile sperm/mL are found in a fresh specimen examined at least 7 months after vasectomy
Do the risks of sexually transmitted infections (STIs) change after a vasectomy?
No, the risks of STIs remain unchanged
What are penile fractures?
Rare urological traumas involving the penile shaft, often involving the urethra
What is the typical history given by patients with penile fractures?
A snapping sensation followed by immediate pain, usually during vigorous intercourse
What are the signs of penile fracture upon examination?
Tense hematoma and blood at the meatus if the urethra is injured
What is the recommended management for penile fractures?
Surgical intervention
What is the surgical approach for penile fractures?
A circumferential incision made immediately inferior to the glans
What is done during the surgical procedure for penile fractures?
The skin and superficial tissues are stripped back, and the penile shaft is inspected
How are penile injuries typically treated during surgery?
They are sutured, and if the urethra is involved, it is repaired over a catheter
What type of genetic condition is tuberous sclerosis (TS)?
Autosomal dominant inheritance
What are the cutaneous features commonly seen in TS?
Depigmented ‘ash-leaf’ spots (fluoresce under UV light), roughened patches of skin over the lumbar spine (Shagreen patches), adenoma sebaceum (butterfly distribution over the nose), fibromata beneath nails (subungual fibromata), and café-au-lait spots
What are the neurological features associated with TS?
Developmental delay, epilepsy (infantile spasms or partial seizures), and intellectual impairment
What are some other features of TS?
Retinal hamartomas (dense white areas on the retina, known as phakomata), rhabdomyomas of the heart, gliomatous changes in brain lesions, and polycystic kidneys with renal angiomyolipomata
What is schistosomiasis?
A parasitic flatworm infection
What are the recognized types of schistosomiasis?
Schistosoma mansoni and Schistosoma intercalatum (intestinal schistosomiasis) and Schistosoma haematobium (urinary schistosomiasis)
What are the features of Schistosoma haematobium infection?
‘Swimmer’s itch’ in patients recently returned from Africa, risk factor for squamous cell bladder cancer, haematuria (blood in urine), and bladder calcification
What is the management for schistosomiasis?
A single oral dose of praziquantel
