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Year 3 - Surgery > 5.04 Urology - The Prostate > Flashcards

5.04 Urology - The Prostate Flashcards

1
Q

What is prostatitis?

A

Inflammation of the prostate gland, most commonly of bacterial aetiology.

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2
Q

Give the pathophysiology of acute bacterial prostatitis.

A

Ascending urethral bacterial infection, most commonly caused by Escherichia coli.

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3
Q

What are the risk factors for acute bacterial prostatitis?

A
  • indwelling catheters
  • phimosis
  • urethral strictures
  • cystoscopy
  • immunocompromised
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4
Q

What are the clinical features of acute bacterial prostatitis?

A
  • LUTS
  • pyrexia
  • perineal or suprapubic pain
  • urethral discharge

OE tender prostate and inguinal lymphadenopathy.

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5
Q

What investigations should be used to assess suspected prostatitis?

A
  • urine culture
  • STI screen
  • routine bloods (FBC, CRP and U&Es)
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6
Q

Why is PSA often not performed when assessing prostatitis?

A

PSA will be falsely raised and adds no clinical benefit to outcome.

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7
Q

What is the management of prostatitis?

A
  • antibiotic therapy (targeted)
  • analgesia
  • tamsulosin or finasteride second line
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8
Q

What is benign prostatic hyperplasia?

A

The benign hyperplasia of the prostate leading to an increase in its size.

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9
Q

What is the function of the prostate?

A

The prostate converts testosterone to dihydrotestosterone (DHT) using the enzyme 5a-reductase.

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10
Q

What are the risk factors for BPH?

A
  • increasing age
  • family history
  • black African or Caribeean ethnicity
  • obesity
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11
Q

What are the clinical features of BPH?

A
  • LUTS (voiding)
  • haematuria
  • haematospermia

OE DRE shows firm, smooth prostate.

NOTE as part of initial assessment, every patient should complete International Prostate Symptom Score (IPSS).

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12
Q

What are the differential diagnoses for BPH?

A
  • prostate cancer
  • UTI
  • overactive bladder
  • bladder cancer
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13
Q

What investigations can be used to assess BPH?

A
  • urinary frequency and volume chart
  • beside urinalysis
  • post-void vladder scan
  • PSA test
  • ultrasound scan
  • urodynamic studies
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14
Q

What lifestyle advice can be given to a patient to manage BPH?

A
  • moderate caffeine and alcohol intake
  • weight loss
  • smoking cessation
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15
Q

What is the medical management of BPH?

A
  1. Tamsulosin
  2. Finasteride
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16
Q

Outline the action of tamsulosin in the treatment of BPH.

A

Alpha blocker used first line, therefore relaxes prostatic smooth muscle and allowing symptomatic benefit within days.

17
Q

Outline the action of finasteride in the treatment of BPH.

A

5a-reductase inhibitor used second line, preventing the conversion of testosterone to DHT.

18
Q

What medication is often co-prescribed alongside finasteride due to its adverse effect of ED?

A

PDE V inhibitor

19
Q

If conservative management of BPH fails, what are the options?

A

TURP to endoscopically remove prostatic tissue and increase urethral lumen size.

20
Q

What are the common complications of TURP?

A
  • TUR syndrome
  • haemorrhage
  • sexual dysfunction
  • retrograde ejaculation
  • urethral stricture
21
Q

What is TUR syndrome?

A

A life-threatening complication of TURP.

The use of hypoosmolar fluid during surgery causes fluid overload and dilutional hyponatraemia.

Saline is now more commonly used to prevent TUR syndrome.

22
Q

What are the common complications of BPH?

A
  • high-pressure urinary renention
  • post-renal kidney injury
  • UTIs
  • haematuria
  • urinary retention
23
Q

What is the most common cancer in men?

A

Prostate cancer

24
Q

What is the most common subtype of prostate cancer?

A

Adenocarcinoma (95%)

25
Q

Prostate cancer most commonly affects which zone of the prostate?

A

Peripheral zone

26
Q

What are the risk factors for prostate cancer?

A
  • increasing age
  • black African or Caribbean ethnicity
  • family history of prostate cancer
  • obesity
  • smoking
  • diabetes mellitus

NB exercise considered protective.

27
Q

What specific genetic mutations predispose to prostate cancer?

A

BRCA1 or BRCA2 gene

28
Q

What are the clinical features of prostate cancer?

A
  • LUTS (late)
  • haematuria
  • dysuria
  • incontinence
  • haematospermia
  • suprapubic pain
  • loin pain
  • rectal tenesmus

Screen for metastatic bone disease etc.

29
Q

DRE of prostate cancer shows…

A
  • asymmetrical
  • nodular
  • irregular masses
30
Q

What are the differential diagnoses for prostate cancer?

A
  • BPH
  • prostatitis
  • bladder cancer
  • urinary stones
31
Q

What tests can be used to investigate prostate cancer?

A
  • PSA

Note can also be raised due to prostatitis, DRE, BPH. Not specific enough to confirm diagnosis but can support.

32
Q

What imaging technique is used to assess prostate cancer?

A

MRI scan of the prostate to target biopsy.

Can also use CT chest-abdomen-pelvis and PET-CT to stage prostate cancer.

33
Q

Which grading system is used to classify prostate cancers?

A

Gleason grading system.

34
Q

How is prostate cancer managed?

A
  • active surveillance if low risk
  • radical prostatectomy (open, laparoscopically, robotically)
  • chemotherapy

Year 3 - Surgery (30 decks)

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