Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal / Urology > Benign Disease of the Prostate > Flashcards

Benign Disease of the Prostate Flashcards

1
Q

What is BPE/H

A

Benign prostatic enlargement / hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is BPO

A

Benign prostatic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is BOO

A

Bladder outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes benign prostatic hyperplasia and where is affected

A

Fibromuscular and glandular hyperplasia
Transition zone affected which surrounds urethra
Which is why likely to present LUTS
Hormone dependent condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are the symptoms of BPE scored

A

IPSS

- International Prostate Severity Score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the voiding symptoms of BPE due to obstruction and the storage symptoms due to irritation of bladder?

A 
LUTS due to BOO 
Voiding problem (obstruction) - SSHEDS
- Strain 
- Stream poor / stop start / difficulty initiating 
- Hesitation
- Emptying incomplete
- Dribbling - terminal 
- Stranguary - urinary tenesmus

Storage (irriration)

  • Frequency
  • Urgency
  • Nocturia - 2+ times
  • Overflow incontinence
  • Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can be found on examination of BPE

A

Palpable bladder if in retention
Enlarged smooth prostate - if can feel on DRE likely enlarged

Urethral stricture
Phismosis - can’t retract foreskin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is BPE common ?

A

Part of ageing process in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you diagnosis BPE

Other tests depending on Sx

A

PSA prior to DRE as will elevate
DRE
Urinanalysis + MSSU to look for UTI as cause
FBC, U+E to see if retention / abnormal kidney function
Post-void bladder USS = large residual volume or hydronephrosis

Trans-rectal USS / MRI +- biopsy to rule out prostate cancer
- if PSA raised or abnormal DRE
Renal tract USS if abnormal U+E
Cystoscopy if haematruia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat uncomplicated BPE

A

Watch and wait - diet / bladder retrain
Alpha blocker - relax smooth muscle, lower BP = 1st line (doxasin / tamsulosin)
5 alpha reductase inhibitor - finasteride
TURP if failed medical = day case procedure
Endoscopic ablation or prostatectomy
Long term urethral or suprapubic catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do 5 alpha reductase inhibitors do (finasteride)

A 
Stop conversion of testosterone to dihydrotestosterone which makes prostate grow
Shrinks prostate 
Reduce LUTS 
Reduce vascularity and haematuria
Reduce prostate cancer risk 
Takes 6 months to work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the complications of BPE/O

A 
Acute and chronic retention
Overflow Incontinence
UTI due to stasis 
Bladder stones
Renal failure due to high bladder pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of surgery

A 
TURP syndrome - hyponatraemic state 
Urethral stricture 
UTI
Retrograde ejaculation as sphincter destroyed (common) 
Perforation of prostate
Other 
Bleeding in urine or sperm
Infections
Stress incontinence
Erectile dysfunction
Prostatic regrowth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat the complications of BPE

A

Cystolitholapaxy of bladder stones
Long term urethral or suprapubic catheter if incontinence
Clean intermittent catheterisation if detrusor under activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why do you do urinalysis

A

Exclude infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is it important to do U+E

A

To see if retention causing renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you always do after initial management of BOO if haematuria

A

Cystoscopy to look for bladder Ca

18
Q

What will USS show

A

Large residual volume

Hydronephrosis

19
Q

What does TURP syndrome cause and what puts you at higher risk

A

Venous destruction and absorption of irrigation fluid
Hyponatraemia and fluid overloaded

RF

  • CCF
  • Time >1 hour
  • Large amount of fluid used
  • Larged blood loss
  • Large section resected
20
Q

How do you Rx

A

Fluid restrict

Rx hypoNa

21
Q

What do A blocker do (tamsulosin / Doxazain)

A

Lower BP

Relax smooth muscle

22
Q

What are voiding issues (due to obstruction)

A 
Hesitation
Poor stream
Terminal dribbling
Intermittent
Incomplete emptying
23
Q

What are storage symptoms / LUTS

A 
Frequency
Urgency
Nocturia
Overflow incontinence
Haematuria
UTI
24
Q

How do you investigate LUTS

A 
Urinanalysis
PSA before DRE
DRE
Bladder diary 
Post void USS of bladder to see volume
Urodynamic studies for voiding issue
25
Q

How do you treat voiding Sx

A

PFMT / bladder retrain = 1st line
A blocker if severe
5 alpha reductase if prostate enlarged

26
Q

If mixed Sx

A

Anti-cholinergic can be added

27
Q

What do you do for storage symtpoms / overactive bladder

A

Advice fluid intake
Bladder retraining
Anti-cholinergic if symptoms persist

28
Q

What do you do if noturia

A

Advise fluid intake
Give diuretic late afternoon
Desmopression - ADH so absorbs

29
Q

What is important to remember when using finasteride

A

PSA will be lower as shrinks prostate so always double value

30
Q

If still symptomatic after Rx of prostate what should you suspect

A

Bladder instability

31
Q

What should you refer for

A

Urodynamic studies

32
Q

What can cause raised PSA

A 
BPH
Prostate cancer - 33% of raised PSA
Prostaitits / UTI
Ejaculation
Urine retention
DRE
Prostate biopsy
33
Q

What are age adjusted limits for 50-60, 60-70, >70

A 
<60 = <3
<60 = <4
>70 = <5
34
Q

Who gets referred

A

Anyone <70 and PSA >3

35
Q

Does screening exist

A

No but men can request

36
Q

When do you avoid doing PSA test (timings)

Biopsy, UTI, DRE, ejaculation

A

Biopsy 6 months
UTI 4 weeks
DRE 1 week
Ejaculation / vigorous exercise = 48 hours

37
Q

What are examples of anti-cholinergic

A

Oxybutynin / Tolterodine = immediate release

38
Q

How long for 5 alpha reducastase inhibitor to work

A

Can take 6 months

39
Q

What are SE of a-blocker

A 
Drowsy 
Dizzy 
Depression
Decreased BP
Dry mouth 
Libido
40
Q

What are SE of 5a-reductase inhibitor

A 
Impotence
Decreased libido
Ejaculation issue 
Gynaecomastia 
Decreases PSA

Renal / Urology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions