Brainscape's Knowledge GenomeTM

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


See full index

Renal (Year 2 GM) > Benign Disease of The Prostate and Urinary Tract Obstruction > Flashcards

Benign Disease of The Prostate and Urinary Tract Obstruction Flashcards

1
Q

How big is an unenlarged prostate?

A

20 cc

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

What are the different parts of the prostate?

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

What are does benign prostatic hyperplasia affect?

A

Predominantly affects the transition zone

Characterised by fibromuscular and glandular hyperplasia

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

Who does benign prostatic hyperplasia affect?

A

•Part of aging process in men :

  • 50% of men at 60 years
  • 90% of men at 85 years
  • 50% of men with BPH have moderate to severe LUTS
  • Progressive condition resulting Bladder Outflow Obstruction (BOO)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the prostate symptom score sheet based on?

A

Incomplete emptying

Frequency

Intermittency

Urgency

Weak Stream

Straining

Nocturia

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

What are the voiding (obstructuve LUTs)?

A
  • Hesitancy
  • Poor stream
  • Terminal dribbling
  • Incomplete emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the storage (irritative) LUTs?

A

Frequency

Nocturia

Urgency +/- urge incontinence

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

What physical examinations are possible for BPH?

A

Abdomen - palpable bladder

Penis - External urethral meatal stricture, phimosis

Digital rectal examination - assessment of the prostate size, suspicious nodules or firmness

Urinalysis - blood, signs of UTI

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

What are the relevant investigations for Benign Prostate Hypertrophy?

A

•MSSU

  • Flow rate study
  • Post-void bladder residual USS
  • Bloods :

–PSA

–urea and creatinine (if chronic retention)

  • Renal tract USS if renal failure or bladder stone suspected
  • Flexible cystoscopy if haematuria
  • Urodynamic studies in selected cases
  • TRUS-guided prostate biopsy if PSA raised or abnormal DRE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two categories of BPO?

A

Uncomplicated

Complicated

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

What is the treatment of uncomlpicated BPO?

A

•Watchful waiting

•Medical therapy

– Alpha blockers

–5 alpha reductase inhibitors (Finasteride or Dutasteride)

–Combination

•Surgical intervention

–TURP (prostate size <100cc) (transurethral resection of the prostate)

–Open retropubic or transvesical prostatectomy (prostate size >100cc)

–Endoscopic ablative procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the function of alpha blockers?

A

•Alpha blockers cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Here are some types of alpha blockers

A

non-selective (i.e. alpha 1 and 2) : phenoxybenzamine

  • selective short acting : prazosin, indoramin
  • selective long acting : alfuzosin, doxazosin, terazosin
  • highly selective (i.e. alpha-1a) : tamsulosin

•All a-blockers appear to be equally effective but differences in side effect profiles and pharmacodynamic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the function of 5a reductase inhibitors?

A

Converts testosterone to dihydrotestosterone

•Role of 5ARIs :

  • reduces prostate size and reduces risks of progression of BPE

(but only if >25cc prostate)

  • also reduces LUTS (but not as effective as alpha blockers)
  • combination therapy of 5ARIs + alpha blockers most effective

in reducing risk of progression of BPE

  • can also reduce prostatic vascularity and hence reduces

haematuria due to prostatic bleeding

  • potential role in prostate cancer prevention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the gold standard for surgical intervention of BPH?

A

TURP

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

What are complications of TURP?

A

bleeding, infection, retrograde ejaculation, stress urinary

incontinence, prostatic regrowth causing recurrent haematuria

or BOO

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

What are the complications of BPO?

A

Progression of LUTS

Acute urinary retention

Chronic urinary retention

Urinary incontinence (overflow)

UTI

Bladder stone

Renal Failure from ibstructed ureteric outflow due to high bladder pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the treatment of complicated BPO?

A

Most require surgery - cystolitholapaxy and TURP for patients with BPO and bladder stones

If unfit for surgery:

  • urethral / suprapubic cathaterisation
  • CISC (Clean intermittent self-cathaterisation)
19
Q

What are the complications of cathaterisation?

A

Catheter trauma, blockages, frank haematuria or recurrent UTI

20
Q

What is acute urinary retention?

A

Painful inability to void with a palpable and percussible bladder

21
Q

What are the causes of acute urinary retention?

A

BPO (main risk factor)

UTI, urethral stricture, alcohol excess, post - operative causes

22
Q

What is immediate treatment of acute urinary retention?

A
  • Immediate treatment is catheterisation (either urethral or suprapubic)
  • If no renal failure, start alpha blocker immediately and remove catheter in 2 days (60% will void successfully); if fail to void, recatheterise and organise TURP (after 6 weeks)
23
Q

What are complications of acute urinary retention?

A

UTI

Post decompression haematuria

Pathological diuresis

Renal failure

Electrolyte abnormalities

24
Q

What is chronic urinary retention defined as?

A

Painless, palpable and percussable bladder after voiding

25
Q

What is the main aetiological factor for chronic urinary retention?

A

•Main aetiological factor is detrusor underactivity which can be primary (i.e. primary bladder failure) or secondary (i.e. due to longstanding BOO, such as BPO or urethral stricture)

26
Q

What does chronic urinary retention present with?

A

LUTS

Complications (e.g. UTI, bladder stones, overflow incontinence, post - renal or obstructive renal failure) or incidental finding

27
Q

What are complications of chronic urinary retention?

A

UTI

Post decompression haematuria

Pathological diuresis

Electrolyte abnormalities

Renal dysfunction - as a result of acute tubular necrosis

28
Q

What are the electrolyte abnormalities seen in chronic urinary retention?

A

Hyponatraemia

Hyperkalaemia

Metabolic acidosis

29
Q

What are the features of pathological diuresis?

A

•Pathological diuresis features : urine output >200ml/hr + postural hypotension (systolic differential >20mm Hg between lying and standing) + weight loss + electrolyte abnormalities

30
Q

What is the longer term treatment for chronic urinary retention?

A

•Subsequent treatment is with either long term urethral or suprapubic catheter, CISC or TURP

31
Q

What are the types of urinery tract obstruction?

A

•Upper tract (i.e. supra-vesical)

  • PUJ
  • ureter
  • VUJ

•Lower tract (i.e. bladder outflow obstruction)

  • bladder neck
  • prostate
  • urethra
  • urethral meatus
  • foreskin (e.g. phimosis)
32
Q

What are the intrinsic causes of upper tract obstruction?

A

PUJ, ureter and VUJ:

Stone

Ureteric tumour

PUJ and ureter: blood clot and fungal ball

33
Q

What are the extrinsic causes of upper tract obstruction?

A

PUJ - PUJ obstruction by crossing vessel, lymph nodes, abdominal mass

Ureter - Lymph nodes, abdominal / pelvic mass, iatrogenic

VUJ - cervical tumour, prostate cancer

34
Q

What is the presentation of upper tract obstruction?

A

Symptoms: Pain, frank haematuria, symptoms of complications

Signs: Palpable mass, microscopic haemauria, signs of complications

35
Q

What are the complications of upper tract obstruction?

A

Infection and sepsis

Renal failure

36
Q

What is management of upper urinary tract obstruction?

A

•Resuscitation

- ABCs

  • IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
  • IV fluids, broad-spectrum antibiotics (if appropriate)
  • Analgesia
  • HDU care +/- renal replacement therapy (if appropriate)
  • Investigations (including imaging)
  • Emergency treatment of obstruction (for unremitting pain or complications)
  • Percutaneous nephrostomy insertion OR
  • Retrograde stent insertion

•Definitive treatment of obstruction

  • Treat underlying cause
  • e.g. stone – ureteroscopy and laser lithotripsy +/- basketing or ESWL - Extracorpeal shockwave lithotripsy
  • e.g. ureteric tumour – radical nephro-ureterectomy
  • e.g. PUJ obstruction – laparoscopic pyeloplasty

pyeloplasty - Pyeloplasty is the surgical reconstruction or revision of the renal pelvis to drain and decompress the kidney

37
Q

Define nephrostomy

A

Urinary diversion from the kidney to the skin

38
Q

How is nephrostomy carried out?

A
  • Usually under LA + sedation
  • US or xray guidance
39
Q

What is the presentation of lower tract obstruction?

A

•Lower urinary tract symptoms

  • including urinary incontinence
  • Acute urinary retention
  • Chronic urinary retention
  • Recurrent urinary tract infection and sepsis
  • Frank haematuria
  • Formation of bladder stones
  • Renal failure
40
Q

What is the difference between acute and chronic urinary retention in patient presentation?

A

Acute - Can’t pee, in agony, creatinine - 70

Chronic - Peeing fine, pain free, creatinine - 170

41
Q

What is the management for lower tract obstruction?

A

•Resuscitation

  • ABCs
  • IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
  • IV fluids, broad-spectrum antibiotics (if appropriate)
  • Analgesia
  • HDU care +/- renal replacement therapy (if appropriate)
  • Investigations (including imaging: Bladder scan, USS renal tract)
  • Emergency treatment of obstruction (for unremitting pain or complications)
  • Urethral catheterisation OR
  • Suprapubic catheterisation

•Definitive treatment of obstruction

  • Treat underlying cause
  • e.g. BPE – TURP
  • e.g. Urethral stricture – Optical urethrotomy
  • e.g. Meatal stenosis – Meatal dilatation
  • e.g. Phimosis – Circumcision
42
Q

What is decompression haematuria?

A

Shearing of small vessels due to differing compliance of tissue layers

Usually self - liiting

43
Q

What is post obstructive diuresis

A

Postobstructive diuresis. Postobstructive diuresis is a polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tractobstruction. In most patients, the diuresis will resolve once the kidneys normalize the volume and solute status and homeostasis is achieved.

Renal (Year 2 GM) (28 decks)

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