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urinary > Benign disease of the prostate gland and UTO > Flashcards

Benign disease of the prostate gland and UTO Flashcards

1
Q

What is the average size of the prostate gland

A

20cc - size of a walnut

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2
Q

Describe the anatomy of the prostate

A

The prostate the part of the prostatic urethra and is in close proximity to the rectum

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3
Q

What is the most common site of prostatic cancers

A

The peripheral zones which is also palpable in the digital rectal exam

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4
Q

What is BOO

A

Bladder outflow obstruction

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5
Q

What is BPE

A

Benign prostatic enlargement

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6
Q

what is BPH

A

Benign prostatic hyperplasia

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7
Q

What is BPO

A

Benign prostatic obstruction

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8
Q

What is LUTS

A

Lower urinary tract symptoms

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9
Q

What does the lower part of the urinary system consist of

A

Everything below ureters - bladder and urethra

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10
Q

What are the 2 parts of the prostate made up of

A

The glandular part makes up 2/3 of the prostate - the fibromuscular part makes up the other third

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11
Q

What kind of hyperplasia is seen in benign prostatic hyperplasia

A

fibromuscular and glandular - same as what makes up the parts of the prostate

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12
Q

What causes BPH

A

disordered regulation of dihydroterstosterone

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13
Q

What is the prognosis generally like in BPH

A

A condition which gradually gets worse and can cause BPO and BOO - bladder outflow obstruction

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14
Q

What are voiding (obstructive) symptoms

A

Hesitancy, poor stream, terminal dribbling and incomplete emptying of the bladder

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15
Q

What are storage (irritative) symptoms

A

Frequency, nocturia, urgency with or without urge incontinence

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16
Q

What is urge incontinence

A

Not making it to the toilet in time with urgency

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17
Q

What scoring system does determines the assessment of LUTS

A

IPSS - international prostate symptom score - 0-7 mild - greater than or equal to 20 is severe

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18
Q

What is checked in a physical exam with urinary issues

A

Is there a palpable bladder - is the external urethral meatus constricted - is the foreskin tight (phimosis) - Digital rectal examination (check prostate) - urinalysis (check if there is blood or signs of UTI

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19
Q

What is a MSSU

A

Mid stream specimen urine - patient urinates, then stops, then urinates again and the second urination is what is invesrtigated

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20
Q

What bloods are checked in urinary issues

A

PSA in men - Prostate specific antigen - urea and creatinine

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21
Q

What investigation is done if PSA is raised or DRE (digital rectam exam) is abnormal

A

TRUS-guided biopsy - Transrectal ultrasound

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22
Q

What does a flow rate of less than 10mls as the Qmax indicate

A

90% chance of BOO

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23
Q

What should the prostate normally look like on cystoscopy

A

A tunnel going through it but in BPE the tunnel appears closed

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24
Q

When does BPH and BPE require treatment

A

When there are symptoms and obstruction present

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25
What is uncomplicated BPO
Only symptoms with no obstruction
26
What is the treatment of uncomplicated BPO
Watchful waiting can be done - monitor patient doesn't get worse The first line of treatment is 5 alpha reductase inhibitors and alpha blockers which are usually given as a combination
27
What do 5 alpha reductase inhibitors do
Reduce dihydrotestosterone in the prostate which causes the prostate to shrink
28
What are examples of 5 alpha reductase inhibitors
finasteride and dutasteride
29
What is the surgical intervention for uncomplicated BPO - prostate <100cc
TURP - Transurethral resection of the prostate
30
What is the surgical intervention for uncomplicated BPO - prostate >100cc
HoLEP - holmium laser enucleation of prostate
31
What is the surgical intervention for uncomplicated BPO - prostate > 200cc
Prostatectomy - either robotic, open retropubic or transvesical
32
What innervates the intrinsic urethral sphincter (smooth muscle of bladder neck)
sympathetic alpha-adrgernic nerves
33
What do alpha blockers do
Cause smooth muscle relaxation and fight back against prostatic obstruction of the prostatic urethra
34
What is an example of a non selective alpha blocker
phenoxybenzamine
35
what are the selective short acting alpha blockers
prazosin and indoramin - prazosin is the only -zosin which isn't long acting
36
What are the selective long acting
Alfuzosin, doxazosin and terazosin
37
What is the highly selective alpha blocker
tamsulosin - alpha-1-a blocker which is the specific type of nerve for the smooth muscle of the bladder neck
38
How do 5 alpha reductase inhibitors work
They inhibit 5 alpha reductase and 5 alpha reductase converts testosterone into dihydrotestosterone which can enlarge prostate in high amounts
39
What is the indication for surgery
Failure of the treatments - alpha blockers and 5 alpha reductase inhibitors
40
Describe how TURP works
general anaesthetic is used, then a cystoscope is put into the urethra and gets to the prostate where some of the prostate is then shaved off to reduce the size
41
What are the complications of BPO
progression of LUTS, urinary retention (chronic and acute), urinary incontinence, UTI and renal failure
42
Treatment of complicated obstruction (both symptoms and obstruction)
Surgical treatment is the main method of treatment apart from when the patient has acute urinary retention TURP is the usual surgery option as well as cystolitholapaxy if bladder stones If patients are unfit for surgery then long term catheters are an option but they can increase risk of infection
43
Define Acute urinary retention presentation
Painful inability to void with a palpable and percussible bladder
44
What is the treatment for acute urinary retention
Immediate treatment - catheterisation and also treat the underlying cause Usually use alpha blockers if the kidneys are functioning well as they are used in BOO and can relax the neck of the bladder - remove the catheter when starting the alpha blockers
45
Define the presentation of chronic urinary retention
Painless and the bladder is percussible and palpable after voiding
46
What is the main cause of chronic urinary retention
Under activity of the detrusor muscle
47
Treatment of chronic urinary retention
Patients with symptoms or complications need treatment but medical therapy is not of any use Immediate treatment is catheterisation and manage with IV fluids TURP is not as effective in chronic retention compared to acute retention but patients with high pressure chronic retention have a better outcome with TURP compared to low pressure chronic retention
48
Short term urethral catheters should not be left in for longer than how long
4 weeks
49
Long term urethral catheters should not be left in longer than how long
12 weeks
50
Where are common places for Urinary tract obstruction in the upper tract
PUJ - pelvic ureteric junction, ureters and VUJ - vesico ureteric junction
51
Common places of urinary tract obstruction in the lower tract
Bladder neck prostate urethra urethral meatus foreskin
52
What are the symptoms of urinary tract obstructions
Pain, frank haematuria (macrascopic) and symptoms of complications
53
What are the signs of urinary tract obstruction
palpable mass, microscopic haematuria and signs of complications
54
What are the complications of Urinary tract obstructions
Infection and sepsis as well as the possibility of renal failure Unilateral obstruction doesn't usually cause renal failure
55
Why does Urinary tract obstruction increase risk infections
Obstruction causes the stasis of urine which can develop infections or sepsis
56
What is the gold standard scan for looking at renal obstruction if the patient is stable
CT-KUB - CT kidneys, ureters and bladder
57
Management of upper tract urinary obstruction
Rescuss - ABCs - IV access, bloods and blood cultures, IV fluids and antibiotics if needed
58
Emergency treatment of upper urinary tract obstruction
Percutaneous nephrostomy insertion or retrogade stent insertion
59
Definitive treatment of upper urinary tract obstruction
Treat underlying cause
60
emergency treatment of lower urinary tract obstruction
urethral catheterisation and suprapubic catheterisation
61
Definitive treatments of obstruction
Treat the underlying cause
62

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