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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
Q

What is uncomplicated BPO

A

Only symptoms with no obstruction

26
Q

What is the treatment of uncomplicated BPO

A

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
Q

What do 5 alpha reductase inhibitors do

A

Reduce dihydrotestosterone in the prostate which causes the prostate to shrink

28
Q

What are examples of 5 alpha reductase inhibitors

A

finasteride and dutasteride

29
Q

What is the surgical intervention for uncomplicated BPO - prostate <100cc

A

TURP - Transurethral resection of the prostate

30
Q

What is the surgical intervention for uncomplicated BPO - prostate >100cc

A

HoLEP - holmium laser enucleation of prostate

31
Q

What is the surgical intervention for uncomplicated BPO - prostate > 200cc

A

Prostatectomy - either robotic, open retropubic or transvesical

32
Q

What innervates the intrinsic urethral sphincter (smooth muscle of bladder neck)

A

sympathetic alpha-adrgernic nerves

33
Q

What do alpha blockers do

A

Cause smooth muscle relaxation and fight back against prostatic obstruction of the prostatic urethra

34
Q

What is an example of a non selective alpha blocker

A

phenoxybenzamine

35
Q

what are the selective short acting alpha blockers

A

prazosin and indoramin - prazosin is the only -zosin which isn’t long acting

36
Q

What are the selective long acting

A

Alfuzosin, doxazosin and terazosin

37
Q

What is the highly selective alpha blocker

A

tamsulosin - alpha-1-a blocker which is the specific type of nerve for the smooth muscle of the bladder neck

38
Q

How do 5 alpha reductase inhibitors work

A

They inhibit 5 alpha reductase and 5 alpha reductase converts testosterone into dihydrotestosterone which can enlarge prostate in high amounts

39
Q

What is the indication for surgery

A

Failure of the treatments - alpha blockers and 5 alpha reductase inhibitors

40
Q

Describe how TURP works

A

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
Q

What are the complications of BPO

A

progression of LUTS, urinary retention (chronic and acute), urinary incontinence, UTI and renal failure

42
Q

Treatment of complicated obstruction (both symptoms and obstruction)

A

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
Q

Define Acute urinary retention presentation

A

Painful inability to void with a palpable and percussible bladder

44
Q

What is the treatment for acute urinary retention

A

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
Q

Define the presentation of chronic urinary retention

A

Painless and the bladder is percussible and palpable after voiding

46
Q

What is the main cause of chronic urinary retention

A

Under activity of the detrusor muscle

47
Q

Treatment of chronic urinary retention

A

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
Q

Short term urethral catheters should not be left in for longer than how long

A

4 weeks

49
Q

Long term urethral catheters should not be left in longer than how long

A

12 weeks

50
Q

Where are common places for Urinary tract obstruction in the upper tract

A

PUJ - pelvic ureteric junction, ureters and VUJ - vesico ureteric junction

51
Q

Common places of urinary tract obstruction in the lower tract

A

Bladder neck
prostate
urethra
urethral meatus
foreskin

52
Q

What are the symptoms of urinary tract obstructions

A

Pain, frank haematuria (macrascopic) and symptoms of complications

53
Q

What are the signs of urinary tract obstruction

A

palpable mass, microscopic haematuria and signs of complications

54
Q

What are the complications of Urinary tract obstructions

A

Infection and sepsis as well as the possibility of renal failure
Unilateral obstruction doesn’t usually cause renal failure

55
Q

Why does Urinary tract obstruction increase risk infections

A

Obstruction causes the stasis of urine which can develop infections or sepsis

56
Q

What is the gold standard scan for looking at renal obstruction if the patient is stable

A

CT-KUB - CT kidneys, ureters and bladder

57
Q

Management of upper tract urinary obstruction

A

Rescuss - ABCs - IV access, bloods and blood cultures, IV fluids and antibiotics if needed

58
Q

Emergency treatment of upper urinary tract obstruction

A

Percutaneous nephrostomy insertion or retrogade stent insertion

59
Q

Definitive treatment of upper urinary tract obstruction

A

Treat underlying cause

60
Q

emergency treatment of lower urinary tract obstruction

A

urethral catheterisation and suprapubic catheterisation

61
Q

Definitive treatments of obstruction

A

Treat the underlying cause

62
Q
A

urinary (24 decks)

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