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Urinary > Benign diseases of the prostate > Flashcards

Benign diseases of the prostate Flashcards

1
Q

What are the different zones of the prostate called

A

central peripheral anterior transitional

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2
Q

What is BPH

A

Benign prostatic hyperplasia -big under microscope (histological)

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3
Q

What is BPE

A

Benign prostatic enlargement (BPE) – big prostate gland

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4
Q

What is BPO

A

Benign prostatic obstruction (BPO) – symptoms associated with a big prostate

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5
Q

What is BOO

A

Bladder outflow obstruction (BOO) – bladder neck and prostate causing obstruction and symptoms

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6
Q

What characterises BPH

A

Characterised by fibromuscular and glandular hyperplasia

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7
Q

What zone of the prostate does BPH usually affect

A

Transition zone

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8
Q

What % of men will have BPH by the age of 60

A

50%

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9
Q

What are the two main categories of lower urinary tract symptoms

A

Voiding Storage

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10
Q

What are voiding symptoms

A

Obstructive - Hesitancy - Poor stream - Terminal dribbling - Incomplete emptying

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11
Q

What are storage symtpoms

A

Irritative - Frequency - Nocturia - Urgency +/- urge incontinence

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12
Q

How do assess LUTS from prostate disease

A

International prostate symptom score sheet

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13
Q

What is the International prostate symptom score sheet scored out of

A

Total score is out of 35

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14
Q

What are the ranges on the International prostate symptom score sheet

A

Mild: 0-7 Moderate: 8-19 Severe: ≥ 20

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15
Q

What areas do you examine if if patient has LUTS

A

Abdomen Penis Urinalysis

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16
Q

What do you examine in the abdomen in patient with LUTS symptoms

A

palpable bladder

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17
Q

What do you examine on the penis in patient with LUTS symptoms

A

External urethral meatal stricture Phimosis Digital rectal examination (DRE) to assess prostate size Suspicious nodules or firmness

18
Q

What investigations should you do for LUTS

A

MSSU Bloods 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

19
Q

What do you inves in the urinalysis for patient with LUTS symptoms

A

Blood - PSA - Urine and creatinine (if chronic urinary retention) Signs of UTI

20
Q

What is treatment for uncomplicated LUTS from prostate disease

A

Watchful waiting Medical therapy Surgical intervention

21
Q

What medicines are used for treatment for uncomplicated LUTS from prostate disease

A

Alpha blockers 5 alpha reductase inhibitors (Finasteride or Dutasteride) Combination of both ^^

22
Q

What can be done surgically for treatment for uncomplicated LUTS from prostate disease

A

TURP (prostate size <100cc) (transurethral resection of prostate) Open retropubic or transvesical prostatectomy (prostate size >100cc) Endoscopic ablative procedures

23
Q

What is treatment for complicated LUTS from prostate disease

A

No role for Medical therapy (except for acute urinary retention) Most patients will require surgery eg. cystolitholapaxy and TURP for patients with BPO and bladder stones Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications)

24
Q

What is the main treatment for Lower Urinary Tract Symptoms due to Benign Prostate Obstruction

A

Alpha blockers

25
Q

What do alpha blockers do

A

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

26
Q

How do alpha blockers work

A

Smooth muscle of bladder neck (i.e. intrinsic urethral sphincter) and prostate innervated by sympathetic alpha-adrenergic nerves (mostly alpha-1a subtype

27
Q

What are the different categories of alpha blocker

A

Non-selective Selective short Selective long Highly selective

28
Q

What are the non selective alpha blockers

A

phenoxybenzamine

29
Q

What are the selective short acting alpha blockers

A

prazosin, indoramin

30
Q

What are the selective long acting alpha blockers

A

alfuzosin, doxazosin, terazosin

31
Q

What are the highly selective alpha blockers

A

tamulosin

32
Q

What is the prefferred alpha blocker and why

A

Tamsulosin (best as stops older people falling over when they stand up)

33
Q

What is a possible side effect of alpha blockers

A

Can give retrograde ejaculation

34
Q

What do 5a-reductase inhibitors do to the prostate

A

Reduces prostate size and reduces risks of progression of BPE (but only if >25cc prostate)

35
Q

What does 5a-reductase do in the body

A

5a-reductase converts testosterone to dihydrotestosterone

36
Q

What drugs is best for treating the LUTS symptoms

A

Combination therapy of 5ARIs + alpha blockers most effective in reducing risk of progression of BPE and can also reduce prostatic vascularity and hence reduces haematuria due to prostatic bleeding

37
Q

What is a possible side effect of 5a-reductase inhibitors

A

Can give erectile dysfuction

38
Q

When can you start 5a-reductase inhibitors

A

Need to determine size before starting and only really start if its beyond a certain size

39
Q

What are possible complications of Benign outlet obstruction (x7)

A

Progression of LUTS (worsening) Acute urinary retention (painful) Chronic urinary retention (painless) Urinary incontinence (overflow) UTI Bladder stone formation Renal failure from obstructed ureteric outflow due to high bladder pressure

40
Q

What is TURP

A

Transurethral resection of prostate (TURP) - GOLD STANDARD

Urinary (13 decks)

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