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Urinary System > Benign Diseases of the Prostate > Flashcards

Benign Diseases of the Prostate Flashcards

1
Q

What is the average size of the prostate gland in men aged 25-30 years?

A

20cc

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2
Q

What are the McNeal’s prostatic zones?

A

Transition, central, peripheral and anterior fibromuscular

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3
Q

What are some benign prostate diseases?

A

Benign prostate enlargement - BPE
Benign prostate hyperplasia - BPH
Benign prostatic obstruction - BPO
Benign outflow obstruction - BOO
Lower Urinary Tract Symptoms - LUTS

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4
Q

What 3 benign diseases can be linked together?

A

LUTS
Bladder outflow obstruction
Benign prostatic enlargement

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5
Q

Describe benign prostatic hyperplasia

A

Characterised by fibromuscular and glandular hyperplasia
Predominantly affects transition zone
Disordered regulation of dihydrotestosterone
Part of ageing process in men - 50% at 60 yrs and 90% at 85yrs

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6
Q

What does BPH present as?

A

50% have moderate to severe LUTS
Progressive condition can result in BPO or BOO

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7
Q

How is LUTS assessed?

A

Symptoms scoring systems - IPSS total score is out of 35
Frequency volume charts

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8
Q

What are the LUTS - voiding?

A

Hesitancy, poor system, terminal dribbling, and incomplete emptying

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9
Q

What are the LUTS - irritative?

A

Nocturia, frequency, urgency and possible urge incontinence

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10
Q

What is included in the physical examination?

A

Abdomen - palpable bladder
Penis - external urethral meatal stricture and phimosis
Digital rectal exam - assess prostate size and suspicious nodules and firmness
Urinalysis - blood and signs of UTI

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11
Q

What investigations are done?

A

MSSU, flow rate study, post-void bladder residual USS, bloods - PSA, urea and creatinine, renal tract USS, flexible cystoscopy if haematuria, urodynamic studies and TRUS guided prostate biopsy if PSA raised

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12
Q

What are the types of BPO?

A

Uncomplicated BPO - no complications
Complicated BPO

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13
Q

What is the treatment for uncomplicated BPO?

A

Watchful waiting if mild symptoms
Medical therapy - 5 alpha reductase inhibitors, alpha blockers and combo. therapy
Surgical intervention

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14
Q

What is the surgical intervention for uncomplicated BPO?

A

TURP - prostate size is less than 100cc
Open retropubic or trans vesical prostatectomy
Endoscopic ablative procedures

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15
Q

Describe alpha blockers

A

Main treatment for LUTS due to BPO
Smooth muscle of bladder neck and prostate innervated by sympathetic alpha adrenergic nerves
Cause smooth muscle relaxation and antagonise dynamic element to prostatic obstruction

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16
Q

What are the types of alpha blockers?

A

Non selective - phenoxybenzamine
Selective short acting - prazosin and indoramin
Selective long acting - alfuzosin, doxazosin and terazosin
Highly selective - Tamsulosin
Equally effective but different side profiles

17
Q

Describe 5a reductase inhibitors

A

Converts testosterone to dihydrotestosterone
2 drugs available - finasteride and dutasteride
Combo. of 5ASI and alpha blocker is most effective in reducing risk of progression of BPE

18
Q

What are the roles of 5ARIs?

A

Reduces size of prostate and reduces risk of progression of BPE
Also reduces LUTS but no as effective as alpha blockers
Can reduce prostatic vascularity and haematuria
Potential role in prostate cancer prevention

19
Q

What is the gold standard for surgical management of BPE causing BOO?

A

TURP - transurethral resection of prostate

20
Q

Describe TURP

A

Transurethral resection of the prostate
Can be done using glycine or saline
Very effective in relieving symptoms and improves dynamic parameters

21
Q

What are the complications of TURP?

A

Bleeding, infection, retrograde ejaculation, stress urinary incontinence, prostatic regrowth causing recurrent haematuria or BOO

22
Q

What prostate size is TURP used?

A

> 100cc is too large for TURP - high risk of bleeding, fluid overload, hypothermia and TUR syndrome

23
Q

What is TUR syndrome?

A

Triad of dilutional hyponatraemia, fluid overload and glycine toxicity

24
Q

What are the complications of BPO?

A

Progression of LUTS, acute and chronic urinary retention, urinary incontinence, UTI, bladder stone and renal failure from obstructed ureteric outflow

25
Q

What is the treatment for complicated BPO?

A

No role for medical therapy except acute urinary retention
Most patients require surgery

26
Q

What are some alternative treatment options for complicated BPO?

A

Long term urethral or suprapubic catheterisation
Clean intermittent self-catheterisation
Can develop catheter problems, blockages, frank haematuria and recurrent UTIs

27
Q

What is the definition of acute urinary retention?

A

Painful inability to void with a palpable and percussable bladder
Residuals vary from 500ml-1l

28
Q

What is the immediate treatment of acute urinary retention?

A

Catheterisation
If no renal failure then start on alpha blocker immediately and remove catheter in 2 days

29
Q

What are the complications of acute urinary retention?

A

UTI, post-decompression haematuria, pathological diuresis, renal failure and electrolyte abnormalities

30
Q

What is the definition of chronic urinary retention?

A

Painless, palpable and precussible bladder after voiding
Patients often void and have residuals with 400ml-2l

31
Q

What is the main aetiological factor for chronic urinary retention?

A

Detrusor muscle underactivity

32
Q

How does chronic urinary retention present?

A

LUTS or complications
Outflow obstruction and renal failure occur at severe stage

33
Q

What is the treatment for chronic urinary retention?

A

No treatment for asymptomatic
Symptoms and complications - catheterisation
Long term is TURP or CISC

34
Q

What are the complications of chronic urinary retention?

A

UTI, post-decompression haematuria, pathological diuresis, electrolyte abnormalities and persistent renal dysfunction

35
Q

What are the features of pathological diuresis?

A

Urine output more than 200ml/hr, postural hypertension, weight loss and electrolyte abnormalities

36
Q

What are some absolute indications for surgical intervention in patients with BPO?

A

Refractory acute urinary retention
Renal failure
Recurrent UTI
Failure of medical therapy to control symptoms

37
Q

What are common causes of acute urinary retention in men?

A

Spinal cord decompression
UTI
Constipation
Pain from laparotomy wound

38
Q

Short term urethral catheters should not be left in-situ for longer than?

A

4 weeks

39
Q

Long term urethral catheters should not be left in-situ for longer than?

A

12 weeks

Urinary System (26 decks)

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