Benign Diseases of the Prostate Flashcards
Name the different area’s of the prostate from centre outwards
Known as Mcneal’s Zones
Transition zone - wraps around the urethra
Central zone
Peripheral zone - where more cancers occur
Anterior fibromuscular stroma
What do the following stand for - BPE, BPH, BPO, BOO, LUTS
BPE - Benign prostatic enlargement BPH - "" "" hyperplasia BPO - "" "" obstruction BOO - bladder outflow obstruction LUTS - Lower urinary tract symptoms
What is BPH characterised by?
Fibromuscular and glandular hyperplasia
Presents with LUTS
What zone does BPH affect?
Transition zone
Prevalence of BPH?
Part of ageing process in men - 50% of men will have it by 60 and 90% by 85
What are the LUTS?
Voiding:
- Hesitancy
- Poor Stream
- Terminal dribbling
- Incomplete Emptying
Storage:
- Frequency
- Nocturia
- Urgency/urge incontinence
Other:
- Intermittency
- Straining
Signs on examination of a BOO?
Palpable bladder
External urethral meatus stricture
Phimosis
Mass on Digital Rectal Exam (mostly BPH)
What is phimosis?
Inability to retract foreskin
Investigations for a UTO?
Midstream urine sample
Flow Rate Study
Post-void bladder ultrasound (looking for residual)
Bloods:
- PSA
- U&C (only if in chronic retention)
Renal tract ultrasound
Cystoscopy - Good for BPE, cancer & strictures
Medical treatment of BPH?
Alpha blockers to relax smooth muscle
5-alpha-reductase inhibitors which reduces prostate size by metabolizing testosterone
Surgical treatment for BPH?
Trans-Urethral-Resection of prostate - TURP
Open prostatectomy
Endoscopic ablative procedures
What makes a BPH complicated?
Acute or chronic urinary retention Urinary Incontinence UTI Bladder Stone Renal Failure (due to hydronephrosis)
How can we treat a complicated BPH if they’re not fit for TURP?
- Long term urethral catheter
- CISC (clean intermittent self Catheterisation)
Acute vs chronic urinary retention?
Acute: Painful inability to void bladder
Chronic - painless incomplete voiding, may have LUTS, UTIs or overflow incontinence (bed wetting)
Both have a palpable bladder
Causes of acute urinary retention?
Usually BPH
Triggers of BPH?
Natural ageing process
constipation or a urological procedure.
AUR treatment?
Catheterise and start treatment for BPH
Causes of chronic urinary retention?
Detrusor underactivity
Largely due to primary bladder failure or a longstanding BOO
Chronic urinary retention treatment?
Catheterisation followed by clean intermittent self Catheterisation
TURP can be considered
Chronic urinary retention varies from very dangerous to less dangerous - how can you tell what state patient is in?
High pressure retention - incontinent, raised creatinine and causes bilateral hydronephrosis
Low pressure retention is less dangerous. Its usually dry, Cr is normal and the kidneys are ok.
Both are painless
Is TURP better for high or low pressure CUR?
TURP in CUR has a less successful outcome than for AUR but better in low pressure than high
What are the major complications when you treat urinary retention?
Post-obstructive diuresis
Decompression haematuria
What is post-obstructive diuresis, what does it cause5 and how do you manage it?
Massive UO >200ml/hr which can lead to life-threatening hypotension, weight loss and Electrolyte abnormalities
IV fluids resus and then a long term catheter, CISC or TURP.
What is decompression haematuria?
Shearing of the small vessles during decompression because of different compliance between different tissue layers.
Usually self-limiting
