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Renal Pathology > Benign Diseases of the Prostate > Flashcards

Benign Diseases of the Prostate Flashcards

1
Q

What type of organ is the prostate?

A

A secondary sexual organ

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2
Q

How many sphincters do men and women have?

A

Men - 2

Women - 1

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3
Q

Function of prostate

A

Capacitation - makes the sperm work

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4
Q

What are McNeals Prostatic Zones?

A

Transition zone
Central zone
Peripheral zone

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5
Q

Which McNeals zone does prostate cancer usually lie in?

A

Peripheral zone

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6
Q

What are the benign prostatic diseases?

A

Benign prostatic enlargement (BPE)
Benign prostatic hyperplasia (BPH)
Benign prostatic obstruction (BPO)
Benign outflow obstruction (BOO)

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7
Q

What does LUTS stand for?

A

Lower urinary tract symptoms

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8
Q

What is benign prostatic hyperplasia?

A

Fibromuscular and glandular hyperplasia of the prostate. A progressive condition that results in BOO

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9
Q

What % of men have BPH at 60 and 85 y/o?

A

60 y/o = 50%

85 y/o = 90%

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10
Q

What are the LUTS?

A 
Hesitancy 
Poor stream 
Terminal dribbling
Incomplete emptying 
Frequency 
Nocturia 
Urgency +/- urge incontinence
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11
Q

Types of LUTS

A

Voiding

Storage

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12
Q

What is the scoring system for the assessment of LUTS?

A

IPSS

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13
Q

What is a normal peeing frequency?

A

4-6x a day

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14
Q

Normal urine capacity for women vs men

A

Women - 400ml

Men - 500ml

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15
Q

Examination for LUTS

A 
Abdomen - palpable bladder
Penis 
- external urethral meatal stricture
- phimosis
DRE
- prostate size
- nodules or firmness
Urinalysis 
- bloods
- UTI
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16
Q

Investigations of LUTS

A

MSSU
Flow rate study
Post void bladder residual USS
Bloods
- PSA
- urea and creatinine (if chronic retention)
Renal tract USS (if renal failure or bladder stone suspected)
Flexible cystoscopy haematuria
Urodynamic studies in selected cases
TRUS-guided prostate biopsy if PSA raised or abnormal DRE

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17
Q

What is PSA?

A

Serum protease which is in the blood, specific to the prostate NOT cancer - used to detect size

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18
Q

Types of BPO

A

Uncomplicated

Complicated

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19
Q

Treatment for uncomplicated BPO

A

Watchful waiting
Alpha blockers
5 alpha reductase inhibitors (finasteride or dutasteride)
Surgery
- TURP
- Open retropubic or transvesical prostatectomy
- endoscopic ablative procedures

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20
Q

When is TURP done vs open retropubic or transvesical prostatectomy to treat BPO?

A

TURP = prostate size < 100cc

Other one = Prostate size > 100cc

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21
Q

Complications of BPO

A 
Progression of LUTS
Acute urinary retention 
Chronic urinary retention 
Urinary incontinence (overflow)
UTI
Bladder stone
Renal failure from obstructed ureteric outflow due to high bladder pressure
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22
Q

What are alpha blockers the main treatment of?

A

LUTS due to BPO

23
Q

What does the sympathetic alpha-adrenergic nerves innervate?

A

Smooth muscle of the bladder neck (i.e. intrinsic urethral sphincter) and prostate

24
Q

What do alpha blockers cause?

A

Smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction

25
Q

Types of alpha blockers

A 
Non selective (alpha 1 and 2); phenoxybenzamine 
Selective short acting; prazosin, indoramin 
Selective long acting; alfuzosin, doxazosin 
Highly selective (alpha 1a - Tamsulosin)
26
Q

What do 5-reductase inhibitors do?

A

Convert testosterone to dihydrotestosterone

27
Q

Examples of 5-reductase inhibitors

A

Finasteride

Dutasteride

28
Q

Role of 5AIRs

A

Reduce prostate size and reduces risk of progression of BPE
Reduces LUTS
Reduces prostatic vascularity and reduces haematuria due to prostatic bleeding
Potential role in prostate cancer prevention

29
Q

What does TURP stand for?

A

Transurethral resection of prostate

30
Q

What is the gold standard surgery for prostate surgery?

A

TURP

31
Q

Complications of TURP

A 
Bleeding
Infection 
Retrograde ejaculation 
Stress urinary incontinence 
Prostatic regrowth causing haematuria or BOO
32
Q

Treatment of complicated BPO

A

Medical therapy
Surgery
Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications)

33
Q

What are some alternative treatment options for e.g. if patients are unfit for surgery

A

Long term urethral or suprapubic catheterisation

Clean intermittent self-catheterisation

34
Q

Definition of acute urinary retention

A

Painful inability to void with a palpable and percusable bladder

35
Q

Residuals In acute urinary retention

A

Vary from 500ml > 1 litre depending on lag time in seeking medical attention

36
Q

What is the main risk factor for acute urinary retention?

A

BPO

37
Q

For those with BPO, what can acute urinary retention be caused by?

A

Spontaneously

Triggers

38
Q

What are some triggers for acute urinary retention in people with BPO?

A

Constipation
Alcohol excess
Post op cases
Urological procedures

39
Q

Immediate treatment of acute urinary retention

A

Catheterisation (either urethral or suprapubic)

40
Q

Complications of acute urinary retention

A 
UTI
Post decompression haematuria
Pathological diuresis
Renal failure
Electrolyte abnormalities
41
Q

Longer term treatment of acute urinary retention

A

Treat underlying trigger if present
If no renal failure start alpha blocker immediately
Remove catheter in 2 days
60% will void successfully, if fail to void, catheterise and organise TURP (after 6 weeks)

42
Q

Definition of chronic urinary retention

A

Painless, palpable and percusable bladder after voiding

43
Q

Residuals in chronic urinary retention

A

Patients often able to void but with residuals ranging from 400ml to > 2 litres depending on the stage of the condition (i.e. wide spectrum)

44
Q

Main causative factor of chronic urinary retention

A

Detrusor underactivity

45
Q

Types of detrusor underactivity

A

Primary

Secondary

46
Q

Causes of primary detrusor underactivity

A

Primary bladder failure

47
Q

Causes of secondary detrusor underactivity

A

Longstanding BOO e.g. due to BPO or urethral stricture

48
Q

Presentation of chronic urinary retention

A

LUTS

Complications

49
Q

Complications of chronic urinary retention

A 
UTI
Bladder stones
Overflow incontinence
Post renal or obstructive renal failure
Post decompression haematuria 
Pathological diuresis
Electrolyte abnormalities
- hyponatraemia 
- hyperkalaemia
- metabolic acidosis
Persistent renal dysfunction due to acute tubular necrosis
50
Q

When does overflow incontinence and renal failure occur in chronic urinary retention?

A

At the severe end of the spectrum, when bladder capacity is reached and bladder pressure is in excess of 25cm water (i.e. decompensated chronic urinary retention or acute-on-chronic urinary retention or high pressure chronic urinary retention)

51
Q

Patients with chronic urinary retention who are asymptomatic with low residuals, do they always need treatment?

A

No

52
Q

Immediate treatment of chronic urinary retention

A

Catheterisation (either urethral or suprapubic initially, followed by CISC if appropriate)

53
Q

Features of pathological diuresis

A

Urine output > 200ml/hr
Postural hypotension (systolic differential >200mmHg between lying and standing)
Weight loss
Electrolyte abnormalities

54
Q

Treatment of chronic urinary retention

A

IV fluids (total input = 90% of output)
Long term urethral or suprapubic catheter
CISC
TURP

Renal Pathology (13 decks)

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