BENIGN DISEASES OF THE PROSTATE AND URINARY TRACT OBSTRUCTION: Flashcards
What is the largest accessory gland of the male reproductive system?
Prostate gland
What is the function of the prostate gland?
To secrete protealytic enzymes into the semen
Where is the prostate located?
Inferior to the neck of the bladder
Anterior to the rectum
Why do males have 2 sphincters?
Because one system has both a reproductive and urological function
Which zone of the prostate do tumours typically affect?
peripheral zone
Which zone of the prostate does majority of benign prostatic enlargement occur?
Transitional zone
In the centre
What is the effect of benign prostatic enlargement mainly occurring at the transitional zone?
Pushing on the urethra and causing LUTS
What is BPE?
Benign prostatic enlargement
What is BPH?
Benign prostatic hyperplasia
What is BPO?
Bladder prostatic obstruction
What is LUTS?
Lower urinary tract symptoms
What is benign prostastic hyperplasia chracterised by?
Fibromuscular and glandular hyperplasia
Who does BPE commonly occur in?
Aging men
What is BOO?
Bladder outflow obstruction
What system scores LUTS?
IPSS
What is a mild, moderate and severe IPSS score?
Mild: 0-7
Moderate: 8-19
Severe: 20-35
What would voiding symptoms include?
Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying
What would storage LUTS include?
Frequency
Nocturia
Urgency
+/- urgency incontinence
What could be found on examination for BPE?
Palpable bladder External urethral stricture Phimosis Nodule or firmness of prostate Haematuria
What investigations should be done for BPE?
MSSU Flow rate study Post void bladder residual USS Bloods Renal USS Flexible cystocopy
What blood should be done for BPE?
PSA
Urea and creatinine
When should a renal US be performed?
If renal failure of bladder stone is suspected
When is a flexible cystocopy carried out?
If there is haematuria present
When is a prostate biopsy carried out?
If PSA is positive
What is the treatment for uncomplicated BPO?
Watchful waiting
What is medical therapy Rx for uncomplicated BPO?
5 alpha reductase inhibitors
What is the mechanism of alpha blockers?
Smooth muscle relaxation in internal urethral sphincter and prostate
Which alpha blocker is standard treatment in UK?
Tamsuloin
What is the action of 5 alpha reductase inhibitors?
Convert testosterone to dihydrotestosterone
What is the effect of Converting testosterone to dihydrotestosterone?
Reduced prostatic size and risk of progression of BPE
What is the surgical treatment for BPE if prostate <100cc?
Transurethral resection of prostate
TURP
What are potential complications of BPO?
Progression of LUTS Acute of chronic urinary retention Urinary incontinence UTI Bladder stone Renal failure due to hydronephrosis
What is acute urinary retention defined as?
Painful inability to void with a palpable and percussible bladder
What is the main risk factors for acute urinary retention?
BPO
BPE
What is the immediate treatment for acute urinary retention?
Catheterisation
What is the medical treatment for acute urinary retention?
Alpha blocker immediately
Remove catheter in 2 days
What is the next line treatment for acute urinary retention that has been treated but still inability to void?
Recatheterise and organise TURP
What is chronic urinary retention?
Painless palpable and percussible bladder after voiding
What is the main cause of chronic urinary retention?
Detrusor underactivity
How does chornic urinary retention present?
LUTS of complications or incidental finding
What symptoms and signs are found at the severe end of the spectrum for chronic urinary retention?
Overflow incontinence
Renal failure
What is the treatment for chronic urinary retention?
Catheterisation
When is chronic urinary retention treated?
When patients are symptomatic
What are some complications of chronic urinary retention?
UTI
Haematuria
Pathological diuresis
Electrolyte abnormalities
How should chronic urinary retention be managed?
IV fluids
Long Term catheterisation
TURP
What are causes of upper tract urinary obstruction?
TCC tumours Stones Blood clots Scar tissue Abdo or pelvis mass Lymph nodes
Where do upper tract obstructions commonly occur?
PUJ
Ureter
VUJ
What are the signs and symptoms of upper tract obstruction?
Panin - flank +/- loin
Haematuria
Palpable mass
What are potential complications of upper tract obstruction?
Infection
Sepsis
Renal failure
What are investigations for upper tract obstruction?
USS
CT
What is resus management for upper tract obstruction?
ABCs Bloods Urine.blood cultures Broad spectrum AB Analgesia
What is the emergency management for upper tract obstruction?
Percutaneous nephrostomy insertion
Retrograde stent insertion
What is the definitive treatment for upper tract obstruction?
Treat underlying cause
How would a stone be treated?
Ureteroscopy
Laser lithotripsy
How would a tumour be treated?
Nephroureterectomy
What is the main cause of lower tract obstruction?
BPH
What is a cause of urethral lower tract obstruction?
Urethral meatus
Foreskin
What are signs and symptoms of lower tract obstruction?
Voiding LUTS
Storage LUTS
Intermittency
Straining
What is definitive management for chronic urinary retention?
Treat cause
How would you treat BPE?
Alpha blocker
5 alpha reductase inhibitor
TURP (transurethral resection of prostate)
How would you treat a urethral stricture?
Optical urethrotomy
How would you treat meatal stenosis?
Meatal dilatation
How would you treat phimosis?
Circumcision
What investigations is used in benign prostatic hyperplasia to grade symptoms?
International Prostate Symptom Score (IPSS)
