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Urology > BENIGN DISEASES OF THE PROSTATE AND URINARY TRACT OBSTRUCTION: > Flashcards

BENIGN DISEASES OF THE PROSTATE AND URINARY TRACT OBSTRUCTION: Flashcards

1
Q

What is the largest accessory gland of the male reproductive system?

A

Prostate gland

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2
Q

What is the function of the prostate gland?

A

To secrete protealytic enzymes into the semen

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3
Q

Where is the prostate located?

A

Inferior to the neck of the bladder

Anterior to the rectum

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4
Q

Why do males have 2 sphincters?

A

Because one system has both a reproductive and urological function

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5
Q

Which zone of the prostate do tumours typically affect?

A

peripheral zone

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6
Q

Which zone of the prostate does majority of benign prostatic enlargement occur?

A

Transitional zone

In the centre

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7
Q

What is the effect of benign prostatic enlargement mainly occurring at the transitional zone?

A

Pushing on the urethra and causing LUTS

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8
Q

What is BPE?

A

Benign prostatic enlargement

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9
Q

What is BPH?

A

Benign prostatic hyperplasia

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10
Q

What is BPO?

A

Bladder prostatic obstruction

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11
Q

What is LUTS?

A

Lower urinary tract symptoms

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12
Q

What is benign prostastic hyperplasia chracterised by?

A

Fibromuscular and glandular hyperplasia

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13
Q

Who does BPE commonly occur in?

A

Aging men

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14
Q

What is BOO?

A

Bladder outflow obstruction

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15
Q

What system scores LUTS?

A

IPSS

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16
Q

What is a mild, moderate and severe IPSS score?

A

Mild: 0-7
Moderate: 8-19
Severe: 20-35

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17
Q

What would voiding symptoms include?

A

Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying

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18
Q

What would storage LUTS include?

A

Frequency
Nocturia
Urgency
+/- urgency incontinence

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19
Q

What could be found on examination for BPE?

A 
Palpable bladder
External urethral stricture 
Phimosis 
Nodule or firmness of prostate
Haematuria
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20
Q

What investigations should be done for BPE?

A 
MSSU 
Flow rate study
Post void bladder residual USS 
Bloods 
Renal USS 
Flexible cystocopy
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21
Q

What blood should be done for BPE?

A

PSA

Urea and creatinine

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22
Q

When should a renal US be performed?

A

If renal failure of bladder stone is suspected

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23
Q

When is a flexible cystocopy carried out?

A

If there is haematuria present

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24
Q

When is a prostate biopsy carried out?

A

If PSA is positive

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25
Q

What is the treatment for uncomplicated BPO?

A

Watchful waiting

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26
Q

What is medical therapy Rx for uncomplicated BPO?

A

5 alpha reductase inhibitors

27
Q

What is the mechanism of alpha blockers?

A

Smooth muscle relaxation in internal urethral sphincter and prostate

28
Q

Which alpha blocker is standard treatment in UK?

A

Tamsuloin

29
Q

What is the action of 5 alpha reductase inhibitors?

A

Convert testosterone to dihydrotestosterone

30
Q

What is the effect of Converting testosterone to dihydrotestosterone?

A

Reduced prostatic size and risk of progression of BPE

31
Q

What is the surgical treatment for BPE if prostate <100cc?

A

Transurethral resection of prostate

TURP

32
Q

What are potential complications of BPO?

A 
Progression of LUTS
Acute of chronic urinary retention 
Urinary incontinence
UTI 
Bladder stone 
Renal failure due to hydronephrosis
33
Q

What is acute urinary retention defined as?

A

Painful inability to void with a palpable and percussible bladder

34
Q

What is the main risk factors for acute urinary retention?

A

BPO

BPE

35
Q

What is the immediate treatment for acute urinary retention?

A

Catheterisation

36
Q

What is the medical treatment for acute urinary retention?

A

Alpha blocker immediately

Remove catheter in 2 days

37
Q

What is the next line treatment for acute urinary retention that has been treated but still inability to void?

A

Recatheterise and organise TURP

38
Q

What is chronic urinary retention?

A

Painless palpable and percussible bladder after voiding

39
Q

What is the main cause of chronic urinary retention?

A

Detrusor underactivity

40
Q

How does chornic urinary retention present?

A

LUTS of complications or incidental finding

41
Q

What symptoms and signs are found at the severe end of the spectrum for chronic urinary retention?

A

Overflow incontinence

Renal failure

42
Q

What is the treatment for chronic urinary retention?

A

Catheterisation

43
Q

When is chronic urinary retention treated?

A

When patients are symptomatic

44
Q

What are some complications of chronic urinary retention?

A

UTI
Haematuria
Pathological diuresis
Electrolyte abnormalities

45
Q

How should chronic urinary retention be managed?

A

IV fluids
Long Term catheterisation
TURP

46
Q

What are causes of upper tract urinary obstruction?

A 
TCC tumours 
Stones 
Blood clots
Scar tissue 
Abdo or pelvis mass 
Lymph nodes
47
Q

Where do upper tract obstructions commonly occur?

A

PUJ
Ureter
VUJ

48
Q

What are the signs and symptoms of upper tract obstruction?

A

Panin - flank +/- loin
Haematuria
Palpable mass

49
Q

What are potential complications of upper tract obstruction?

A

Infection
Sepsis
Renal failure

50
Q

What are investigations for upper tract obstruction?

A

USS

CT

51
Q

What is resus management for upper tract obstruction?

A 
ABCs
Bloods 
Urine.blood cultures 
Broad spectrum AB
Analgesia
52
Q

What is the emergency management for upper tract obstruction?

A

Percutaneous nephrostomy insertion

Retrograde stent insertion

53
Q

What is the definitive treatment for upper tract obstruction?

A

Treat underlying cause

54
Q

How would a stone be treated?

A

Ureteroscopy

Laser lithotripsy

55
Q

How would a tumour be treated?

A

Nephroureterectomy

56
Q

What is the main cause of lower tract obstruction?

A

BPH

57
Q

What is a cause of urethral lower tract obstruction?

A

Urethral meatus

Foreskin

58
Q

What are signs and symptoms of lower tract obstruction?

A

Voiding LUTS
Storage LUTS
Intermittency
Straining

59
Q

What is definitive management for chronic urinary retention?

A

Treat cause

60
Q

How would you treat BPE?

A

Alpha blocker
5 alpha reductase inhibitor
TURP (transurethral resection of prostate)

61
Q

How would you treat a urethral stricture?

A

Optical urethrotomy

62
Q

How would you treat meatal stenosis?

A

Meatal dilatation

63
Q

How would you treat phimosis?

A

Circumcision

64
Q

What investigations is used in benign prostatic hyperplasia to grade symptoms?

A

International Prostate Symptom Score (IPSS)

Urology (13 decks)

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