benign prostate disease + urinary tract obstruction Flashcards
BPE
benign prostatic enlargement
BPH
benign prostatic hyperplasia
BPO
benign prostatic obstruction
BOO
bladder outflow obstruction
LUTS
lower urinary tract symptoms
benign prostatic hyperplasia
fibromuscular and glandular hyperplasia
affects transition zone
part of male ageing
LUTS: voiding (obstruction)
hesitancy
poor stream
terminal dribble
incomplete empytin g
LUTS: storage (irritative)
frequency
nocturia
urgerny
+/- urge incontinence
physical exam
abdnomen - palpable bladder?
penis - external urethral meatal stricture, paraphimosos
DRE - prostate
urinalysis
Ix
MSSU
PSA
urea and creatinint
USS
management BPO
watchful waiting
medical therapy - alpha blockers, 5 alpha reductase inhibitors
surgical - TURP, prostatecotmy, alblation
alpha blockers
main treatment of LUTS due to BPO
cause smooth muscle relaxation and antagonise dynamic element to prostatic obstruction
5-alpha reductase inhibitors
converts testosterone to dihydrotestosterone
what do 5-alpha reductase inhibitors do
reduce prostate size and risk progression BPE
reduce LUTS
TURP
transurethral resection of prostate
gold standard - v effective releiving symptoms
TURP complications
bleeding
infection
retrograde ejaculation
stess UI
complications of BOO
progression of LUTS acute urinary retention chronic urinary retention urinary incontince (overflow) UTI bladder stone renal failure
treatment of complicated BOO
surgery
long term cathetrisation
acute urinary retention
painful ability to void with a palpable and percussible bladder
acute urinary retention risk factors
BPO UTI urethral stricture alcohol excess post-op
acute urinary retention immediate treatment
catheterisation - urethral or suprapubic
chronic urinary retention
painless palpable and percussible bladder after voiding
pt able to void but residual volume
chronic urinary retention aetiology
detrusor underactivity:
- 1ry: bladder failure
- 2ry: longstanding BOO
chronic urinary retention presentation
LUTs
UTI
sotnes
overlfow incontinence
chronic urinary retention immediate Mx
catheterisation
upper urinary tract obstruction presentatoin
pain haematuria - frank, micro palpable mass infection renal failure
management of upper tract obstruction
IV access
Bloods, ABG, urine and blood cultures
IV fluid and ?antib
analgesia
lower urinary tract obstruction presentation
LUTs acute or chronic u retention recurrent UTI haematuria bladder stones renal failure
