case 8 - structure and function of the prostate gland Flashcards
what is benign prostate enlargement
clincal
what is benign prostatic hypertrophy
histologic - increase in size
what is benign prostatic hyperplasia
histologic - increase in the number of the cells
what is benign prostatic obstruction
urodynamic
what are the storage/irritative LUT symptoms
frequency
Nocturia - definition: voiding more than two times at night
Urgency
Urge incontinence - when you actually leak urine
what are the voiding/obstructive symptoms of
hesitancy
Poor steam
Straining
Intermittency
Feeling of incomplete voiding
post micturition
Feeling of incomplete emptying
what is dysuria
pain
what is haematuria
blood in urine - most concernng
what is leak in the night
Leak in the night - enuresis - sign of incontinence and bladder is overflowing - may effect the kidney
what is pedal oedema
Pedal edema (foot and ankle swelling) is one of the cardinal signs of congestive heart failure (HF) but can also be due to other systemic or local conditions, including chronic kidney disease, liver disease, thyroid disorders, venous insufficiency, and venous thrombosis1
what can be seen in genitalia on examination
Genitalia - phimosis, meatal stenosis - narrowing of the opening, swelling/tenderness of testis or epidydimyis
what is the normal finding on rectal examination
rubbery, smooth, midline groove
what are the neurological examination tests
Neurological bulbocarvernosal reflex, lower limb reflexes - very important to check the internal sphincter
what are the differential diagnoses
prostate - benign enlargement/cancer
Bladder - overactive/underactive
Urethra - stricture
Infection - cystitis/prostatitis
Psychological - anxiety
what is the structure of the prostate
inverted pyramid
15-20gms
2 by 3 by 4cm
Consists of smooth muscle, stromal and glandular
Ratio changes with disease
what are the functions of the prostate
fertility
Prostatic specific antigen (PSA) enzyme = semen liquefaction
Antegrade ejaculation - musculus enjaculatorious
Contributes to 25% ejaculate volume - acidic
Milieu for sperm to thrive Nutrition Antimicrobial (Zn, selenium)
what is the pathogenesis of BPH
increase in number of cell vs reduced apoptosis
Androgen/oestrogen ratio - receptor signalling - older men start to produce more oestrogen
Imbalance of growth factors - EGF, KGF, IGF vs TGF (TGF is the only growth factor that reduces the growth of the prostate)
Static component - size of the gland
Dynamic component - smooth muscle action
where does most BPH happen
in the transitional zone
what are the investigations
urinalysis and msu for culture - infection or haematuria
Urea electrolytes and creatinine
PSA
Flowrate and post void scan
DRE does not increase PSA
what assesses the symptom severity
the IPSS scale
scores: 1-7 mild, 8-19 moderate and >20 severe
what are the other treatments used
medical - alpha blockers, 5 alpha reductase inhibitors, anticholinergics combinations
Catheters
Minimally invasive
Surgery
what are examples of alpha reductase inhibtors
e.g finasteride, dutasteride
what are the advantages of alpha reductase inhibitors
symptomatic relief
Shrink prostate
Reduce risk of retention
Promote hair growth in male pattern baldness
what are the disadvantages of alpha reductase inhibitors
slow onset
Reduced libido/weak erection
Gynaecomastia
Affect PSA
what are the surgical options
transurethral resection of prostate TURP
Holmium enucleation of prostate HoLEP
what is inclusion health
Inclusion health is a growing discipline that aims to prevent and redress health and social equities among people in extremes of poor health due to poverty, marginalisation and multiple morbidity.
what are the objectives of inclusion health
The objectives of Inclusion Health are:
* Focus: to increase the understanding and visibility of the health needs and outcomes of socially excluded groups; and to establish clear accountability at local and national levels
* Voice: to provide a strong ‘voice’ and advocacy for the most disadvantaged and those who work with them, ensuring that strategic planning and commissioning processes adequately address their needs
* Personalisation: to promote flexible and tailored responses to complex needs that bridge specialist and mainstream services and ensure continuity of care
* Quality and innovation: to drive improvements in quality and standards of services; promoting innovation in service design and delivery; and to build evidence about what works
* Recovery: to ensure services support clients to continually improve by raising health aspirations, improving continuity of care, and building capabilities and capacity for individuals to take control of their lives
* Professional development: to recognise the achievements of professionals and researchers in this demanding specialist field and support their progression; to build connections between professionals and across disciplines; and to exploit the synergies between clinical and social models of care
what is equality
The assumption is that everyone benefits from the same supports. This is equal treatment
what is equity
Everyone gets the supports they need (this is the concept of affirmative action thus producing equity)
what is justice
The causes of the inequity was addressed. The systemic barrier has been removed.
what is at the top of maslows hierarchy of needs
self acutalisation
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