Deck 1 - GU Flashcards
Q. Name two voiding symptoms, and two storage symptoms in men
A. Voiding: poor flow, hesitancy, intermittency, spraying
B. Storage: urgency, nocturia
C. (post micturition: dribbing)
Q. Describe two warning (red flags) LUTS symptoms
A. Pain, haematuria, nocturnal waking, weight loss
Q. Name the symptom assessment used to access LUTS in men
A. International prostate score
Q. Name two investigations that should be carried out to further investigate prostate/LUTS symptoms
A. Urinary flow rate, max flow rate, post void bladder residual, dip test, PSA, creatinine, U&Es (frequency volume chart)
- Q. What is nocturnal polyuria? What condition is it associated with?
A. >30% voided volume at night – associated with sleep apnoea
- Q. Name in two conditions that are associated with a high PSA
A. Increased in BPH, urinary infection, prostate cancer
B. (age adjusted, small amounts in blood usually, produced by the prostate)
- Q. Describe a conservative treatment for BPH
A. Mild symptoms: reassure, watchful waiting
B. Moderate to severe: fluid management, avoid caffeine/alcohol, bladder drill
- Q. Name two indications for surgery
A. (RUSHES): retention, UTIs, stones, haematuria (refractory to 5-ARI), elevated creatinine due to bladder outlet obstruction (blockage at the base of the bladder), symptom deterioration
- Q. Name 2 surgical treatments of BPH, name a side effect
A. TURP: incontinence, erectile dysfunction, retrograde ejaculation risk
B. Open prostatectomy (larger prostates, increased morbidity), holmium enucleation of the prostate, green light laser
- Q. Describe two pharmacological treatments of BPH, describe the mechanism and give an example for each
A. 5-alpha-reductase-inhibitors: Inhibits the conversion of testosterone from dihydrotesterone in prostatic cells: this causes prostatic cells apoptosis, reduces size of prostate by 20-30%
e.g. Finasteride, dutasteride
B. Alpha-blockers: smooth muscle in prostate and bladder neck in innervated by symptomatic nerves – improves urinary flow, works quickly, orthostatic hypotension (elderly falls risk), side effects: retrograde ejaculation
e.g. Tamsulosin and alfuzosins
- Q. Name two complications of untreated LUTs
A. Bladder calculi, UTI, bladder compensation, urinary incontinence, haematuria, acute urinary retention, reduction in QOL (sleep loss, social isolation)
- Q. Name two important causes of acute urinary retention, name two associated signs
A. Spinal cord compression, prostate cancer (BPE etc)
B. Signs: paraesthesia esp saddle tone, leg weakness, loss of anal reflex/anal tone
- Q. Name two treatment options for acute urinary retention
A. Alpha-blocker, if fails surgery (TURP), long term catheter, (Treat predisposing factors/UTI, constipation etc)
- Q. Name 2 prerenal, intrarenal, post-renal causes of renal failure
A. Prerenal: sudden or severe drop in blood pressure/blood flow to kidney (trauma, Injury, illness)
B. Intrarenal: direct damage to kidney by inflammation, toxins, drugs, infection or reduced blood supply
C. Post-renal: sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury
- Q. What masses may cause an obstructive uropathy, where are they most likely to be located?
A. In the lumen: stones
B. In the wall: ureteric bladder or prostate tumour, BPH (high pressure retention)
C. Extrinsic: pelvic mass (tumour, node etc)
- Q. What neural centres are activating during storage and during voiding?
A. During storage: Pontine centre PSC and Onuf’s stimulated
B. During voiding: Pontine centre PMC and destrusor activated
- Q. Describe the neural control of the lower urinary tract
A. Parasympathetic (Cholinergic) S3-5 a. Drive detrusor contraction b. Pelvic nerve: Acts on M3 receptors ACh B. Sympathetic (Noradrenergic) T10-L2 a. Urethral contraction b. Hypogastric nerve: acts on Beta-3 receptors c. Inhibit detrusor contraction C. Non-adrenergic non-cholinergic
- Q. What are the three compartments of the penile shaft? Describe the arterial supply
A. 2 X corpora cavernosa, corpus spongiosum
B. Arterial supply: Internal iliac – internal pudendal artery – dorsal penile artery (glans penis anastomoses with terminal bulbar arteries), cavernosal artery/deep penile arteries (spongy tissue of corpura), bulbar artery
- Q. What sympathetic and parasympathetic nerves supply the penis?
A. Parasymp: S2-4
B. Symp: S2-4
- Q. What is the dominant chemical mediator for smooth muscle relaxation?
A. NO: released from both parasympathetic terminals and vascular endotheliums
- Q. Name two causes of acquired low testosterone
A. Primary: pituitary, hypothalamus
B. Secondary: tumour/injury/drug affects to testes
- Q. Name some hormonal causes of erectile dysfunction
A. Testosterone deficiency: pituitary/hypothalamic failure (Tx = testosterone replacement)
- Q. Name two treatments for erectile dysfunction
A. First line: phosphodiesterase (PDE5) inhibitors – increase arterial blood flow, vasodilation and erection (Nitric oxide) e.g. sildenafil (Viagra), tadalafil, vardenafil
B. Second line: apomorphine SL, intracavernous injections, intraurethral alprostadil, vaccum devices
