Definitions Flashcards
acute retention of urine
is defined as a painful, palpable or percussible bladder, when the patient is unable to pass any urine.
chronic retention
is defined as a non-painful bladder, which remains palpable or percussible after the patient has passed urine. Such patients may be incontinent
detrusor overactivity
is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked
overactive bladder syndrome
is characterised by urinary urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia, if there is no proven infection or other obvious pathology
BOOI
pdetQmax minus 2 x Qmax
more than 40 is obstructed
20-40 equivocal
less than 20 not obstructed
bladder contractility index
pdetQmax plus 5 x qmax
more than 150 strong
50-100 normal
less than 50 weak contractility
action of testosterone in embryology
stimulate wolffian ducts epididymis vas ampulla seminal vesicles common ejaculatory duct
action of DHT
stimulate male exeternal genitalia and prostate
at 16 weeks development prostate under influence DHT
action of androgen receptor
androgen binds
AR dissociates and undergoes compartmentalisation from the cytosol to the nucleus
origin of prostate tissue
glandular = endodermal plus urethra capsule and SM from mesenchymal origin ducts from wolffian ducts central zone from mesonephric duct rest from urogenital sinus
arterial supply prostate
internal iliac anterior branch inferior vesicle urethral group Badenock 5 and 7 Flock 11 and 1 capsular group run with cavernosal nerves
how much of prostate is stroma what is stroma made of how much is transitional zone central zone peripheral zone FM strome
40%
Smooth muscle
70% PZ of glandular tissue
central zone 25% glandular tissue
FM stroma 5%
10% glandular TZ
epithelial cell components
basal epithelial cells
luminal secretory epithelial cells
neuroendocrine cells
which cells secrete PSA
luminal epithelial cells
action of T and DHT on BPH
not sole cause
some role
BPH in older men and maintains responsiveness to androgens
DHT remains high with age
histological change BPH
increase number of epithelial and stromal cells
prevalence BPH
43% in 60s based on prostate more than 20g and flow rate less than 15
embryology of prostate week development action of SRY development of Wolffian ducts action recipricol induction stromal epithelial interaction
begins development week 10 and 16
SRY gene stimulates medullary sex cords in primitive testes to differentiate into sertoli cells
these secreate MIH
stimulates Leydif testosterone
development Wolffian ducts 8-12 weeks
DHT proliferation and budding of endoderm give rise of prostatic acini and glands
recipricol infuction is the process responsible formation of capsule and SM from surrounding mesenchyme
stromal-epithelial interaction relies on DHT production by stromal cells actiong on the AR of epithelial cells
histology of BPH
what are hyerplastic nodules made of
varying proliferations of glands and stroma
lumen have corpora amylacea which are laminated proteinaceous material
glands lined by double layered epithelium
see proliferating glands
stroma is also hyperplastic
zones of prostate eponymous name TZ CZ PZ final zone
McNeal's zones TZ 10% - BPH central 25% peripheral 65% anterior fibromuscular stroma
arterial supply prostate
From the inferior vesical artery arising from the internal iliac artery. The branch to the prostate divides into urethral branches (Flock’s arteries at 1 and 11 o’ clock and Badenock’s arteries at 5 and 7 o’clock) and capsular branches. The prostate also receives arterial supply from the middle rectal artery (also from the internal iliac) and the internal pudendal artery. Important later…..
BPH stromal vs epithelial component
BPH contains mainly stromal cells (88.4%), with only 9.0% epithelial cells suggesting the stromal cells may play more important roles in the development of BPH, even though both the stromal and epithelial components are involved in the development of BPH.
nocturnal polyuria
exceeding 20% of 24 hour urine output in young
and 33% of urine output in over 65
global polyuria
24 hour global polyuria
>40ml/kg over a 24 hour period
causes non urological NP
OSA
congestive cardiac failure
poorly controlled diabetes
DI
venous drainage prostate
peri prostatic venous plexus
also receives deep dorsal vein penis
internal iliac
ipsilateral common iliac
lymph drainage prostate
obturator nodes internal iliac chain also connection pre sacral external iliac paraortic
pathology of BPE
increased cell proliferation early phase
reduction in apoptosis latter phase
where is 5AR found in prostate
on nuclear membrane of stromal cells, not epithelial cells
action testosterone once diffuses into prostate stromal and epithelial cells
binds AR on epithelial cells
stromal cells majority binds type II 5AR and is converted to DHT which binds the AR with greater affinity and potency
action of AR/testosterone or AR/DHT complex
these complexes bind in the nucleus of prostate epithelial cell to induce transcription of androgen dependent genes and protein synthesis
