Definitions

Question 1

acute retention of urine

Answer 1

is defined as a painful, palpable or percussible bladder, when the patient is unable to pass any urine.

Question 2

chronic retention

Answer 2

is defined as a non-painful bladder, which remains palpable or percussible after the patient has passed urine. Such patients may be incontinent

Question 3

detrusor overactivity

Answer 3

is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked

Question 4

overactive bladder syndrome

Answer 4

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

Question 5

BOOI

Answer 5

pdetQmax minus 2 x Qmax
more than 40 is obstructed
20-40 equivocal
less than 20 not obstructed

Question 6

bladder contractility index

Answer 6

pdetQmax plus 5 x qmax
more than 150 strong
50-100 normal
less than 50 weak contractility

Question 7

action of testosterone in embryology

Answer 7

stimulate wolffian ducts
epididymis
vas
ampulla
seminal vesicles
common ejaculatory duct

Question 8

action of DHT

Answer 8

stimulate male exeternal genitalia and prostate

at 16 weeks development prostate under influence DHT

Question 9

action of androgen receptor

Answer 9

androgen binds

AR dissociates and undergoes compartmentalisation from the cytosol to the nucleus

Question 10

origin of prostate tissue

Answer 10

glandular = endodermal plus urethra
capsule and SM from mesenchymal origin
ducts from wolffian ducts
central zone from mesonephric duct
rest from urogenital sinus

Question 11

arterial supply prostate

Answer 11

internal iliac
anterior branch
inferior vesicle
urethral group Badenock 5 and 7
Flock 11 and 1
capsular group run with cavernosal nerves

Question 12

how much of prostate is stroma
what is stroma made of
how much is
transitional zone
central zone
peripheral zone
FM strome

Answer 12

40%
Smooth muscle

70% PZ of glandular tissue
central zone 25% glandular tissue
FM stroma 5%
10% glandular TZ

Question 13

epithelial cell components

Answer 13

basal epithelial cells
luminal secretory epithelial cells
neuroendocrine cells

Question 14

which cells secrete PSA

Answer 14

luminal epithelial cells

Question 15

action of T and DHT on BPH

Answer 15

not sole cause
some role
BPH in older men and maintains responsiveness to androgens
DHT remains high with age

Question 16

histological change BPH

Answer 16

increase number of epithelial and stromal cells

Question 17

prevalence BPH

Answer 17

43% in 60s based on prostate more than 20g and flow rate less than 15

Question 18

embryology of prostate
week development
action of SRY
development of Wolffian ducts
action recipricol induction
stromal epithelial interaction

Answer 18

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

Question 19

histology of BPH

what are hyerplastic nodules made of

Answer 19

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

Question 20

zones of prostate
eponymous name
TZ
CZ
PZ
final zone

Answer 20

McNeal's zones
TZ 10% - BPH
central 25%
peripheral 65%
anterior fibromuscular stroma

Question 21

arterial supply prostate

Answer 21

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…..

Question 22

BPH stromal vs epithelial component

Answer 22

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.

Question 23

nocturnal polyuria

Answer 23

exceeding 20% of 24 hour urine output in young

and 33% of urine output in over 65

Question 24

global polyuria

Answer 24

24 hour global polyuria

>40ml/kg over a 24 hour period

Question 25

causes non urological NP

Answer 25

OSA
congestive cardiac failure
poorly controlled diabetes
DI

Question 26

venous drainage prostate

Answer 26

peri prostatic venous plexus
also receives deep dorsal vein penis
internal iliac
ipsilateral common iliac

Question 27

lymph drainage prostate

Answer 27

obturator nodes
internal iliac chain
also connection
pre sacral
external iliac
paraortic

Question 28

pathology of BPE

Answer 28

increased cell proliferation early phase

reduction in apoptosis latter phase

Question 29

where is 5AR found in prostate

Answer 29

on nuclear membrane of stromal cells, not epithelial cells

Question 30

action testosterone once diffuses into prostate stromal and epithelial cells

Answer 30

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

Question 31

action of AR/testosterone or AR/DHT complex

Answer 31

these complexes bind in the nucleus of prostate epithelial cell to induce transcription of androgen dependent genes and protein synthesis