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RENAL PATHOLOGY > Diseases of Prostate and Urinary Tract > Flashcards

Diseases of Prostate and Urinary Tract Flashcards

1
Q

What is an enlarged prostate?

A

> 30cc

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2
Q

BPH typically affects what?

A

Transition zone of the prostate

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3
Q

What proportion of the population suffers BPH in men?

A

50% at 60y

90% at 85y

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4
Q

How is BPH characterised?

A

Fibromuscular and glandular hyperplasia

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5
Q

How is LUTS assessed?

A

Symptom scoring - IPSS

Frequency volume chart

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6
Q

What are the main types of LUTS?

A

Storage

Voiding

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7
Q

How do voiding LUTS present?

A

Hesitancy
Poor Stream
Terminal dribbling
Incomplete emptying

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8
Q

How do storage LUTS present?

A

Frequency
Nocturia
Urgency +/- urge incontinence

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9
Q

What penis abnormalities can cause BOO?

A

External meatus stricture

Phimosis

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10
Q

What physical assessment is used for LUTS?

A

Abdominal exam
Penis exam
DRE
Urinalysis

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11
Q

What investigations are used in LUTS?

A 
MSSU
Flow rate study
Post-void bladder residual USS
U+E & PSA 
Renal tract USS (stone)
Flexible cystoscopy 
Prostate biopsy (PSA↑)
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12
Q

What are the main types of benign prostatic obstruction?

A

Complicated

Uncomplicated

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13
Q

What is the treatment for an uncomplicated BPO?

A

non unless chronic retention, infections
Alpha blockers
5alpha reductase inhibitors

TURP
Prostatectomy

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14
Q

When are alpha blockers indicated?

A

Treatment for LUTS due to BPO

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15
Q

How do alpha blockers work?

A

Relax smooth muscle of bladder neck and prostate

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16
Q

What are the main types of alpha blockers?

A

Non-selective (1+2)
Selective short acting
Selective long acting
Highly selective

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17
Q

When are alpha blockers contraindicated?

A

Hypotension

Iris surgery

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18
Q

What are the side effects associated with alpha blockers?

A

Retrograde ejaculation

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19
Q

How do 5a-reductase inhibitors work?

A

Inhibit Test –> DHT

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20
Q

What are the two mainly used 5a-reductase inhibitors?

A

Finasteride (Type 2 only)

Dutasteride (Type 1+2)

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21
Q

What is the role of 5a-reductase inhibitors?

A

Reduce prostate size, slow progression
Reduce LUTS
Reduce prostatic bleeding
Reduce prostate cancer

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22
Q

What side effects are associated with 5a-reductase inhibitors?

A

Impaired sexual function

Breast growth

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23
Q

What complications are associated with TURP?

A 
Bleeding
Infection
Retrograde ejaculation
Stress urinary incontinence 
Prostatic growth
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24
Q

What complications are associated with BOO?

A 
Progression of LUTS
Acute/Chronic urinary retention
Urinary incontinence
UTI
Bladder stone
Renal failure
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25
Q

How is complicated BOO treated?

A

Mostly surgery
–> Cystolitholapaxy and TURP
Long term catheterisation
CISC

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26
Q

How is acute urinary retention defined?

A

Painful inability to void with palpable and percussable bladder

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27
Q

What residuals are seen in acute urinary retention?

A

0.5-1L

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28
Q

What are the main risk factors for acute urinary retention?

A 
BPO 
UTI
Urethral stricture
Alcohol excess
Acute surgical issues
29
Q

What events can trigger acute urinary retention in patients with BPO?

A 
(spontaneous)
Constipation
Alcohol excess
Post-op 
Urological procedures
30
Q

What is the immediate treatment for acute urinary retention?

A

Catheterisation

Treat underlying trigger

31
Q

What complications are associated with acute urinary retention?

A 
UTI 
Post-decompression haematuria 
Pathological diuresis 
Renal failure
Electrolyte abnormalities
32
Q

How should the immediate treatment be followed up in absence of renal failure?

A

Remove catheter
Start alpha blockers
Fail to void:
Re-catheterise and TURP

33
Q

How is chronic urinary retention defined?

A

Painless
Palpable
Percussable bladder after voiding

34
Q

What residual urine volumes are seen in chronic urinary retention?

A

0.4-2L

35
Q

What is the cause of chronic urinary retention?

A

Detrusor under-activity

Longstanding BOO

36
Q

How does chronic urinary retention typically present?

A 
LUTS 
UTI
Bladder stone
Overflow incontinence 
(post-) Renal failure
37
Q

When does overflow incontinence occur?

A

When pressure is in excess of 25cm water

38
Q

Which chronic urinary retention patients are not in need of treatment?

A

Low residuals with no symptoms

39
Q

What is the immediate treatment for chronic urinary retention?

A

Catheterisation

–> CISC

40
Q

What complications are associated with chronic urinary retention?

A 
UTI
Post-decompression haematuria 
Pathological diuresis 
Electrolyte abnormalities 
Acute Tubular Necrosis
41
Q

How does pathological diuresis present?

A

> 200ml/hr
postural hypertension
Weight loss
Electrolyte abnormalities

42
Q

How does postural hypertension present?

A

> 20mmHg change in BP from lying to standing

43
Q

How is pathological diuresis treated?

A

IV fluids and oral fluids

44
Q

Where do obstructions typically occur in the upper urinary tract?

A

Pelvico-ureteric junction
Ureter
Vesico-ureteric junction

45
Q

Where do obstructions typically occur in the lower urinary tract?

A 
Bladder neck
Prostate
Urethra
Urethral meatus
Foreskin
46
Q

What are the main types of upper tract obstruction?

A

Intrinsic

Extrinsic

47
Q

What are the common causes of intrinsic PUJ obstruction?

A

Stone
Blood clot
Fungal ball
Ureteric tumour

48
Q

What are the common causes of extrinsic PUJ obstruction?

A

Crossing of a vessel
Lymph node tumour
Abdominal tumour

49
Q

What are the common causes of intrinsic ureter obstruction?

A 
Stone
Tumour
Scar tissue
Blood clot
Fungal ball
50
Q

What are the common causes of extrinsic ureter obstruction?

A

Lymph nodes
Iatrogenic
Abdominal/pelvic

51
Q

What are the common causes of intrinsic VUJ obstruction?

A

Stone
Bladder tumour
Ureteric tumour

52
Q

What are the common causes of extrinsic VUJ obstruction?

A

Cervical tumour

Prostate cancer

53
Q

What are the symptoms of Upper tract obstruction?

A

Pain
Frank haematuria
Symptoms of sepsis/infection
Renal failure

54
Q

What are the signs of Upper tract obstruction?

A

Palpable mass

Microscopic haematuria

55
Q

How can renal function present in upper tract obstruction?

A

Acute - could be normal

Chronic (high pressure) probably wack

56
Q

How should an upper tract obstruction be managed?

A 
ABCs
IV access, bloods, ABG
Urine/blood cultures
Floid balance monitoring
Analgesia
Antibiotics
RRT if necessary

Percutaneous nephrostomy insertion
or
Retrograde stent insertion

57
Q

How would a stone causing upper tract obstruction be managed?

A

Ureteroscopy and laser lithotripsy

58
Q

How would a ureteric tumour causing upper tract obstruction be managed?

A

Radical nephro-ureterectomy

59
Q

How would a PUJ obstruction causing upper tract obstruction be managed?

A

Laparoscopic pyeloplasty

60
Q

What is the presentation of lower tract obstruction?

A 
LUTS + incontinence
Acute/chronic urinary retention
Recurrent UTI
Sepsis
Frank haematuria
Stones
Renal failure
61
Q

How is retention catheterised?

A

Immediate
14/16F
Measure residual
16F SPC if urethra impassable

62
Q

How should a lower tract obstruction be managed?

A 
ABCs
IV access, bloods, ABG
Urine/blood cultures
Floid balance monitoring
Analgesia
Antibiotics
RRT if necessary 
Bladder scan

Catheterisation

63
Q

How should a BPE causing lower tract obstruction be managed?

A

TURP

64
Q

How should a urethral stricture causing lower tract obstruction be managed?

A

Optical urethrotomy

65
Q

How should a meatal stenosis causing lower tract obstruction be managed?

A

Meatal dilation

66
Q

How should a phimosis causing lower tract obstruction be managed?

A

Circumcision

67
Q

What is decompression haematuria?

A

Complication of relieving high pressure in bladder

Blood in urine, shearing of small vessels

68
Q

What is post-obstructive diuresis?

A

> 200ml/hr

Osmotic diuresis

69
Q

How is post-obstructive diuresis managed?

A

Normal saline input, preferably orally

RENAL PATHOLOGY (16 decks)

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