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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
How is complicated BOO treated?
Mostly surgery --> Cystolitholapaxy and TURP Long term catheterisation CISC
26
How is acute urinary retention defined?
Painful inability to void with palpable and percussable bladder
27
What residuals are seen in acute urinary retention?
0.5-1L
28
What are the main risk factors for acute urinary retention?
``` BPO UTI Urethral stricture Alcohol excess Acute surgical issues ```
29
What events can trigger acute urinary retention in patients with BPO?
``` (spontaneous) Constipation Alcohol excess Post-op Urological procedures ```
30
What is the immediate treatment for acute urinary retention?
Catheterisation | Treat underlying trigger
31
What complications are associated with acute urinary retention?
``` UTI Post-decompression haematuria Pathological diuresis Renal failure Electrolyte abnormalities ```
32
How should the immediate treatment be followed up in absence of renal failure?
Remove catheter Start alpha blockers Fail to void: Re-catheterise and TURP
33
How is chronic urinary retention defined?
Painless Palpable Percussable bladder after voiding
34
What residual urine volumes are seen in chronic urinary retention?
0.4-2L
35
What is the cause of chronic urinary retention?
Detrusor under-activity | Longstanding BOO
36
How does chronic urinary retention typically present?
``` LUTS UTI Bladder stone Overflow incontinence (post-) Renal failure ```
37
When does overflow incontinence occur?
When pressure is in excess of 25cm water
38
Which chronic urinary retention patients are not in need of treatment?
Low residuals with no symptoms
39
What is the immediate treatment for chronic urinary retention?
Catheterisation | --> CISC
40
What complications are associated with chronic urinary retention?
``` UTI Post-decompression haematuria Pathological diuresis Electrolyte abnormalities Acute Tubular Necrosis ```
41
How does pathological diuresis present?
>200ml/hr postural hypertension Weight loss Electrolyte abnormalities
42
How does postural hypertension present?
>20mmHg change in BP from lying to standing
43
How is pathological diuresis treated?
IV fluids and oral fluids
44
Where do obstructions typically occur in the upper urinary tract?
Pelvico-ureteric junction Ureter Vesico-ureteric junction
45
Where do obstructions typically occur in the lower urinary tract?
``` Bladder neck Prostate Urethra Urethral meatus Foreskin ```
46
What are the main types of upper tract obstruction?
Intrinsic | Extrinsic
47
What are the common causes of intrinsic PUJ obstruction?
Stone Blood clot Fungal ball Ureteric tumour
48
What are the common causes of extrinsic PUJ obstruction?
Crossing of a vessel Lymph node tumour Abdominal tumour
49
What are the common causes of intrinsic ureter obstruction?
``` Stone Tumour Scar tissue Blood clot Fungal ball ```
50
What are the common causes of extrinsic ureter obstruction?
Lymph nodes Iatrogenic Abdominal/pelvic
51
What are the common causes of intrinsic VUJ obstruction?
Stone Bladder tumour Ureteric tumour
52
What are the common causes of extrinsic VUJ obstruction?
Cervical tumour | Prostate cancer
53
What are the symptoms of Upper tract obstruction?
Pain Frank haematuria Symptoms of sepsis/infection Renal failure
54
What are the signs of Upper tract obstruction?
Palpable mass | Microscopic haematuria
55
How can renal function present in upper tract obstruction?
Acute - could be normal | Chronic (high pressure) probably wack
56
How should an upper tract obstruction be managed?
``` ABCs IV access, bloods, ABG Urine/blood cultures Floid balance monitoring Analgesia Antibiotics RRT if necessary ``` Percutaneous nephrostomy insertion or Retrograde stent insertion
57
How would a stone causing upper tract obstruction be managed?
Ureteroscopy and laser lithotripsy
58
How would a ureteric tumour causing upper tract obstruction be managed?
Radical nephro-ureterectomy
59
How would a PUJ obstruction causing upper tract obstruction be managed?
Laparoscopic pyeloplasty
60
What is the presentation of lower tract obstruction?
``` LUTS + incontinence Acute/chronic urinary retention Recurrent UTI Sepsis Frank haematuria Stones Renal failure ```
61
How is retention catheterised?
Immediate 14/16F Measure residual 16F SPC if urethra impassable
62
How should a lower tract obstruction be managed?
``` ABCs IV access, bloods, ABG Urine/blood cultures Floid balance monitoring Analgesia Antibiotics RRT if necessary Bladder scan ``` Catheterisation
63
How should a BPE causing lower tract obstruction be managed?
TURP
64
How should a urethral stricture causing lower tract obstruction be managed?
Optical urethrotomy
65
How should a meatal stenosis causing lower tract obstruction be managed?
Meatal dilation
66
How should a phimosis causing lower tract obstruction be managed?
Circumcision
67
What is decompression haematuria?
Complication of relieving high pressure in bladder | Blood in urine, shearing of small vessels
68
What is post-obstructive diuresis?
>200ml/hr | Osmotic diuresis
69
How is post-obstructive diuresis managed?
Normal saline input, preferably orally

RENAL PATHOLOGY (16 decks)

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