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Urinary Systems > Diseases of the Prostate > Flashcards

Diseases of the Prostate Flashcards

1
Q

What is the average size of the prostate gland in men aged 25-30 years?

A

20cc

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2
Q

What does the prostate do?

A

Secondary sexual organ

The function of the prostate is to secrete a slightly alkaline fluid, milky or white in appearance, that in humans usually constitutes roughly 30% of the volume of the semen along with spermatozoa and seminal vesicle fluid

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3
Q

Describe McNeal’s Prostatic Zones

A

The “zone” classification is more often used in pathology. The idea of “zones” was first proposed by McNeal in 1968. McNeal found that the relatively homogeneous cut surface of an adult prostate in no way resembled “lobes” and thus led to the description of “zones”.

The prostate gland has four distinct glandular regions, two of which arise from different segments of the prostatic urethra:

  • Transition zone
  • Central zone
  • Peripheral zone
  • Anterior fibromuscular stroma
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4
Q

What are the two important being prostatic disease terminologies for use with patients in general?

A

Bladder outflow obstruction (BOO)

Lower urinary tract symprtoms (LUTS)

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5
Q

When can you use the term benign prostatic hyperplasia (BPH)?

A

Histological diagnosis

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6
Q

What is benign prostatic obstruction (BPO)?

A

Used when you think the prostate is causing BOO

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7
Q

Describe the Hald Diagram

A

A ven diagram including:

  • LUTS
  • BOO
  • BPE

Shows that benign prostate hyperplasia (BPH) was a syndrome of 3 overlapping, yet clinically distinct, entities

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8
Q

What is benign prostatic hyperplasia characterised by?

A

Fibromuscular and Glandular hyperplasia

Predominantly affects transition zone

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9
Q

How does Benign prostatic hyperplasia effect men?

A

Part of aging process

  • 50% of men at 60 years
  • 90% of men at 85 years

50% of men with BPH have moderate to severe LUTS

Progressive condition resulting in BOO
-Doesnt always cause BOO

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10
Q

What is the international prostate symptom score sheet (IPSS)?

A

Questionaire

  • Patients score there different symptoms
  • Saves a list of questions at consultation
  • Focuses on symptoms (YOUR TREATING THE PATIENT NOT JUST PROSTATE HYPERPLASIA)

Score out of 35

  • Mild = 0-7
  • Moderate: 8-19
  • Severe = >/=20

Can repeat to see if treatment is working

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11
Q

How do you assess LUTS?

A

Symptom scoring systems

  • IPSS
  • Can indicate wether bladder or below

Frequency volume charts

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12
Q

What LUTS symptoms indicate Voiding (obstructive) problem?

A
  • Hesitancy
  • Poor stream
  • Terminal dribbling
  • Incomplete emptying
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13
Q

What LUTS symptoms indicate Storage (Irritative) problem?

A
  • Frequency
  • Nocturia
  • Urgency +/- urge incontinence
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14
Q

What is a frequency volume chart?

A

Record date and time of passing urine and the amount passed

Around 500ml normal in males
-Less in females

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15
Q

On physical examination why should you look for a palpable bladder?

A

If there is acute retention

Wont feel on chronic but may be percussive

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16
Q

What should you look for in physical examination of the penis?

A

External urethral meatal stricture

Phimosis

NOTE:
-Get patient to pull back foreskin so that you dont cause them undue discomfort

17
Q

What should you be checking in a digital rectal examination?

A

Assess prostate size
-large or small

Assess feel

  • Firm vs soft
  • Nodular?

Should feel like your nose if normal

Assess anal tone
-Cauda equina problems

18
Q

When should you do urinalysis in LUTS?

A

Always

  • Blood?
  • Signs of UTI
19
Q

What is a MSSU?

A

Mid stream sample of urine

  • Microscopy
  • Culture
  • Serology
20
Q

What is a flow rate study?

A

Get patient to pee into special toilet

Measures how much urine is passing per unit time

  • Look at Qmax
  • Look at total time

If Qmax 90% chance of having BOO

Duration of micturition will also be increased in BOO

21
Q

What is post- void bladder residual USS?

A

USS bladder after voiding to see how much residual fluid is there

22
Q

What blood tests may you want to do and why?

A

PSA

  • Prostate specific antigen
  • Up in infection, catheter, prostate cancer and BPH
  • Used to assess size of BPH
  • Perfectly adequate to do in LUTS

Urea and Creatinine

  • Look at renal function
  • High pressure urinary retention?
23
Q

When should you do a renal tract USS?

A

If renal failure or bladder stone suspected

  • Upper urinary tract more
  • Not needed for LUTS

In larger patient can be hard to see so may want to replace USS with Computerised Tomography of the abdomen and pelvis

24
Q

When may you do a felxible cystoscopy?

What is it?

A

If haematuria

A cystoscopy is a procedure that looks at the bladder and other parts of the urinary system. It involves inserting a special tube, called a cystoscope, into the urethra and then passing it through to the bladder. There are two types of cystoscope: rigid and flexible.

Flexible more for examination, straight more for surgery

25
Q

In selected cases what study may you want to carry out?

A

Urodynamic testing or Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as: incontinence. frequent urination. sudden, strong urges to urinate but nothing comes out.

26
Q

When may you want to carry out a TRUS-guided prostate biopsy?

A

If PSA raised or abnormal DRE

27
Q

How is BPO divided?

A

Uncomplicated
-Guys who come along with classic symptoms

Complicated

  • Retention (palpable bladder)
  • UTI
  • PSA elevated for age
  • Haematuria
  • Elevated uria/ creatinine
28
Q

how do you treat Uncomplicated BPO?

A

30% will stay same
30% will get better
30% will get worse
-Watchful waiting is therefore an option

Medical therapy

  • Alpha blockers
  • 5 alpha rectucatse inhibitors
  • Combination

Surgical intervention

  • TURP (prostate size 100cc)
  • Endoscopic ablative procedures
29
Q

Name the two 5 alpha reductase inhibitors

A

Finasteride

Dutasteride

30
Q

What are alpha blockers?

A

Main treatment for LUTS due to BPO

Smooth muscle of bladder neck (intrinsic urethral sphincter) and prostate innervated by sympathetic alpha agrenergic nerves (mostly alpha-1a subtype)

Alpha blockers cause smooth muscle relaxation and antagonise the dynamic element to BPO

31
Q

Give some types of alpha blockers

A

Non-selective (i.e. alpha 1 and 2): phenoxybenzamine

Selective short acting: prazosin, indoramin

Selective long lasting: ALFUZOSIN, doxazosin, terazosin

Highly selective (i.e. alpha-1a): TAMSULOSIN

32
Q

What side effect should you be aware of in alpha blockers?

A

Relaxes intrinstic urethral sphincter -> retrograde ejaculation

Sperm enters bladder and pee out during next micturition

Cannot pregnate
-Must make patients aware

33
Q

What is the role of 5a- reductase inhibitors?

A

Reduces prostate size and REDUCES RISK OF PROGRESSION of BPE (only if >25cc)

Also reduces LUTS (not as effective as alpha blockers)

Combination therapy with alpha blockers most effective in reducing risk of progression of BPE

Can also reduce vascularity and hence reduces haematuria due to prostatic bleeding

Potential role in prostate cancer prevention
-BUT increases risk of aggressive prostate cancer in 10-15 years -> may want to think twice in younger patients

34
Q

What is TURP?

A

Trans-Urethral Resection of Prostate

Remains GOLD STANDARD

V. effective in relieving symptoms and improves urodynamic parameters (90% efficacy at 1 year)

35
Q

What are the complications of TURP?

A
  • Bleeding
  • Infection
  • Retrograde ejaculation
  • Stress urinary incontinence
  • Prostatic regrowth causing recurrent haematuria or BOO
36
Q

What new alternative endoscopic ablative procedures are available for prostate resection?

A

Transurethral laser vaporisation
-Urolift

NOT as effective as TURP

37
Q

What are the complications of BPO?

A

Progression of LUTS

Acute urinary retention

Chronic urinary retention

Urinary incontinence (overflow)

UTI

Bladder stone

Renal failure from obstructed ureteric outflow due to high bladder pressure

38
Q

How do you treat complicated BPO?

A

Medical therapy

Most patients will require surgery
-e.g. cystolitholapaxy and TURP for patients with BPO and bladder stones

Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications

39
Q

What alternative treatment options are available for complicated BPO (e.g. patients unfit for surgery)?

A

Long term urethral or suprapubic catheterisation

Clean intermittent self-catheterisation

May develop problems with difficult catheterisation, catheter trauma, blockages, frank haematuria or recurrent UTI

Urinary Systems (26 decks)

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