Diseases of the Prostate Flashcards
What is the average size of the prostate gland in men aged 25-30 years?
20cc
What does the prostate do?
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
Describe McNeal’s Prostatic Zones
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
What are the two important being prostatic disease terminologies for use with patients in general?
Bladder outflow obstruction (BOO)
Lower urinary tract symprtoms (LUTS)
When can you use the term benign prostatic hyperplasia (BPH)?
Histological diagnosis
What is benign prostatic obstruction (BPO)?
Used when you think the prostate is causing BOO
Describe the Hald Diagram
A ven diagram including:
- LUTS
- BOO
- BPE
Shows that benign prostate hyperplasia (BPH) was a syndrome of 3 overlapping, yet clinically distinct, entities
What is benign prostatic hyperplasia characterised by?
Fibromuscular and Glandular hyperplasia
Predominantly affects transition zone
How does Benign prostatic hyperplasia effect men?
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
What is the international prostate symptom score sheet (IPSS)?
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
How do you assess LUTS?
Symptom scoring systems
- IPSS
- Can indicate wether bladder or below
Frequency volume charts
What LUTS symptoms indicate Voiding (obstructive) problem?
- Hesitancy
- Poor stream
- Terminal dribbling
- Incomplete emptying
What LUTS symptoms indicate Storage (Irritative) problem?
- Frequency
- Nocturia
- Urgency +/- urge incontinence
What is a frequency volume chart?
Record date and time of passing urine and the amount passed
Around 500ml normal in males
-Less in females
On physical examination why should you look for a palpable bladder?
If there is acute retention
Wont feel on chronic but may be percussive
What should you look for in physical examination of the penis?
External urethral meatal stricture
Phimosis
NOTE:
-Get patient to pull back foreskin so that you dont cause them undue discomfort
What should you be checking in a digital rectal examination?
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
When should you do urinalysis in LUTS?
Always
- Blood?
- Signs of UTI
What is a MSSU?
Mid stream sample of urine
- Microscopy
- Culture
- Serology
What is a flow rate study?
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
What is post- void bladder residual USS?
USS bladder after voiding to see how much residual fluid is there
What blood tests may you want to do and why?
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?
When should you do a renal tract USS?
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
When may you do a felxible cystoscopy?
What is it?
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
