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Year 2 Urinary (JK) > Diseases of the prostate and urinary tract obstruction > Flashcards

Diseases of the prostate and urinary tract obstruction Flashcards

1
Q

What zone of the prostate does cancer usually form?

A

peripheral zone

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2
Q

What happens in BPH?

A

fibromuscular and glandular hyperplasia

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3
Q

What zone of the prostate does BPH usually occur?

A

transitional zone

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4
Q

What is the IPSS score and explain the components

A

international prostate symptoms score out of 35
includes things like urgency, frequency, nocturia, weak stream etc
0-7 = mild, 8-19=moderate and over 20 is severe

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5
Q

The 2 ways to assess LUTS

A

symptom scoring system - IPSS

frequency volume charts

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6
Q

Voiding (obstructive) LUTS

A

poor stream
hesitancy
terminal dribbling
incomplete emptying

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7
Q

Storage (irritative) LUTS

A

frequency
nocturia
incontinence/urgency

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8
Q

4 physical examinations conducted on the patient with LUTS and what we look for

A

abdomen - palpable bladder - retention?
digital rectal examination
urinalysis - blood? infection?
penis - stricture?phimosis?

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9
Q

Investigations of LUTS

A 
flexible cystoscopy if haematuria 
MSSU 
flow rate study 
post void bladder residual USS 
bloods eg PSA, urea and creatinine 
renal tract USS 
urodynamic studies 
TRUS guided prostate biopsy (raised PSA/abnormal DRE)
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10
Q

Treatment for uncomplicated BPO

A

watchful waiting
medical - alpha blockers, 5 alpha reductase inhibitors or combination
surgery - TURP (<100cc) or open retropubic prostatectomy
endoscopic ablative procedures

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11
Q

What are alpha blockers most used for in terms of prostate and obstruction?

A

BPO LUTS

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12
Q

How do alpha blockers work?

A

smooth muscle of bladder neck and prostate innervated by sympathetic alpha adrenergic nerves so alpha blockers cause smooth muscle relaxation

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13
Q

Types of alpha blockers

A

non selective, long acting and short acting selective and highly selective

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14
Q

What does 5 alpha reductase do?

A

Enzyme which converts testosterone to DHT

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15
Q

5 actions of 5ARI

A

reduce prostate size and reduce risk of progression
Reduce LUTS
reduce risk of medium and low grade cancers
reduce vascularity and hence haematuria
best taken in combo with alpha blockers

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16
Q

Complications of TURP

A

bleeding, infection, BOO, prostatic regrowth causing recurrent haematuria, stress urinary incontinence

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17
Q

Complications of BPO

A 
progression of LUTS 
UTI 
acute/chronic urinary retention 
bladder stone 
overflow incontinence 
renal failure
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18
Q

Alternatives for treating complicated BPO

A

apart from medical and surgical procedures

long term catheter, CISC

19
Q

Sites of upper tract obstruction

A

PUJ, VUJ and ureter

20
Q

Sites of lower urinary tract BOO

A

bladder neck, prostate, urethra, urethral meatus and foreskin

21
Q

Intrinsic causes of PUJ obstruction

A

PUJ obstruction, stone, TCC, blood clot, fungal ball

22
Q

Extrinsic causes of PUJ obstruction

A

PUJ obstruction, LN and abdominal mass

23
Q

Intrinsic causes of ureter obstruction

A

stone, TCC, scar tissue, blood clot, fungal ball

24
Q

Extrinsic causes of ureteric obstruction

A

LN, iatrogenic, pelvic mass

25
Q

Intrinsic causes of VUJ obstruction

A

stone, bladder tumour, ureteric tumour

26
Q

Extrinsic causes of VUJ obstruction

A

cervical tumour, prostate cancer

27
Q

Symptoms of upper tract obstruction

A

pain, frank haematuria, complications eg renal failure

28
Q

Signs of upper tract obstruction

A

palpable mass, microscopic haematuria, complications

29
Q

Complications of upper tract obstruction

A

infection & sepsis, renal failure

30
Q

Management of upper tract obstruction

A

Resuscitation, ABC’s

IV access, bloods, ABG, blood and urine cultures, fluid monitoring, iv fluids, antibiotics, analgesia, HDU care+/- RRT

31
Q

Emergency treatment of upper tract obstruction

A

percutaneous nephrostomy insertion

retrograde stent insertion

32
Q

Definitive treatment of upper tract obstruction examples

A

stone - ureteroscope, laser lithotripsy, ESWL
tumour - radical nephron-ureterectomy
PUJ obstruction - laparascopic pyeloplasty

33
Q

What is a nephrostomy?

A

percutaneous puncture allowing urine to drain

34
Q

How is nephrostomy done and what are its complications

A

US or X-ray guided under LA+sedation

bleeding and adjacent organs

35
Q

Material of most ureteric stents

A

silicone

36
Q

Lower urinary tract obstruction symptoms

A 
LUTS - including urinary incontinence 
acute or chronic urinary retention 
recurrent UTI 
Frank haematuria 
renal failure 
bladder stones
37
Q

Immediate treatment for urinary retention

A

urethral catheter

if not possible after 2 attempts do a suprapubic catheter

38
Q

Resuscitation management of lower urinary tract obstruction

A

ABC, IV access, bloods, ABG, urine and blood cultures, fluid monitoring, antibiotics, IV fluids, analgesia, HDU+/- RRT

39
Q

Investigations of lower urinary tract obstruction

A

bladder scan and USS renal tract

40
Q

Emergency treatment of LUT obstruction

A

urethral or sp catheter

41
Q

Definitive treatment of LUT obstruction examples

A

BPE = TURP
urethral stricture = optical urethrotomy
meatal stenosis - meatal dilation
phimosis = circumcision

42
Q

High pressure chronic retention symptoms

A

painless, incontinent, increased creatinine and bilateral hydronephrosis

43
Q

Low pressure chronic retention symptoms

A

Painless, dry, normal creatinine and kidneys

44
Q

2 main complications of treating chronic retention and LUT obstruction

A

decompression haematuria - sheer small vessels but usually self limiting
post obstructive diuresis - can be dangerous due to fluid and sodium loss so give saline

Year 2 Urinary (JK) (26 decks)

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