GU Flashcards
what is the comonest male malignancy in 15-44yos
testicular cancer
what is most common type of testic cancer
germ cell tumours of whihc 50% = seminoma (sperm producing tissue)
RF of testicular cancer
fam Hx
undescended tester
klinefelters syndrome
Cfs of testicular cancer
painless lump haematospermia secondary hydrocele mets? - abdo mass (enlarged nodes) back pain (bones) dyspnoea (lungs) "dragging sensation"
Ix of testic cacner
bloods -alpha fetoprotein (made by yolk sac tumurs and others)
beta - hCG (= beta humanchorionic gonadotropin) NEVER IN NORM MEN
lactate dehydrogenase
biopsy = inguinal orchiectomy
CT to assess metastasis
Management of Testicular tumours
Radical orchiectomy plus Radiotherapy
chemo
5yr survival rate for testic cancer
90%
Staging system for Testicular tumour
Stage 1 no metastasize
2 spread to infradiaphragmatic
3 supradiaphragmatic
4 involvement into the lungs
where does prostate cancer most often spread to
metastasis to bone and lymph nodes
or spread locally to bladder, seminal vesicles, rectum
Presentation of prostate cancer
LUTS, voiding and storing,
+ haematuria, dysuria
Back pain ( also found in prostatitis)
weight loss and anemia
Epidimeology assosiations and risk factors of prostate cancer
+ve family history, Age
increased testosterone (Black people)
BRCA2 gene
What type of cancer is prostate cancer and which cells does it originate from
adenocarcinoma, originating from epithelium in the TRANSITIONAL ZONE of prostate
Physical examinations for prostate cancer
DRE shows hard irregular prostate
examination could show enlarged lymph nodes (late stage)
Investigations for Prostate cancer
PSA- Elevated
Transrectal ultrasound and biopsy - diagnostic and graded
CT/MRI used to identify spread.
Bone scan
why does PSA elevation not necces mean prostate cancer
PSA increases in BPH (more cells)
after ejaculation
infection
catheters
what scoring system used for Prostate cancer
gleason scoring (/10) 6 or less = low grade 7=intermed 8-10 = high
DDx of prostate cancer
BPH
prostatitis
bladder tumours
complication of prostate cancer
spinal cord compression
Mx of prostate cancer (metasised)
hormone therapy -
STIM INHIB SHRINKS
antiandrogen FIRST - increases testosterone production
high GNRH (Goserelin) therefore pit gland resistent
give LH anatgonist (flutamide ) = no testosterone
+radiotherapy
Mx - localised
active surveillence
if progressing =
radical Prostatectomy + supplementary chemo and radiotherapy
SE of hormone therapy in prostate cancer
loss of libido
osteroporosis
what is the biomarker in prostate cancer and where found
PCA3 - in urine
what converts testosterone to dihydrotestosterone
5-alpha reductase
what does testosterione get converted to
dihydrotestosterone (DHT)
why is dihydrotestosterone assos w BPH
more potent than testosterone and can cross cell membrane and bind to recepotors and inib apoptosis= HYPERPLASIA
what is BPH
increased size of prostate without malignancy
prolif og musculofibrous/glandular tissue
Rf of BPH
age
obesity
fam hx
what does digital rectal exam show in BPH
smooth and enlarged
CFs of BPH
LUTS
storage - freq, urgency, nocturia
voiding - hesitancy, dysuria, incomplete voiding, post micturation dribbling, poor stream
haematuria, dysuria - Cancer??
Dx of BPH
DRE - smooth enlarged PSA - excl malignancy Transrectal ultrasound - size palp bladder? Urinalysis: MSU MS and C. all comes back clear, eliminates UTI dipstick
what does α1-adrenergic receptors do
vasoconstiction, induces contraction of the urinary bladder
lifestyle changes to someone with BPH = mild
less caffiene
less alcohol
bladder training
complications of BPH
stones haematuria infections retention renal disease
Differential for LUTS voiding and storing
BPH UTI Prostatic carcinoma Bladder cancer Overactive bladder prostatitis
Management of BPH
pharamacological
5 alpha reductase inhibitor - finasteride (SE = reduced libido)
= decrease in testosterone conversion to dihydrotestosterone
alpha 1 anatagonist - TAMSULOSIN
SE-dry mouth dizzy
or orchiectomy as testosterone linked
5-alpha reductase inhib used in BPH
finasteride
alpha blocker used in BPH
tamsulosin (alpha 1 anatagonist)
indications for surgey in BPH
RUSHES retention UTI recurrent Stones Haematuria elevated creatinine symptoms deterioration (uncontrolled)
what is treatment for overactive bladder syndrome
Anticholinergics- tolterodine
Surgery options for BPH
Transurethral resection of prostate (TURP)
Transurethral Incision of Prostate (TUIP)
Prostatectomy
what are symptoms of urinary retention
Painful confusion fever flank pain LUTS
what can cause urinary retention
any urethral obstruction BPH malignancy from outside stones, Anticholinergics Iatrogenic
treatment of urinary retention
Urethral catheter and treat underlying causes
