GUM Flashcards
What does the mechanical control of LUTS involve?
- bladder neck mechanism- smooth muscle internal urethral sphincter
- external urethral sphincter
- detrusor muscle
- pelvic floor muscles
What does the neural control of LUTS involve?
- parasympathetic (cholinergic) - S3 to S5 - detrusor contraction and internal sphincter relaxation
- sympathetic (noradrenergic)- T10 to L2 - internal sphincter contraction and inhibits detrusor contraction
- somatic - voluntary control of external urethral sphincter (striated muscle)
- CNS- pontine micturition centre
Why are women more susceptible to stress incontinence whilst men more susceptible to over-retention?
Women have a weak bladder neck mechanism which is stronger in men to prevent retrograde ejaculation. In women, the external urethral sphincter is the primary mechanism and is controlled by the pelvic floor muscles which tend to loosen up post-partum.
What are the storage symptoms in LUTS?
frequency nocturia urgency incontinence dysuria
what are the voiding symptoms in LUTS?
hesitancy straining poor/slow stream intermittent stream spitting/spraying terminal dribble
What are the risk factors for men developing LUTS?
- high serum dihydrotestosterone levels
- obesity
- elevated fasting glucose
- diabetes
- fat and red meat intake
- inflammation
What are the causes of voiding LUTS?
bladder stone bladder tumour bladder inflammation detrusor weakness prostate inflammation BPH/prostate cancer (most common) urethral scarring
What are the causes of storage LUTS?
alcohol/caffeine obstructive sleep apnoea stroke MS cauda equina syndrome blood pressure medication obesity lower UTI
What is prostate-specific antigen?
PSA is a protease whose function is to break down the high molecular weight protein of the seminal coagulum into smaller polypeptides and hence makes semen more liquid, allowing sperm to swim more freely.
Which cells can produce PSA?
benign and malignant epithelial cells of the prostate
What conditions may present with an elevated PSA?
acute urinary retention benign prostatic hyperplasia old age prostatitis prostate cancer transurethral resection of prostate urinary catheterisation recent sexual activity UTI trauma
Why is PSA not used as a national screening test for prostate cancer?
- not supported by evidence
- does not reduce PC specific mortality
- mutations that cause reduced PSA production would lead to false negatives
- if positive, likelihood of PC is 25-30%
- if negative, likelihood of PC is 6%
- anxiety-causing as it’s non-specific to PC
- side effects of implicated biopsy if positive
- false reassurance if negative result
Which groups are at high risk of PC hence making the PSA test most valuable?
age over 70
afro-caribbean
family history of PC
What are the arguments for radical prostectomy as a treatment option for prostate cancer?
curative
PC has high mortality
reduces patient anxiety
longterm studies show benefits
What are the arugments against radical prostectomy as a treatment option for prostate cancer?
disease of the elderly
competing causes of death
30% of men with prostate cancer die of it
adverse efects of treatment - sexual dysfunction
