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
What are the reasons for and against screening for prostate cancer?
FOR: high mortality, commonest form of cancer in men, early diagnosis (cure) and early treatment of advanced disease (effective palliation).
AGAINST: uncertain natural history, over-treatment, morbidity of treatment/investigation (biopsy side effects too)
Which zone of the prostate gland increases in prostate cancer?
Peripheral zone
Which zone of the prostate gland increases in BPH?
Transitional zone
What are the contents of the spermatic cord?
vas deferens
lymphatics vessels
processus vaginalis
Blood vssels: testicular artery, cremasteric artery and vein, artery to vas deferens (inferior vesicle artery from internal iliac) and panpiriform plexus of testicualr veins
Nerves: autonomic testicular, genital branch of genitofemoral nerve
Which hormone activates Sertoli cells in the testes?
FSH
Which cells produce testosterone and where are they found?
Inerstitial cells or cells of Leydig- found in between the seminiferous tubules in the testes
Which cell line is most susceptible to ischaemia?
Germ cells
What are the two most important determinants of salvaging the testis during tsticular torsion?
- time between onset of symptoms and detorsion
2. degree of cord twisting
What are the indicators of a psychological cause of erectile dysfunction?
sudden onset younger patient situational ED good nocturnal and early morning erections psychosexual factors underlying psychiatric illness
How do you manage patients who do not respond to ED medication like sildenafil?
- check licensed medication
- check correct usage and prescription
- change phosphodiesterase inhibitor
- regular dosing
- change therapy
What is the adverse effect of sildenafil?
priapism prolonged erection lasting over 4 hours risk of permanent ischaemic damage to corpora aspirate corpora with 19 gauge needle if fails, inject with phenylephrine
