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Urology > Lecture 19 and 20 Benign Diseases of the Prostate and Urinary Tract Obstruction > Flashcards

Lecture 19 and 20 Benign Diseases of the Prostate and Urinary Tract Obstruction Flashcards

1
Q

What are the zones of the prostate

A

Fibromuscular zone
Transitional zone
Peripheral zone
Central zone

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2
Q

What does BPE stand for

A

Benign Prostatic Enlargement

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3
Q

What does BPH stand for

A

Benign Prostatic Hyperplasia

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4
Q

What does BPO stand for

A

Benign Prostatic Obstruction

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5
Q

What does BOO stand for

A

Benign Outflow Obstruction

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6
Q

What 3 things overlap to form the Hard Diagram

A

LUTS
BOO
BPE

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7
Q

What is BPH characterised by

A

Fibromuscular and glandular hyperplasia

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8
Q

What zone does BPH normally effect

A

Transitional zone

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9
Q

How is LUTS assessed

A

International prostate Symptoms Score Sheet and Frequency volume charts

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10
Q

What is involved in a physical examination when assessing LUTS

A
  • Abdomen
  • ? palpable bladder
  • Penis
  • ? external urethral meatal stricture
  • ? phimosis
  • Digital rectal examination (DRE)
  • assess prostate size
  • ? suspicious nodules or firmness
  • Urinalysis
  • ? blood
  • ? signs of UTI
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11
Q

What investigations are carried out when a patient presents with LUTS

A
  • MSSU
  • Flow rate study- If Qmax <10 ml/s : 90% chance of having BOO
  • Post-void bladder residual USS
  • Bloods :
  • PSA
  • urea and creatinine (if chronic retention)
  • Renal tract USS if renal failure or bladder stone suspected
  • Flexible cystoscopy if haematuria
  • Urodynamic studies in selected cases
  • TRUS-guided prostate biopsy if PSA raised or abnormal DRE (digital rectal exam)
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12
Q

What is the treatment for uncomplicated BPO

A

Watchful waiting
Alpha blockers
5 alpha reductase inhibitors (Finasteride or Dutasteride)
– TURP (prostate size <100cc)
– Open retropubic or transvesical prostatectomy (prostate size >100cc)
– Endoscopic ablative procedures

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13
Q

What is the mechanism of alpha blockers

A
  • Alpha blockers cause smooth muscle relaxation and antagonise the ‘dynamic’ element to prostatic obstruction
  • Smooth muscle of bladder neck (i.e. intrinsic urethral sphincter) and prostate innervated by sympathetic alpha-adrenergic nerves (mostly alpha-1a subtype)
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14
Q

Name the types of alpha blockers

A

Non-selective- phenoxybenzamine
Selective short acting-prazosin, indoramin
Selective long acting- alfuzosin, doxazosin, terazosin
Highly selective- tamsulosin

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15
Q

What is the mechanism of 5a-reductase inhibitors

A

– Reduces prostate size and reduces risks of progression of BPE (but only if >25cc prostate)
– Also reduces LUTS (but not as effective as alpha blockers)
– Can also reduce prostatic vascularity and hence reduces haematuria due to prostatic bleeding

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16
Q

Name 5a reductase inhibitors

A
  • Finasteride (5AR Type II inhibitor)

- Dutasteride (5AR Type I and II inhibitor)

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17
Q

What is the gold standard surgical technique for BPO

A

TURP- Transurethral resection of prostate

18
Q

What are the complications of BPO

A
  • Progression of LUTS
  • Acute urinary retention
  • Chronic urinary retention
  • Urinary incontinence (overflow)
  • UTI
  • Bladder stone
  • Renal failure from obstructed ureteric outflow due to high bladder pressure
19
Q

Treatment for complicated BPO

A

o Cystolitholapaxy and TURP for patients with BPO and bladder
No treatment
o long term urethral or suprapubic catheterisation
o clean intermittent self-catheterisation

20
Q

What is the main cause of chronic urinary retention

A

Detrusor underactivity

21
Q

What is the primary and secondary cause for detrusor under activity

A

Primary- bladder failure

Secondary- longstanding BOO such as BPO or urethral stricture

22
Q

Treatment for chronic urinary retention

A

Immediate catheterisation

Manage IV fluids

23
Q

What are the complications of urinary retention

A

Post-decompression haematuria
Pathological diuresis
Electrolyte abnormalities- hyperkalaemia, hyponatraemia, metabolic acidosis

24
Q

What are the types of urinary tract obstruction

A

Upper tract- PUJ, VUJ, ureter

Lower Tract- Bladder neck, prostate, urethra, urethral meatus, foreskin

25
Q

Name intrinsic causes of PUJ obstruction

A
  • Stone
  • Ureteric tumour (TCC)
  • Blood clot
  • Fungal ball
26
Q

Name Extrinsic causes of PUJ obstruction

A
  • PUJ obstruction (crossing vessel)
  • Lymph nodes (tumour)
  • Abdominal mass (tumour)
27
Q

Name intrinsic causes of ureter obstruction

A
  • Stone
  • Ureteric tumour (TCC)
  • Scar tissue
  • Blood clot
  • Fungal ball
28
Q

Name extrinsic causes of ureter obstruction

A
  • Lymph nodes (tumour, retroperitoneal fibrosis)
  • Iatrogenic
  • Abdominal/pelvic mass (tumour, pregnant uterus)
29
Q

Name intrinsic causes of VUJ obstruction

A
  • Stone
  • Bladder tumour
  • Ureteric tumour
30
Q

Name extrinsic causes of VUJ obstruction

A
  • Cervical tumour

* Prostate cancer

31
Q

What are the symptoms of upper tract obstruction

A

Loin pain

Frank haematuria

32
Q

What are signs of upper tract obstruction

A
  • Palpable mass
  • Microscopic haematuria
  • Signs of complications - infection, sepsis, RF
33
Q

When someone has a urinary tract obstruction what is the management

A

• Immediate catheter
Pain management – NSAIDs/opiates
• ABCs
• IV access, bloods, ABG, urine and blood cultures, fluid balance monitoring
• IV fluids, broad-spectrum antibiotics (if appropriate)
• Emergency treatment
– Percutaneous nephrostomy insertion under LA OR
– Retrograde stent insertion
• Definite treatment
– Ureteroscopy
– Stone Fragmentation (laser)
– Ureteric tumour- radical nephro-ureterectomy
– PUJ obstruction- laparoscopic pyeloplasty

34
Q

When someone has a urinary tract obstruction what is the investigations

A
  • Urine dipstick
  • U&Es
  • FBC
  • CT KUB
35
Q

What are the symptoms of lower tract obstruction

A
  • Lower urinary tract symptoms
    • including urinary incontinence
  • Acute urinary retention
  • Chronic urinary retention
  • Recurrent urinary tract infection and sepsis
  • Frank haematuria
  • Formation of bladder stones
  • Renal failure
36
Q

What are the symptoms of high pressure chronic urinary retention

A
  • Painless
  • Incontinent
  • Raised creatinine
  • Bilateral hydronephrosis
37
Q

What are the symptoms of low pressure chronic retention

A
  • Painless
  • Dry
  • Normal creatinine
  • Normal kidneys
38
Q

Why does decompression haematuria occur

A

– Shearing of small vessels due to differing compliance of tissue layers
– Usually self-limiting

39
Q

Short-term urethral catheters (e.g. latex-based ones) should not be left in-situ for longer than

A

4 weeks

40
Q

Long-term urethral catheters (e.g. silicone-based ones) should not be left in-situ for longer than:

A

12 weeks

41
Q

What is the ‘gold standard’ investigation for renal colic

A

CT-KUB

42
Q

What are common types of renal tract stones

A

Calcium phosphate
Calcium oxalate- most common
Uric acid (urate)
Magnesium ammonium phosphate (struvite)

Urology (26 decks)

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