Lower Urinary Tract and Nephrolithiasis

Question 1

What are “irritative” lower urinary tract symptoms?

Answer 1

1. frequency- peeing a lot in the daytime
2. urgency- insuppressible urge to pee
3. nocturia- peeing a lot at night

Interfere with normal STORAGE of the bladder

Question 2

What are the “obstructive” LUTS?

Answer 2

1. weak urine stream
2. intermittent
3. straining- trouble starting the urine stream

Interfere with normal voiding from the bladder

Question 3

What are the 7 most common etiologies of LUTS?

Answer 3

1. BPH
2. prostate cancer
3. urethral stones
4. urethral stricture
5. weak bladder muscles
6. bladder stones
7. bladder neck sclerosis/contracture

Question 4

Are the following treated surgically, medically or both?
1. renal cancer
2. bladder cancer
3 .BPH 
4 .UTI

Answer 4

1. surgical
2. both
3. both
4. medical

Question 5

What is the purpose of the prostate?
When does it grow?
What portion of the prostate grows? What is the problem with this?
What does it look like histologically?

Answer 5

It contributes fluid and secretion to semen during ejaculation. It grows under the influence of testosterone.
The transitional zone grows narrowing the lumen of the prostatic urethra with periurethral glandular and stromal hyperplasia

Question 6

What is the “static” component of LUTS?

Answer 6

the progressive obstruction upon the prostatic urethra by the enlarging glandular and stromal hyperplasia.

Question 7

What is the “dynamic” component of LUTS?

What drugs can block this?

Answer 7

Bladder neck, prostate, and capsule are innervated by sympathetics (a-1a recepters in high concentration) instead of parasympathetics like the bladder muscles.

Uroselective a blockers (-osin) will decrease tone of the bladder neck and prostate allowing more flow.

Question 8

What do 5a reductase inhibitors do?

Answer 8

Block testosterone –> DHT which will decrease prostate volume 25%. This relieves obstructive NOT irritative symptoms

Question 9

What is PSA? What level is very suspicious for prostate cancer?
What is the grey zone? What measurement is taken if the patients PSA is in the grey zone?

Answer 9

PSA - glycoprotein produced by the glandular epithelial cells of the prostate released as free or bound to a1-macroglobulin

Normal PSA 10

Question 10

What does a urine flow rate recording of less than 10 mean?

Answer 10

It is indicative of an obstruction. Normal flow rate is above 15.

Question 11

What is residual urine? How much is normal?
What does increased residual urine suggest?
What are the consequences?

Answer 11

Residual urine is the amount that remains in the bladder after attempted complete voiding.

Normal is less than 30cc

Increased is suggestive of:

1. obstruction
2. weak detrusor muscle

Consequences:

1. UTI
2. blockage of ureters, kidney–>hydronephrosis