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TCD 14 - Urological Diseases > LUTS and Prostate > Flashcards

LUTS and Prostate Flashcards

1
Q

What do the scores of the international prostate symptom score indicate?

A 
1-7 = mild
8-19 = moderate
20-35 = severe
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2
Q

What are voiding symptoms?

A
  • Hesitancy
  • Poor intermittent stream
  • Straining
  • Incomplete emptying
  • Terminal dribbling
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3
Q

What are storage symptoms?

A
  • Urgency
  • Frequency
  • Nocturia
  • Urinary incontinence
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4
Q

What are post-micturition symptoms?

A
  • Post-micturition dribbling

- Sensation of incomplete emptying

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5
Q

What investigations would you do for LUTS?

A
  • Urine dipstick
  • DRE
  • Serum creatinine and eGFR
  • PSA
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6
Q

Why do a urine dipstick?

A

Exclude infection

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7
Q

When would you do a serum creatinine and eGFR?

A
  • Chronic urinary retention (bedwetting or an enlarged bladder)
  • Recurrent UTI
  • Hx renal stones
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8
Q

Who do you offer a PSA to?

A
  • Men >50 who request one
  • LUTS
  • Erectile dysfunction
  • Visible haematuria
  • Unexplained symptoms (lower back pain, bone pain, weight loss)
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9
Q

When do you delay PSA testing?

A
  • Active urinary infection
  • Ejaculaton within previous 48hrs
  • Vigorous exercise in previous 48hrs
  • Prostate biopsy in previous 6 weeks
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10
Q

What is a normal PSA?

A

o Normal <4ng/ml

o 60-69 <4.5ng/ml

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11
Q

How do you conservatively manage voiding symptoms?

A
  • Pelvic floor muscle training
  • Bladder training
  • Prudent fluid intake
  • Containment products
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12
Q

How do you medically manage moderate-severe voiding symptoms?

A

Alpha blocker

  • Tamsulosin
  • Alfuzosin
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13
Q

What do alpha blockers do?

A

Decrease smooth muscle tone in the prostate and bladder

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14
Q

What are the side-effects of alpha blockers?

A
  • Dizziness
  • Postural hypotension
  • Dry mouth
  • Depression
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15
Q

How do you manage an overactive bladder?

A
  • Conservative -> measuring fluid intake
  • Bladder retraining should be offered
  • Symptoms persist -> Antimuscarinic drugs (oxybutynin, tolterodine or darifenacin)
  • 2nd line -> Mirabegron
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16
Q

How do you manage nocturia?

A
  • Advise about moderating fluid intake at night
  • Furosemide 40mg in late afternoon
  • Desmopressin
17
Q

What are the risk factors for BPH?

A
  • Age

- Black>white>asian

18
Q

How does BPH present?

A

LUTS

19
Q

How do you manage BPH medically?

A

5-alpha reductase inhibitor +/- alpha blocker

20
Q

How do 5-alpha reductase inhibitors work?

A

o Block conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
o Reduces prostate volume and may slow disease progression

21
Q

What are the side effects of BPH?

A
  • Erectile dysfunction
  • Reduced libido
  • Ejaculation problems
  • Gynaecomastia
22
Q

How can you surgically manage BPH?

A

TURP

23
Q

What are the complications of TURP?

A

FIRES

F - Failure to resolve symptoms
I - Incontinence
R - Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)
E - Erectile dysfunction
S - Strictures
24
Q

How may prostate cancer present?

A
  • LUTS
  • Bone pain
  • Pelvic pain
  • No symptoms
25
Q

What investigations would you do when suspecting prostate cancer?

A
  • PSA
  • DRE
  • Trans-rectal USS +/- biopsy
  • MRI/CT and bone scan for imaging
26
Q

How is prostate cancer graded?

A

Gleason grading system

• 2 is the best prognosis and 10 is the worst

27
Q

When do you ‘watch and wait’ for prostate cancer?

A

Elderly, multiple co-morbidities,

Low risk patients:

  • Gleason score 6
  • PSA <10 ng/ml
  • Normal DRE
  • Stage T1c
28
Q

What is the risk of giving radiotherapy for prostate cancer?

A
  • Erectile dysfunction

- Long-term debilitating bowel disturbance

29
Q

What is the risk of a radical prostatectomy for treatment of prostate cancer?

A
  • Incontinence

- Erectile dysfunction

30
Q

What is the risk of prostate brachytherapy for treatment of prostate cancer?

A
  • Erectile dysfunction

- Long-term debilitating urinary symptoms

TCD 14 - Urological Diseases (6 decks)

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