Male GU

Question 1

Describe a diagnostic ultrasound (US)

Answer 1

-usually non-invasive
-usually requires full bladder but no bowel prep
-identifies strictures, calculi, and masses

Question 2

Describe a bladder scan

Answer 2

-bedside assessment
-measures the volume of urine in the bladder
-determines post void residual (PVR) bladder volume (after urination)
-keep pt supine

Question 3

Describe cytoscopy

Answer 3

-endoscopy that shows the urinary tract and can involve procedures such as biopsy, insertion of ureter stents, removal of calculi
-local anaesthetic is instilled into the urethra, saline solution is instilled to slowly distend the bladder and a catheter with a camera is inserted through the urethra
-normal findings after cystoscopy are mild to moderate dysuria, mild hematuria, some frequency
-report symptoms of gross hematuria with clots, evidence of UTI (fever combined with dysuria and frequency) and urinary retention

Question 4

Describe Benign Prostatic Hyperplasia

Answer 4

-prostate enlargement due to static and dynamic mechanisms
-compresses urethra and blocks urine output

Question 5

What are the two mechanisms involved in BPH?

Answer 5

static and dynamic mechanisms

Question 6

Describe static mechanism

Answer 6

-prostate enlarges due to stromal and glandular tissue hyperplasia
-enlarged gland–>increased pressure compresses urethra and blocks urine outflow

Question 7

Describe dynamic mechanism

Answer 7

-stromal tissue hyperplasia–>more smooth muscle–>increased muscle tone–>narrows urethra–>decreases urine outflow
-smooth muscle contracts when norepinephrine/epinephrine binds to its alpha1-adrenergic receptors

Question 8

What are the signs and symptoms of BPH?

Answer 8

-frequency, urgency, nocturia and incontinence
-slow urinary stream, straining to void, urinary intermittency or hesitancy, splitting of the voiding stream, and dribbling

Question 9

How is BPH diagnosed?

Answer 9

-combination of symptoms and DRE findings and prostate specific antigen (PSA) results
-physical examination findings include a non-tender, enlarged prostate on digital rectal examination (DRE)– the size of the prostate on examination does not correlate with symptom severity
-prostate-specific antigen (PSA) is a glycoprotein that is expressed by both normal and neoplastic prostate tissue but will be higher per gram than normal prostate tissue

Question 10

What is used to treat BPH?

Answer 10

-drugs that treat urinary symptoms (alpha 1 antagonists, beta 3 agonists, anticholinergics)
-drugs that slow hyperplasia (5 alpha-reductase inhibitors)