Prostate Disease and Obstruction

Question 1

What are some symptoms for voiding LUTS (obstructive)?

Answer 1

Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying

Question 2

What are some symptoms for storage LUTS (irritative)?

Answer 2

Frequency
Nocturia
Urgency
Urge incontinence

Question 3

What are some treatments for uncomplicated BPO?

Answer 3

Watchful waiting

Medical therapy
Alpha blockers
5 alpha reductase inhibitors (Finasteride or Dutasteride)
Combination of both of these

Surgical intervention
TURP (prostate size <100cc)
Open retropubic or transvesical prostatectomy (prostate size >100cc)
Endoscopic ablative procedures

Question 4

What are four types of alpha blockers?

Answer 4

Non-selective (i.e. alpha 1 and 2) : phenoxybenzamine
Selective short acting : prazosin, indoramin
Selective long acting : alfuzosin, doxazosin, terazosin
Highly selective (i.e. alpha-1a) : tamsulosin

Question 5

What are some side effects of alpha blockers?

Answer 5

Hypotension
Floppy iris syndrome
Retrograde ejaculation (sperm in the bladder)

Question 6

Name two 5A reductase inhibitors

Answer 6

Finasteride (5AR Type II inhibitor)

Dutasteride (5AR Type I and II inhibitor)

Question 7

What are two side effects of 5A reductase inhibitors?

Answer 7

Sexual dysfunction

Gynecomastia

Question 8

What does TURP stand for?

Answer 8

Transurethral resection of prostate

Question 9

What are some side effects of TURP?

Answer 9

Bleeding
Infection
Retrograde ejaculation
Stress urinary incontinence
Prostatic regrowth causing recurrent haematuria or BOO

Question 10

What are some complications of BOO?

Answer 10

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

Question 11

What is some treatment for complicated BOO?

Answer 11

Medical therapy
Most patients will require surgery
eg. cystolitholapaxy and TURP for patients with BPO and bladder stones

Some patients do not need any treatment (especially if residuals are relatively low, asymptomatic and no complications)

Alternative treatment options (e.g. patients unfit for surgery) :
long term urethral or suprapubic catheterisation
clean intermittent self-catheterisation
may develop problems with difficult catheterisation, catheter trauma, blockages, frank haematuria or recurrent UTI

Question 12

What are some causes of acute urinary retention?

Answer 12

UTI, urethral stricture, alcohol excess, post-operative causes, acute surgical or medical problems

Question 13

What are some complications of acute urinary retention?

Answer 13

UTI, post-decompression haematuria, pathological diuresis, renal failure, electrolyte abnormalities

Question 14

What are two emergency procedures for urinary obstruction?

Answer 14

Percutaneous nephrostomy insertion

Retrograde stent insertion

Question 15

What are two complications that can occur after relieving chronic urinary retention?

Answer 15

Decompression haematuria
Shearing of small vessels due to differing compliance of tissue layers
Usually self limiting

Post obstructive diuresis
Greater than 200ml/hr
Osmotic diuresis 2y to urea; ADH; altered tubular function
Can lead to life threatening sodium and water depletion
Normal saline at input = output-30ml/hr