Station 6

Question 1

71 Year old Man - Nocturia

Assess

Answer 1

Focused History
LUTS - Duration,Severity,Impact
Red Flags - NE, Back pain, rapid progression, infections, haematuria
Lifestyle- Caffeine, carbonated drinks, fluid consumption
DH - Diuretics, LUTS medications, Allergies, Anticoagulation
SH - ? Fitness
PMH: Pelvic surgery, radiation, instrumentation, neurological disorders

Examination
General - ?infection, ?fluid status
Abdominal - Pain, Renal Angle Tenderness
Rectal - Perineal sensation, Prostate size, Prostatitis
External Genitalia - Strictures at meatus

Question 2

What does nocturnal enuresis point toward

Answer 2

HPCUR

Question 3

What is IPSS

Answer 3

International Prostate Symptom Score:

8 Question
1-7 Scored 0-5

8th Question is QOL question

FUNWISE
Frequency, Urgency, Nocturia, Weak Stream, Intermittency, Straining, Incomplete Emptying

Question 4

What baseline male LUTS investigations

Answer 4

Bloods - FBC, UE, INR, Consider PSA after counselling with patient
Urinalysis + Culture
FR + PVR

Imaging
TRUS/US Abdomen - Treatment PLanning
US Urinary Tract - IF Haematuria/Pain/Infections/Sterile Pyuria, Significant PVR, Deranged REnal Function

**Cystoscopy ** IF Haematuria, Sterile Pyuria, Recurrent UTIs

Question 5

Indications for urodynamics

Answer 5

EAU Indications

<50 or >80 years of age
Failed invasive treatments
Neurological Issues
Men who can’t void 150 ml or greater
PVR of >300 ml
FR >10 ml/sec QMax

Question 6

Consent for TURP/ HOLEP

Answer 6

Confirm patient details
Use visual aids/PDAs/patient advice leaflets - offer time if necessary
Offer all appropriate treatments discussing pros/cons (including doing nothing)

Bleeding, infection, pain, urinary retention, TUR syndrome

Symptoms - worsening, persisting, incontinence (temporary/permanent <1%), retrograde ejaculation, erectile dysfunction, further procedure, finding of cancer,
Damage - bladder, urethra, ureteric orifice, urethral stricture

Anaesthetic risk

Question 7

How would you perform a TURP

Answer 7

Confirm consent, pre-operative bloods/urine cultures, theatre briefing, who checklist performed, appropriate patient position (lithotomy), cleaning and preparation

DRE
Perform Cystoscopy - UO Positions, Lesions, Veru position/prostate anatomy

Insert Resectoscope
Resection median lobe to bladder neck fibres
Resect lateral lobes one at a time
Constant re-checking of veru montagnum ensuring resection is proximal to this to avoid sphincter damage
Constant re-checking of UOs to avoid diathermy injury

Ellick chips out
Haemostasis using roller ball diathermy/ button diathermy
3 way catheter on irrigation
Sign out
Operartion note and plan
Review patient post-operatively