The Bladder and Prostate Flashcards
Describe what bladder stones are made from and the commonest cause for them forming?
Bladder stones are formed from uric acid.
Causes:
- The most common cause of them forming is due to bladder outlet obstruction e.g. BPH, neurogenic bladder
- Foreign body e.g. prolonged catheterisation
- Stone from kidneys passing down
Describe the signs and symptoms of a patient with bladder caliculi?
May be asymptomatic
UTI symptoms: frequency, pain, haematuria
- Pain and haematuria occurs at the end of micturation as the bladder contracts
Pain in the suprapubic region or in men may radiate to the tip of the penis or scrotum it may be relieved by lying down.
Poyluria and nocturia. (not completely voiding bladder so you need to go more frequently)
Hesistancy.
What investigations should be done for a patient with suspected bladder calculi?
Similar investigations as for renal stones
Bedside:
Urinalysis (haematuria)
MSU (if infection likely)
DRE (looking for BPH)
Bloods:
FBC/U/E’s/LFT’s/bHCG
Imaging:
Bladder US
Xray/CT KUB
How are bladder calculi managed?
Name a long term risk of bladder calculi?
Often are caused by an element of bladder obstruction therefore unlike to pass naturally.
Often require cystolitholapaxy:
A cystocope is inserted through the urethra into the bladder. A laser/US devices is used to break up the stone and it is then washed out. (Under a GA)
> long term can predispose to SCC
Describe the different types of bladder cancer and the risk factors for developing it?
TRANSITIONAL CELL CARCINOMAS
- Account for 90% of cases
Risk Factors include:
Increasing age >60
Being male 3:1
Smoking (aromatic amines are renally excreted)
Occupational exposure to aromatic aminesin dyes, paints and solvents.
Phenacetin (ee) Smoking Analine Cyclophosphamide
SQUAMOUS CELL CARCINOMAS
Chronic inflammation from recurrent stones
Schistosomiasis
Long term catheters
Describe the signs and symptoms of transitional cell carcinoma?
Painless haematuria usually frank blood.
Painless haematuria should always be treated as malignancy of the urinary tract until proven otherwise.
In advanced disease patients may also have voiding symptoms.
Can also have recurrent UTI
Describe how suspected bladder Ca is investigated?
Bedside:
Urinalysis (Cancers can cause sterile pyruria)
MCU (rule out infection)
Bloods:
FBC (anaemia)
U/E’s
Gold standard: Cystoscopy, used to visualise suspicious legions and biopsy them.
Can then do CT/MRI imaging to assess spread
How is bladder cancer managed?
Low risk Ca: e.g G1pTa
-TURBT and surveilnace at 3 months with cystoscopy + intravesical chemo mitomycin C
High risk Ca: e.g G3pT2
- Cystectomy + urostomy.
- Radical radiotherapy is an alternative option.
Multifocal low risk Ca G1pTa:
- Intravesical chemotherapy Mitomycin. Weekly for 6 weeks.
- Follow up with cystoscopy
Invaded beyond the bladder:
-Pallitively
CIS: Different entity tend to be high grade but have not invaded BM and instead spread within the bladder.
-Treat with immunotherapy BCG (same as vaccine) intravesically (attracts TNF cytokines)
How should those with bladder Ca that has been treated be followed up?
Those with non invasive tumours should be followed up with cystoscopy every 3 months for minimum of a year, may be longer depending on the type.
After radical cystectomy patients should be monitored for:
- hydronephrosis, stones and cancer using imaging
- local and distant recurrence using CT
- GFR
- B12 and Folate levels annually (if terminal ileum has been used in a neobladder)
List the causes of bladder outlet obstruction?
Benign Prostatic Hyperplasia (most common)
Bladder Stones
Pelvic tumors (prostate, cervix, uterus, rectum)
Bladder cancer
Urethral stricture (previous inflammation which has left scar tissue)
Neuropathic bladder
Phimosis or parpaphimosis
List the signs and symptoms of benign prostatic hyperplasia (BPH)?
Filling symptoms (FUN): -Frequency, Urgency, Nocturia
Voiding symptoms:
- Hesitacy
- Poor stream
- Post void dripple
- Feeling of incomplete voiding of the bladder.
- Strangury
How should suspected BPH be investigated?
Bedisde:
- PR exam
- Urinalysis and MSU
Bloods:
- FBC, U/E’s and LFT’s
- PSA
- Uroflowmetry
- Ask patient to fill out a frequency volume charts
Imaging:
- Post void bladder US
- Transrectal US +/- biopsy can be used to rule out Ca (high sepsis rate so only do if ? cancer)
What are the complications of BPH?
Urinary retention (this may be precipitated by anticholinergic meds, TCA’s opiates)
Formation of bladder caliculi.
Recurrent UTI’s
Kidney damage from hydronephrosis
Haematuria (microscopic or gross)
How can BPH be managed?
Assess impact on daily life options are:
- Watch and wait
- Medication
- Surgery
Lifestyle: avoid alcohol or caffine, relaxation techniques, void twice in a row to help emptying
Medication:
- Alpha blockers e.g. tamsulosin, doxasosin
- Finasteride
Surgery:
- Transurethral resection of the prostate
- HoLEP - used for very large prostates
If old and don’t want surgery - can learn to intermittent catheterise
Which area of the prostate is most likely to be affected in prostate cancer and what is the prognosis?
Adenocarcinoma of the prostate usually occurs in the posterior glandular outer portion of the prostate.
It is a very common cancer in elderly gentleman. As it is very slow growing most patients die of other causes although it does have metastatic potential.
