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CP3 @ UoN - Medicine & Surgery > The Bladder & Prostate > Flashcards

The Bladder & Prostate Flashcards

1
Q

What are the two main complications for bladder trauma?

A

Intraperitoneal bladder rupture

Extraperitoneal bladder rupture

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2
Q

How should intraperitoneal bladder rupture be managed?

A

Laparotomy & bladder suturing

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3
Q

How should extraperitoneal bladder rupture be managed?

A

Prolonged urethral/suprapubic catheterisation

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4
Q

What are the luminal causes of bladder outlet obstruction?

A

Bladder tumour

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5
Q

What are the mural causes of bladder outlet obstruction?

A

Urethral stricture (post-calculus/infection)
Congenital abnormalities
Neuropathic bladder

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6
Q

What are the extramural causes of bladder outlet obstruction?

A

BPH/prostatic carcinoma

Phimosis/paraphimosis

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7
Q

What are the sx of bladder outlet obstruction?

A 
Suprapubic pain
Hesitancy/diminished force of strength
Terminal dribbling
Overflow incontinence (retention, leakage)
Signs of infection
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8
Q

What are the signs of bladder outlet obstruction?

A

Palpable full bladder
Loin tenderness/palpable hydronephrotic kidney
Enlarged prostate (on PR)

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9
Q

What investigations are appropriate in suspected bladder outlet obstruction?

A

Bloods (FBC, U&Es)
Urine dip & MCS
USS (?hydronephrosis)
CT/MRI

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10
Q

What are the management options for bladder outlet obstruction?

A

Catheterisation (suprapubic/urethral)

Treat underlying cause

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11
Q

What are the causes of bladder calculi?

A

Bladder outflow obstruction
Presence of FB
Passage of upper urinary tract stone

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12
Q

How do bladder calculi present?

A

Present w/ sx of UTI
-haematuria & pain occur at end of micturition
Pain felt at tip of penis
Perineal pain (if trigonitis)
Anuria/bladder distention (if obstruction)

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13
Q

What are the appropriate investigations for bladder calculi?

A

Investigate as for upper tract stone
Medical expulsive therapy
ESWL if stone is large

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14
Q

What is the main complication of a bladder calculus?

A

Predisposition to SCC

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15
Q

What is Benign Prostatic Hyperplasia?

A

Benign nodular/diffuse proliferation of glandular layers of prostate
-enlargement of inner transitional zone

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16
Q

How common is BPH?

A

70% of >70yrs

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17
Q

What are the sx of BPH?

A

Filling sx
Voiding sx
Sx due to complications

18
Q

What are the filling sx of BPH?

A

Frequency (1st as nocturia)

Urgency +/- strangury

19
Q

What are the voiding sx of BPH?

A 
Hesitancy
Poor/intermittent stream
Post-void dribbling
Strangury
Retention w/ overflow incontinence/acute retention
20
Q

What are the sx due to complications of BPH?

A

Haematuria (rupture of vv)

Sx of associated UTI

21
Q

What investigations are appropriate in suspected BPH?

A 
PR (palpable sulcus)
Freq/volume chart
Bloods (FBC, U&Es, PSA)
Urinalysis/MCS
Uroflowmetry
Bladder USS (pre/post void)
Transrectal USS +/- biopsy (?carcinoma)
22
Q

What is Prostate Specific Antigen?

A

Prostate cancer marker

Concentrations <4.0ng/ml are normal

23
Q

Describe uroflowmetry

A

Measures flow rate, requires >150ml be voided

-flow rate <12ml/sex suggests obstruction/weak contractility

24
Q

What are the potential complications of BPH?

A 
UTI
Overflow incontinence
Bladder calculi
Bladder diverticulae
Bilateral hydronephrosis &amp; ESRD
25
Q

What is the acute management of BPH?

A

Urethral catheter/suprapubic drainage

26
Q

What are the conservative management options for BPH?

A 
Avoid alcohol/caffeine
Relax when voiding
Void twice in a row to aid emptying
Bladder retraining therapy
Watchful waiting (if sx mild)
27
Q

What are the medical management options for BPH?

A 
alpha blockers (tamsulosin)
5-a reductase inhibitors finasteride)
28
Q

What are the s/e of a-blockers?

A

Drowsiness
Dizziness
Depression
Hypotension

29
Q

What are the s/e of 5a-reductase inhibitors?

A

Impotence
Reduce libido
Excreted in semen (use condoms)

30
Q

What are the surgical management options for BPH?

A

Transurethral resection of BPH (TURP)

Holmium laser prostatectomy (HoLEP)

31
Q

What are the risks of TURP?

A 
Impotence (10%)
Repeat procedure need (20% w/i 10yrs)
Bleeding
TURP syndrome
   -absorption of washout leading to hyponatremia &amp; fits
32
Q

Describe HoLEP

A

Endoscopic, used for large prostates

Urinary incontinence as main complication

33
Q

What is the aetiology of prostate carcinoma?

A

2nd most common malignancy in males
Present in<80% of males >80
-only 4% die from it
Mostly adenocarcinomas (peripheral)

34
Q

How do prostate carcinomas spread?

A

Local (seminal vesicles/bladder/rectum)
Lymphatic
Haematogenous (to bone)

35
Q

How do prostate carcinomas present?

A

Asymptomatic, incidental finding
Filling/voiding/complication sx (as per BPH)
Wt loss/bone pain (metastatic disease)
Hard, craggy prostate

36
Q

What investigations are appropriate in suspected prostate carcinoma?

A 
PR (T-staging)
PSA (rise >10ng/ml suggestive of tumour)
Transrectal USS/biopsy (gleason grading)
Bone XR
Scan/contrast enhanced MRI
37
Q

What factors may affect the PSA levels?

A

Mountain biking
Infection
Recent intercourse (48h)
Cystoscopy

38
Q

What is the Gleason grade?

A

Two areas graded out of 5
>8 = high risk
<6 = low risk

39
Q

What is D’Amico risk stratification?

A

Combines Gleason score w/ clinical stage & PSA to give more accurate prognostic score

40
Q

What are the management options for localised prostate cancer (T1/T2)?

A

PATIENT CHOICE

  • active surveillance (PSA/DRE)
  • radiotherapy/brachytherapy (risk of impotence/incontinence)
  • surgery (risk of impotence/incontinence)
41
Q

What are the management options for advanced prostate cancer (T3/T4)?

A

Choice b/w radiotherapy & surgery

-no difference in outcomes

42
Q

What are the management options for metastatic prostate cancer?

A

Hormonal therapy (GnRH agonists)
-palliative or as adjunct to curative disease
-1st stimulate then inhibit pituitary LH release, reduces testosterone production
Anti-androgens (cyproterone acetate)
-co-prescribed w/ hormonal therapy
-prevents early rise in testosterone

CP3 @ UoN - Medicine & Surgery (135 decks)

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