The Bladder & Prostate Flashcards by Tim Resch

What are the two main complications for bladder trauma?

Intraperitoneal bladder rupture

Extraperitoneal bladder rupture

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How should intraperitoneal bladder rupture be managed?

Laparotomy & bladder suturing

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How should extraperitoneal bladder rupture be managed?

Prolonged urethral/suprapubic catheterisation

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What are the luminal causes of bladder outlet obstruction?

Bladder tumour

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What are the mural causes of bladder outlet obstruction?

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

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What are the extramural causes of bladder outlet obstruction?

BPH/prostatic carcinoma

Phimosis/paraphimosis

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What are the sx of bladder outlet obstruction?

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

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What are the signs of bladder outlet obstruction?

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

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What investigations are appropriate in suspected bladder outlet obstruction?

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

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What are the management options for bladder outlet obstruction?

Catheterisation (suprapubic/urethral)

Treat underlying cause

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What are the causes of bladder calculi?

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

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How do bladder calculi present?

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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What are the appropriate investigations for bladder calculi?

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

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What is the main complication of a bladder calculus?

Predisposition to SCC

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What is Benign Prostatic Hyperplasia?

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

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How common is BPH?

70% of >70yrs

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What are the sx of BPH?

Filling sx
Voiding sx
Sx due to complications

What are the filling sx of BPH?

Frequency (1st as nocturia)

Urgency +/- strangury

What are the voiding sx of BPH?

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

What are the sx due to complications of BPH?

Haematuria (rupture of vv)

Sx of associated UTI

What investigations are appropriate in suspected BPH?

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

What is Prostate Specific Antigen?

Prostate cancer marker

Concentrations <4.0ng/ml are normal

Describe uroflowmetry

Measures flow rate, requires >150ml be voided

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

What are the potential complications of BPH?

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

What is the acute management of BPH?

Urethral catheter/suprapubic drainage

What are the conservative management options for BPH?

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

What are the medical management options for BPH?

``` alpha blockers (tamsulosin) 5-a reductase inhibitors finasteride) ```

What are the s/e of a-blockers?

Drowsiness Dizziness Depression Hypotension

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

Impotence Reduce libido Excreted in semen (use condoms)

What are the surgical management options for BPH?

Transurethral resection of BPH (TURP) | Holmium laser prostatectomy (HoLEP)

What are the risks of TURP?

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

Describe HoLEP

Endoscopic, used for large prostates | Urinary incontinence as main complication

What is the aetiology of prostate carcinoma?

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

How do prostate carcinomas spread?

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

How do prostate carcinomas present?

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

What investigations are appropriate in suspected prostate carcinoma?

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

What factors may affect the PSA levels?

Mountain biking Infection Recent intercourse (48h) Cystoscopy

What is the Gleason grade?

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

What is D'Amico risk stratification?

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

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

PATIENT CHOICE - active surveillance (PSA/DRE) - radiotherapy/brachytherapy (risk of impotence/incontinence) - surgery (risk of impotence/incontinence)

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

Choice b/w radiotherapy & surgery | -no difference in outcomes

What are the management options for metastatic prostate cancer?

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

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The Bladder & Prostate Flashcards

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