the structure and fucntion of prostate gland and treatment for BPH (lecture) Flashcards
What does dysuria mean ?
pain with urinating
What are the lower urinary tract symptoms ?
storage symptoms
- nocturia (>2x a night)
- frequency
- urgency
- incontinence
obstructive/voiding symptoms
- hesitancy (delay before starting urination)
- poor stream/strength of stream
- straining
- intermittency (start and stop pattern)
- feeling of incomplete voiding/emptying
What are red flag symptoms of prostate problems ?
- dysuria (pain)
- haematuria/haematospermia (blood in urine/semen)
- enuresis (leak at night)
- recurrent infection
- symptoms of renal failure
- prostate size and consistency
What does enuresis mean ?
leaking urine at night
“wetting the bed”
What to examine if presenting with potential prostrate issues ?
- general (gait, tremor etc)
- abdomen (palpable bladder)
- genitalia (phimosis, swelling tenderness of testis or epididymis)
- rectal exam (size and sphincter tone: rubbery, smooth, midline groove)
- neuro (bulbocarvernosal reflex, lower limb reflexes)
What is phimosis ?
inability to retract foreskin of penis in adult male
What are some common differential diagnoses for benign prostate hyperplasia (bph ) ?
- cancer
- under/overactive bladder
- construction of urethra
- infection (cystitis/prostasis)
- psychological (anxiety…)
What are the 4 zones of prostate ?
- central zone
- peripheral zone (largest ~70%)
- fibromuscular stroma
- transitional zone
which is the most posterior zone of prostate ?
peripheral zone
Which zone of prostate directly surrounds urethra ?
transitional zone
Dimensions of prostate ?
2 by 3 by 4 cm
15-20 grams
What are the functions of the prostate ?
- fertility
- prostatic specific antigen (PSA) enzyme = semen liquefaction
- anterograde ejaculation
- contributes to 25% of ejaculate volume (acidic)
- provides milieu for sperm to thrive
What causes prostate enlargement ?
- increase in number of cells (more production or less apoptosis)
- imbalance of growth factors (EGF, KGF, IGF vs TGF)
- androgen/oestrogen ratio imbalance (more oestrogen and less testosterone in older men)
What investigations would you do if suspecting benign prostate enlargement/prostate cancer ?
- urinalysis
- urea electrolytes and creatinine
- PSA
- kidney function test
- flow rate and post void scan
optional
- ultrasound
- flexible cystoscopy
What kind of gait is seen in parkinson’s ?
shuffling gait
