Urinary track diseases II Flashcards
Prostate
A gland that surrounds the bladder neck and proximal urethra;
slowly grows with age
Four zones (central, peripheral, transitional, periurethral)
What ages are prostate diseases very common?
> age 50
What are three common prostate disease?
- Benign prostatic hyperplasia
- Prostate cancer
- Prostatitis - an infection, usually caused by bacteria
What is nodular hyperplasia referred to as?
benign prostatic hyperplasia (BPH)
Nodular Hyperplasia
non-neoplastic enlargement
Nodular Hyperplasia - Histology
fibromuscular and glandular hyperplasia
What happens to the prostate with Nodular Hyperplasia?
prostate enlarged with nodule formation
Nodular Hyperplasia - Is it common?
common > 60 years
Nodular Hyperplasia - What percentage show symptoms?
only 10%
BPH Pathogenesis
The cause is unknown, but might be related to levels of male sex hormone (testosterone)
BPH Pathology
Nodular hyperplasia
− Stroma (smooth muscle and fibrous tissue)
− Glands
BPH Pathology Flow Diagram
Hyperplasia
(lateral and median lobe)
compression of urethra
bladder outflow obstruction
BPH Main Symptoms
Hesitancy in Initiation of Micturition
A poor stream
dribbling postmicturition
frequency and nocturia
BPH- Investigation
Digital rectal examination for the prostate (firm, smooth & rubbery)
Abdominal examination for an enlarged palpable bladder
BPH Treatment - medical
alpha blockers
- relax smooth muscle at the bladder neck
anti androgens
- prevent testosterone conversion
BPH Treatment - surgical
transurethral resection (TURP)
What is the new BPH treatment?
prostate artery embolisation
Prostate Cancer
second most common cancer in men which accounts for 1/4 of all cancers in men
a disease of elderly men occurring 1 in 10 men
unknown cause
Aetiology of Prostate Cancer
unknown
- hormonal changes - androgens
- family history
- associated with BPH but no proof
Pathology of Prostate Cancer
Adenocarcinoma
Mostly in peripheral zone, classically posterior location
Grading – Gleason Classification
Spread
- local or distant metastases
Presentation of Prostate Cancer
Symptoms of lower urinary tract obstruction
Hard craggy prostate on rectal examination
Metastatic disease in the bone; pain
Asymptomatic carcinoma, found in autopsies
Diagnosis of Prostate Cancer
Transrectal ultrasound: size & staging
Prostatic biopsy:
- histological diagnosis & Gleason scoring
- Prostate-specific antigen (PSA) - metastases
Gleason Classification
grade 1-5 depending on glandular differentiation and architectural patterns
Prostate Cancer Histology
Adenocarcinoma
