Urologial Conditions + Management Flashcards
What are the 2 categories of LUTS? Which symptoms are associated with each?
Irritative/storage
- day frequency
- night frequency
- urgency
- incontinence (urge/stress/overflow/anatomical)
Obstructive/Voiding:
- hesitancy
- poor stream
- terminal dribbling
- post-micturition dribbling
What phase is bladder in most of the time?
Filling phase due to urinary flow from kidneys and contraction of urinary sphincters
How are LUTS assessed?
Symptom questionnaires MSU U/E Bladder scan i.e. if they are emptying their bladder or not Freq/Vol chart
Optional: Flow rare Plan X-ray USS renal tract Urodynamics Cystoscopy= invasive procedure to look at bladder
What affects maximal flow rates? What are the normal values? How does this change for a 70 yo man?
Rate decreases with age
> 15mls/sec= normal
10-15 mls/sec= equivocal
<10mls/sec= obstructed
10-15ml/sec may be normal for 70 yo
What are the causes of voiding dysfunction?
UTI Overactive bladder Bladder outlet obstruction-BHP Bladder cancer Prostate cancer Gynaecological problems Bladder stones Fistulas
How are LUTS managed?
-Conservative i.e. diet and drinking less
-Medical therapy i.e.
alphablocker or5-alpha reductase inhibitors for BPH= shrinks prostate
Anticholinergic= for overactive bladder
-Surgery (for BPH) Urolift Rezum/steam therapy TURP Holmium laser enucleation of prostate Open/robotic prostaretomy
What are urological complications associated with advanced BPH?
Bladder stone formation
Thickened bladder wall
Diverticulum formation in bladder wall due to increased pressure causing outpouching
Renal impairement and UTI due to urine flowing back up ureter
What are the types of incontinence and their causes?
Overflow
-due to urethral blockage leading to improper bladder emptying
Stress
- relaxed pelvic floor and increased abdominal pressure
- oestrogen deficiency in menopause
Urge
- bladder oversensitivity
- neurological disorders
What is the management of urinary incontinence?
Conservative Urethral catheter for overflow Anticholinergic/adrenergic agonist for urge incontinence Surgical for stress -plugs -bulking agents -tapes -mesh -artificial sphincters (for men when prostate removed)
How can bladder pressure be measure? Why would a probe into the bladder alone give an inaccurate measurement
Probe placed in bladder and in rectum (males) or vaginas which measures abdominal pressure. Subtract the pressure measure in rectum/vagina from the bladder probe to find true vesicles pressure
Bladder probe is detecting vesicle and abdominal pressure
What are the 2 forms of haematuria?
Visual
Non-visual (can be symptomatic or asymptomatic)
A patient presents with haematuria. What investigations do they require?
FBC/U+E Urine cytology and blood PSA USS CT urogram MRI Endoscopy i.e. Flexible or rigid cytoscopy Biopsy rarely used
What are the different bladder cancer classifications?
Ta= not invaded basement membrane i.e. low risk T1= invaded basement membrane + lamina propria edge T2= lamina propria entirely T3= muscle T4= peritoneum
How is risk of bladder cancer decided? What treatment options correlate to the different risks of cancer?
Histopathology grading
Low risk= TURBT mitomycin C X1
Medium risk= Mitomycin C X6
High risk= BCG therapy/radical cystectomy
Muscle invasive= radical cystectomy or radiotherapy
(See slides for classification)
How is BCG therapy used to treat high risk bladder cancer?
Induces inflammatory response which leads to leukocytes and immune cell recruitment to bladder which then act to target the cancer cells
