Urological Surgery Flashcards
1
Q
What is obstructive uropathy?
A
- Obstructive uropathy is blockage of urinary flow, which can affect one or both kidneys depending on the level of obstruction.
- If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal.
- When kidney function is affected, this is termed obstructive nephropathy.
- Hydronephrosis refers to dilation of the renal pelvis and can be present with or without obstruction
2
Q
What are some of the symptoms of obstructive uropathy?
A
- Flank pain
- Fever
- Lower urinary tract symptoms
- Distended abdomen/palpable bladder
- Inability to urinate
- Enlarged or hard nodular prostate on rectal examination
- Costovertebral angle tenderness
3
Q
What are some of the causes of obstructive uropathy? How would these be classified?
A
- Luminal: stones, blood clot, sloughed papilla, tumour: renal, ureteric, or bladder
- Mural: congenital or acquired stricture, neuromuscular dysfunction, schistosomiasis
- Extra-mural: abdominal or pelvic mass/tumour, retroperitoneal fibrosis, or iatrogenic—eg post surgery
4
Q
What are some of the RFs for urological surgery?
A
- BPH
- Constipation
- Medication (anticholinergic agents, narcotic analgesia, alpha receptor agonists)
- Urolithiasis (ureteric calculi)
- Spinal cord injury, Parkinson’s disease, or multiple sclerosis
- Malignancy
5
Q
What investigations should be considered for obstructive uropathy?
A
- Bedside: urine dipstick, pregnancy for female, urine MC+S
- Bloods: FBC, UE, CRP, PSA, CK,
- Others to consider: tumour markers (CEA, CA125))
- Imaging: renal USS, CT (if there is hydronephrosis or hydroureter)
6
Q
How would you manage obstructive uropathy?
A
Upper Tract Obstruction
- 1st: analgesia (diclofenac) and rehydration (IV fluids)
- 2nd: ureteric stent or nephrostomy
- alpha blockers e.g. tamsulosin
- Abx (if needed) e,g, gentamycin
Lower Tract Obstruction
- Urethral or suprapubic catheter - Monitor weight, fluid balance, and u&e closely
- After 2-3 days TWOC
7
Q
What are renal stones and who do they affect?
A
- Renal stones (calculi) consist of crystal aggregates.
- Stones form in collecting ducts and may be deposited anywhere from the renal pelvis to the urethra
- 2-3% of the Western population.
- Males <65yrs
- They can form as both renal stones or ureteric stones
8
Q
Where do kidney stones commonly form?
A
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction.
9
Q
What types of kidney stones do you get?
A
- Calcium oxalate (75%).
- Magnesium ammonium phosphate (struvite/triple phosphate; 15%).
- Also: urate (5%), hydroxyapatite (5%), brushite, cystine (1%), mixed.
10
Q
How do kidney stones present generally?
A
- Can be assymptomatic
- Pain: ‘loin to groin’ (or genitals/inner thigh), with
- Nausea/vomiting.
- Cannot lie still
- Haematuria
- Proteinuria
- Sterile pyuria
- Anuria
11
Q
Depending on where the stone is obstructed, what type of symptoms do you get?
A
- Obstruction of kidney: felt in the loin, between rib 12 and lateral edge of lumbar muscles (like intercostal nerve irritation pain; not colicky, worsened by specific movements/pressure on a trigger spot).
- Obstruction of mid-ureter: mimic appendicitis/diverticulitis.
- Obstruction of lower ureter: sx of bladder irritability. Pain in scrotum, penile tip, or labia majora.
- Obstruction in bladder or urethra: pelvic pain, dysuria, strangury (desire but inability to void) ± interrupted flow.
12
Q
How do the stones appear depending on their composition?
A
- Calcium (oxolate, phosphate) - radio-opaque (spikey, smooth)
- Magnesium ammonium phosphate (struvite) - stag horn calculi, radio-opaque
- Urate - radio lucent
13
Q
Why do kidney stones appear?
A
- Over-saturation of urine
- High levels of purine in the blood (diet, haematological disorders)
14
Q
What are some of the more specific reasons kidney stones appear?
A
- Diet: chocolate, tea, rhubarb, strawberries, nuts, and spinach (↑oxalate)
- Season: variations in calcium and oxalate levels mediated by vitamin d synthesis
- Work: Water consumption (can they hydrate regularly)
- Medications: diuretics, antacids, acetazolamide, corticosteroids, theophylline, aspirin, allopurinol, vitamin c and d, indinavir.
15
Q
What are some of the predisposing factors to kidney stones?
A
- Recurrent UTIs (magnesium ammonium phosphate )
-
Metabolic abnormalities:
- Hypercalciuria/hypercalcaemia, hyperparathyroidism, neoplasia, sarcoidosis, hyperthyroidism, Addison’s, Cushing’s, lithium, vitamin d excess
- Hyperuricosuria/↑plasma urate: on its own, or with gout
- Cystinuria
- Renal tubular acidosis
- Urinary tract abnormalities: PUJ obstruction, hydronephrosis, horseshoe kidney, vesicoureteric reflux, ureteral stricture
- Foreign bodies: cathetar, stents
- FMH: ↑3-fold
16
Q
What investigations are needed for diagnosis of kidney stones?
A
- Urine dipstick: Usually +ve for blood (90%) (non visible haematuria)+ mc&s
- Bloods: fbc, u&e, Ca2+, po43−, glucose, bicarbonate, urate
- Urine pH; 24h urine for: calcium, oxalate, urate, citrate, sodium, creatinine; stone biochemistry (sieve urine & send stone)
-
Imaging:
- GOLD STANDARD: CT KUB (high sensitivity and specificity)
- AXR - sometimes used for initial assessment, - will only show radio opaque stones (80% but not all)
- USS (hydronephrosis)
17
Q
What would the initial management be for kidney stones?
A
- IV fluid resuscitation
- Analgesia: PR diclofenac 100mg
- If infection: Abx (eg piperacillin/tazobactam 4.5g/8h iv, or gentamicin)
- Anti emetic: ondansetron
- ↑Fluid intake
Renal stones will pass spontaneously if in the lower ureter or <5mm in diameter
Unless pregnant: remove stones via Ureteroscopy
18
Q
When should you admit a patient for kidney stones?
A
- Post-obstructive AKI
- Uncontrollable pain from simple analgesics
- Infected stone(s)
- Large stones (>5mm)
19
Q
What management is required for stones >5mm or pain not resolving?
A
Medical expulsive therapy:
- α-blockers (tamsulosin 0.4mg/d) - Most pass within 48h
- ESWL (extracorporeal shockwave lithotripsy) - US waves shatter stone. Small stones: <2cm, performed via radiological guidance (either X-ray or USS). SE: renal injury, may also cause ↑bp and dm
- PCNL (Percutaneous nephrolithotomy): Keyhole surgery to remove stones, when large, multiple, or complex. For: large renal stones (including staghorn calculi).
- URS (Flexible uretero-renoscopy) - passing a scope retrograde up into the ureter, allowing stones to be fragmented through laser lithotripsy and fragments removed
20
Q
How are kidney stones prevented generally and specifically?
A
Generally
- Drink plenty
- Normal dietary Ca2+ intake
Specifically:
- Calcium stones: thiazide diuretic to ↓Ca2+ excretion.
- Oxalate: ↓oxalate intake; pyridoxine
- Struvite (phosphate mineral): treat infection
- Urate: allopurinol (100–300mg/24h po)
- Cystine: vigorous hydration and urinary alkalinization
21
Q
How is obstructive nephropathy or significant infection secondary to renal stones managed?
A
- Retrograde stent insertion is the placement of a stent within the ureter, approaching from distal to proximal via cystoscopy
- Nephrostomy is a tube placed directly into the renal pelvis and collecting system, relieving the obstruction proximally
22
Q
What are the nice guidelines for urological referral (haematuria)?
A
- Aged ≥45yrs with either:
- Unexplained visible haematuria without urinary tract infection
- Visible haematuria that persists or recurs after successful treatment of urinary tract infection
- Aged 60yrs with have unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test.
23
Q
How is haematuria classified?
A
- Visible haematuria
-
Non-visible haematuria (NVH): Blood is present in the urine on urinalysis, but not visible. Further categorised:
- Symptomatic non-visible haematuria (s-NVH): with associated symptoms, e.g. suprapubic pain or renal colic.
- Asymptomatic non-visible haematuria (a-NVH): + no associated symptoms.
24
Q
What are some causes of haematuria?
A
- Infection, including pyelonephritis, cystitis, or prostatitis
- Malignancy, including urothelial carcinoma or prostate adenocarcinoma
- Renal calculi
- Trauma or recent surgery
- Radiation cystitis
- Parasitic, most commonly schistosomiasis
25
Q
How would you investigate haematuria?
A
- Bedside: urine dipstick
- Bloods: FBC, UE, CRP, clotting, PSA, tumour markers
- Imaging: USS KUB, CT urogram
- Specialist: flexible cystoscopy - gold standard , urine cytology
26
Q
How would you investigate acute urinary retention?
A
- Examination: palpate bladder, PR exam (check for constipation
- Bedside: post-void bedside bladder scan, dipstick
- Bloods: FBC, CRP, and U&Es . Post-catheterisation (see below), a CSU (Catheterised Specimen of Urine)
- Imaging: USS
27
Q
What are some of the causes of acute urinary retention?
A
- Obstructive: BPH, urethral strictures or prostate cancer.
- Infections: UTI
- Constipation
- Medications: anti-muscarinics or spinal or epidural anaesthesia
- Neurological: peripheral neuropathy, iatrogenic nerve damage during pelvic surgery, upper motor neurone disease (such as Multiple Sclerosis Parkinson’s disease), or Bladder Sphincter Dysinergy
28
Q
What are some of the possible complications of obstructive uropathy?
A
- Hyperkalaemia
- Metabolic acidosis
- Post obstructive diuresis - lots of wee
- Na and Bicarb losing nephropathy - as kidneys under diuresis large amounts are lost from kidney. Replace bicarb
- Infection
29
Q
What are some of the symptoms of BPH?
A
- LUTS: post micturition dribbling
- Voiding symptoms: hesitancy, weak stream, terminal dribbling, or incomplete empyting
- Storage symptoms: urinary frequency, nocturia, nocturnal enuresis, or urge incontinence
30
Q
How do you investigate BPH:
A
- Bedside: urinalysis (to exclude UTI), DRE, post void bladder scan
- Bloods: routine + PSA
- Imaging: USS, Urodynamic studies
31
Q
How do you treat BPH?
A
- Conservative: avoid caffeine + alcohol, relax when voiding. Control urgency by practising distraction methods (eg breathing exercises). Bladder training.
-
Pharmacological:
- Tamsulosin/ doxazosin. SE: drowsiness; depression; dizziness; ↓bp; dry mouth; ejaculatory failure; extra-pyramidal signs; nasal congestion; ↑weight
- 5α-reductase inhibitors: e.g.finasteride 5mg/d po
-
Surgical:
- TURP: Transurethral resection of prostate (turp)
- Transurethral incision of the prostate (TUIP): less destruction than turp, and less risk to sexual function, gives similar benefit.
- Retropubic prostatectomy: is an open operation (if prostate very large).
- TULIP: Transurethral laser-induced prostatectomy
- ? Robotic prostatectomy is gaining popularity as a less traumatic and minimally invasive treatment option.
32
Q
What are the complications of BPH? What is TURP syndrome?
A
High-pressure retention: chronic or acute-on-chronic urinary retention results in a post-renal kidney injury
TURP Syndrome:
-
TURP with monopolar energy requires use of hypoosmolar irrigation during the procedure -> causes:
- Fluid overload
- Hyponatremia (must be corrected)
- Glycine toxicity as the fluid enters the circulation through the exposed venous beds.
- Pt: confusion, nausea, agitation, or visual changes
Complications: TURP
T syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate
33
Q
What is prostatitis?
Who does it affect?
How does it present?
How is it investigated?
How is it treated?
A
-
What: inflammation of the prostate gland
- Causative organisms: E. Coli (most common), Enterobacter, Serratia, Pseudomonas, and Proteus species. STIs - rare cause.
- Who: men < 50yo
-
Presents: LUTS, pyrexia, perineal or suprapubic pain, or urethral discharge.
- DRE: very tender and boggy prostate +/- inguinal lymphadenopathy; can be chronic (>3 mo), perineum is the most common site for pain
- Ix: Urine culture, STI screen and routine bloods (FBC, CRP, and U&Es, PSA)
- Other: transrectal prostatic ultrasound (TRUS) or CT imaging (if abscess suspected)
- Management:
- 1st: analgesia (paracetemol + ibuprofen/ diclofenac), Abx prolonged (cefotaxamine)
- 2nd: Alpha blockers or 5a-redictase inhibitors (chronic)
- +Cathetar (if obstructed)
- Surgical: if abscess
34
Q
How would you manage acute urinary retention?
A
-
Immediate urethral catheterisation
- Monitored post-catheterisation for evidence of post-obstructive diuresis.
- BPH: Tamsulosin
- CSU for any evidence of infection and treat with antibiotics if needed.
- Review medications: for any potential contributing causes and treat any constipation if present.
- TWOC: after 24-48hrs, If the patient voids successfully, with a minimal residual volume, the TWOC is considered successful, whilst if the patient re-enters retention, the patient will require re-catheterisation.
35
Q
What is post obstructive diuresis?
A
- Can occur after resolution of the retention through catheterisation, the kidneys can often over-diurese due to the loss of their medullary concentration gradient, which can take time to re-equilibrate.
-
-> Worsening AKI
- Patients producing >200ml/hr urine output should have around 50% of their urine output replaced with IVI to avoid any worsening AKI.
- Monitor UO in these patients over the following 24 hours post-catheterisation.
36
Q
What is a hyrocoele?
How will a hydroceoele present?
How should they be investigated?
A
- Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis
- Presents as: painless fluctuant swelling that will transilluminate, either unilateral or bilateral
- Urgent ultrasound scan
- Treatment: nothing
37
Q
What is a varicocoele?
How will a varicocoele present?
How should they be investigated?
What are the red flag signs?
How should they be managed?
A
-
What? Abnormal dilatation of the pampiniform venous plexus within the spermatic cord
- Can be a sign of malignancy
- Can cause infertility
-
Presents: lump, “bag of worms” or with a “dragging sensation” may disappear on lying flat.
- Examine patient lying down, standing up and whilst performing a valsava manoeuvre.
- Red flags: acute onset, right-sided, or remain when lying flat, and should be investigated urgently.
-
Management:
- Mild varcicoeles do not need intervention and can be managed conservatively
- If not: embolisation and surgical approaches either open or laparoscopic approach for ligation of the spermatic veins
38
Q
What are Epididymal Cysts and how do they present?
How are they treated?
A
- What? Benign fluid-filled sacs arising from the epididymis. Present: smooth fluctuant nodule, found above and separate from the testis that will transilluminate, often they are multiple.
- Who? Middle-aged men.
- Do not require treatment
39
Q
What is Epididymitis and how do they present?
How are they treated?
A
- Unilateral acute onset scrotal pain, swelling, erythematous overlying skin, and systemic symptoms such as fever.
- Above + behind testis - think of where the epidydymis is)
- On examination, the epididymis is tender and pain may be relieved on elevation of the testis (+ve Prehn’s sign).
- Treatment: oral antibiotics and analgesia.
40
Q
What are testiticular tumours?
Who gets them?
How do they present?
How are they investigated treated?
A
- PC: Painless lump arising from testes, unilateral, will not transluminate. Irregular, firm, fixed mass. 5% will report pain (if late presentation):
- Germ cell tumours (GCT) (95%)
-
Non-germ cell tumours (NGCTs) (BENIGN) (5%)
- Seminomas
- Non-seminomatous GCTs (NSGCT)
- RFS: Cryptorchidism (undescended testes),testicular malignancy, FH, Kleinfelter’s syndrome.
- Who: Men aged 20-40yrs
- Ix: Urgent USS, CT + contrast chest-abdomen-pelvis, do not biopsy
- Tumours markers: ßHCG + AFP
- Tr: Radical inguinal orchidectomy, +/- chemo
- Pre-treatment fertility assessment if of repro age
41
Q
What is epididymitis?
Who does it affect?
How does it present?
How do you investigate it?
How do you treat it?
A
- What: Inflammation of epididymis. Local extension of infection from UTI or STI (chlamyia or gonorrhea)
- Who: men, bimodal, young 15-30yrs and old >60yrs
-
Presents: Fever and rigots, dysuria, storage LUTS, urethral discharge. Sexual history? Red and swollen. Tenderness on palpation of epididymis +/- the testis
- Cremasteric reflex: intact
- Prehn’s sign - pain is relieved by elevation of scrotum: +ve
- Investigations: urine dip, first void bladder scan, STI screening, bloods: FBC, UE, CRP, cultures; USS
- Management: Abx (doxy for chlamydia, ceftriaxone for gonorhea) - 2-4 wks, analgesia, abstain
- Complications: infertility
42
Q
What is orchitis?
How does it present?
What is the treatment?
A
- Inflammation of the testis. Rare.
- Cause: mumps virus. Often preceded with a history of parotid swelling.
- Treatment: rest and analgesia.
- Complications: intra-testicular abscess - rare - may require drainage and occasionally orchidectomy.
43
Q
What do inguinal hernias present? How are they treated?
A
- You cannot “get above” an inguinal hernia within the scrotum (i.e. cannot palpate its superior surface)
- A cough may exacerbate the swelling and may disappear upon lying flat
- All inguinal hernia should be assessed for strangulation or obstruction.
44
Q
When should patients be referred for prostate cancer?
A
- ‘If a hard, irregular prostate typical of a prostate carcinoma is felt on DRE, then the patient should be referred urgently.
- The PSA should be measured and the result should accompany the referral.
45
Q
What is Testicular torsion ?
Who does it affect?
How does it present?
How do you investigate it?
How do you treat it?
A
- What? Spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle. Surgical emergency
- Who: neonates and adolescents between the ages of 12-25yrs. Those with ‘bell-clapper deformity’; lack normal attachment to the tunica vaginalis and is more mobile
- Present: sudden onset, severe unilateral testicular pain; nausea and vomiting; testis will have a high position*
- Absence of cremasteric reflex
- -ve Prehn’s sign
- Diagnosis: doppler USS, urine dip, clinical
- Management:
- surgical emergency with a 4-6hrs: bilateral orchidopexy (the cord and testis will be untwisted and both testicles fixed to the scrotum)
- Pre op: analgesia and anti-emetics
- Orchidectomy if testis is non-viable
46
Q
What are the most common types of renal cancer?
A
-
RCC: adenocarcinoma of the renal cortex, upper pole
- Can spread through direct invasion in to perinephric tissues, adrenal gland, renal vein* or the inferior vena cava. RCC can spread via the lymphatic system to pre-aortic and hilar nodes, or by haematogenous sprea
- Other:
- TCC (urothelial tumours)
- Nephroblastoma in children (Wilm’s tumour)
- SCC: chronic inflammation secondary to renal calculi, infection and schistosomiasis
47
Q
What are some of the RFs for renal cancer?
How does renal cancer present?
A
- smoking
- industrial exposure
- dialysis
- hypertension
- obesity
- Anatomical abnormalities: PCKD, horseshoe kidneys.
- Genetic: von Hippel-Lindau disease (associated with bilateral multifocal toumours), BAP1 mutant disease, and Birt-Hogg-Dube syndrome.
- Presentation: haematuria (visible or non-visible), flank pain, flank mass, or non-specific symptoms, such as lethargy or weight loss
- Left-sided masses may also present with a left varicocoele
- Paraneoplastic syndromes: hypercalcaemia, hypertension due to renin, or pyrexia of unknown origin, or with the clinical features of metastasis (such as haemoptysis or pathological fractures
48
Q
How would you investigate renal carcinoma?
A
- Bedside: urinalysis, send urine for cytology
- Blood: FBC, UE, CRP, LFT, calcium
- Imaging: Gold standard: **CT imaging of the abdomen-pelvis pre and post IV contrast
- USS
- Biopsy
49
Q
How do you manage RCC?
A
Management:
Localised - Surgical management (laparoscopic or open)
- Smaller tumours: partial nephrectomy
- Larger: radical nephrectomy, + remove perinephric fat, and local lymph nodes en bloc.
- Percutaneous radiofrequency ablation or laparoscopic/percutaneous cryotherapy: if not fit enough for surgical management
Metastatic: chemo is useless
- Nephrectomy + immunotherapy (such as IFN-α or IL-2 agents)
- Biological agents: Sunitinib (a tyrosine kinase inhibitor) and Pazopanib (also a tyrosine kinase inhibitor)
- Metastasectomy: surgical resection of solitary metastases is recommended where the disease is resectable and the patient is otherwise well.
50
Q
What are some of the RFs for penile cancer?
How does it present?
How is it managed and investigated?
A
-
RFS: HPV infection, phimosis, smoking, lichen sclerosis, untreated HIV infection, Psoralen-UV-A Photochemotherapy (PUVA) treatment (used for some forms of psoriasis and cancer).
- Circumcision is deemed protective
- Presentation: palpable or ulcerating lesion on the penis, foreskin, penile shaft, and scrotum
-
Investigation: referred to a specialist regional centre for further investigation, penile biopsy, confirm inguinal lymphadenopathy should be determined, typically using PET-CT imaging (especially in those with palpable nodes).
- CT chest abdo pelvic: if +ve inguinal lymph nodes
- Management: complete tumour removal and oncological control, whilst ensuring as much organ preservation as possible. Management often requires a combination of surgery, radiotherapy, and chemotherapy.
51
Q
What are the different types of urinary incontinence you can get? What are their causes?
A
-
Stress - increasing intra abdo pressure.
- Causes: constipation (due to recurrent straining), obesity, post-menopausal, or pelvic surgery, weak pelvic floor, pregnancy
-
Management:
- C: Pelvic floor exercise x 3m
- P: Duloxetine
- S: Tension-free vaginal tape
-
Urge - Detrusor instability/ overactive bladder. rise in intravesical pressure and subsequent leakage of urine
- Causes: neurogenic causes (eg stroke), infection, malignancy, or idiopathic. Medication (cholinesterase inhibitors)
-
Management:
- C: Bladder training
- P: Anti muscarinics: oxybutynin or tolterodine
- S: botulinum toxin A injections, perc. sacral nerve stimulation, augmentation cystoplasty
- Mixed - Stress and Urge
-
Overflow - complication of chronic urinary retention. Stretching of the bladder wall -> damage of sacral reflex and loss of bladder sensation.
- Causes: BPH
- Continuous - fistulae.
52
Q
What are the different types of bladder cancer that you can get?
What are some RFs for developing bladder cancer?
A
- TCC: most common, 80-90% cases
- SCC
- Rare: adenocarcinoma + sarcoma
Bladder cancers can further be classified into:
- Non-muscle-invasive bladder cancer – 70-80%
- Muscle-invasive bladder cancer – penetrates deeper layers of the bladder wall
- Locally advanced or metastatic bladder cancer – spreading beyond the bladder and distally
- RF: smoking, age, exposure to aeromatic hydrocarbons (e.g. industrial dyes or rubbers), schistosomiasis infection (SCC), and previous radiation to the pelvis.
53
Q
How would you investigate and manage bladder cancer?
A
-
**Urgent cystoscopy
- If suspicious lesion is identified from initial cystoscopy > rigid cystoscopy - under general anaesthetic for more definitive assessment
- Tumours identified will require biopsy and potential resection via transurethral resection of bladder tumour (TURBT), either on initial assessment (if appears superficial) or following biopsy results
- Imaging: CT staging
- Urine cytology
54
Q
How are bladder cancers managed?
A
MDT discussion
- Carcinoma in-situ or T1 tumours: resected via TURBT: Transurethral Resection of Bladder Tumour - resection of bladder tissue by diathermy during rigid cystoscopy.
-
High risk disease: adjuvant intravesical therapy, such as Bacille Calmette-Guerin (BCG) or Mitomycin C.
- Or Radical cystectomy: high-risk disease or limited response to initial treatments.
- Superficial bladder tumours: high rate of recurrence, with around 70% recurring within 3 years, and these recurrences are more likely to be more invasive. Patients require routine follow-up with regular surveillance via cytology and cystoscopy.
-
Muscle-invasive bladder cancer: radical cystectomy +/- neoadjuvant chemotherapy, typically with a cisplatin combination regimen.
-
Urinary diversion:
- Ileal conduit formation with urine draining via a urostomy
- Bladder reconstruction, from a segment of small bowel* (often termed a neobladder) and urine draining urethrally or via catheter
-
Urinary diversion:
55
Q
What are the most common types of prostate cancer?
How is prostate cancer investigated?
What scoring system is used?
A
-
Adenocarcinomas (>95%) - >75% of prostate adenocarcinomas arise from the peripheral zone
- Acinar adenocarcinoma (most common)– originates in the glandular cells that line the prostate gland
- Ductal adenocarcinoma – originates in the cells that line the ducts of the prostate gland
Scoring system: Gleason Scoring SYstem (lowest 3+3)
Investigations
-
Bloods: PSA (can become artificially raised with several other conditions, including BPH, prostatitis, vigorous exercise, ejaculation, and recent DRE, reducing its specificity)
- Can also use free:total PSA ratio, PSA density
-
Biopsies of prostatic tissue
- Transperineal (Template) biopsy: sampling prostatic tissue transperineally in a systematic manner, done as a day case under general anaesthetic. good for anterior.
- TransRectal UltraSound-guided (TRUS) biopsy: sampling the prostate transrectally, usually under local anaesthetic
- Repeat prostate biopsy: after previous negative biopsy is recommended for men with rising or persistently elevated PSA and/or suspicious DRE
