Urology Flashcards
Alpha1 adrenergic blockers
Relax the smooth muscles of the bladder neck and the prostate capsule and inhibits hypertrophy of these tissues
Useful in treating urinary retention
Alpha 1 adrenergic blockers
Selective TSA: Are specific and have less side effects -Tamsulosin - Silodosin - Alfuzosin
Non selective PDT
- Prazosin
- Docazosin
- Terazosin
Alpha1 adrenergic side effects
DIZZINESS ●POSTURAL HYPOTENSION ●HEADACHE ●RHINITIS or nasal congestion ●DECREASED EJACULATION ●ASTHENIA abnormal physical weakness or lack of energy. ●OTHERS: RAre
5 alpha reductase inhibitors
Shrinks an enlarged prostate gland in order to prevent urinary retention and improved the flow of urine. These drugs block the conversion of testosterone to dihydrotestosterone. No DHT no prostate gland emlagement
Eg: Finasteride: proscar, propecia
Episteride
Dutasteride : completely inhibits both isomer 1(20%) and 2(80%): avodart
5 alpha reductase inhibitors
LOSS/REDUCED LIBIDO
●EJACULATORY DISORDER
●ERECTILE DYSFUNCTION
●GYNAECOMATIA
Phosphodisterase 5 inhibitors
Relaxes the smooth muscle of the bladder neck for the patient to urinate
Enhances prologed erection
Controls BP
Eg: Sildenafil (Viagra)
Tadalafil (Cialis)
Verdenafil
Avanafil
Lodenafil
Phototherapy
Plant derived medication that are used to treat and manage UT symptoms Eg: Prostacure Prostamax Prostacare Prostafit
DRE in prostate cancer
- rectal mucosa is fixed
- consistency is hard
- median sulcus is obliterated
- prostate shrinks due to anaplastic tumor
- Ill defined edges
DRE for BPH
- rectal mucosa is flexible
- consistency is firm
- median sulcus is palpable and prostrate symmetrical
- prostate is enlarged
- well defined edges
Exclusion criteria IPSS
- people in urethral catheter will be relieved of all the four voiding symptoms since the catether will remove all
- when symptoms have not lasted for thirty days
Obstructive or voiding symptoms
WISE Weak or poor stream Intermittency Straining Incomplete emptying of the bladder
Irritative and storage symptoms
FUN
- Frequency
- Urgency
- Nocturia
Appendages around the urethra
- seminal vesicles
- epididymis
- prostate
- testes
Organs around the prostate
- seminal vesicles: hemospermia
- rectum: constipation
- lumbar vertebrae: causes low back pain, para- paresis/ plegia(if compressing the nerve root)
Urethra: urinary retention
Urethral stricture hx
- age: less than 50 years old
- pc : difficulty in voiding 3-6 months duration
Hpc: Do you have splitting or forked stream when urinating
Have you had any discharge from your penis in the past? How many years ago
Have you had an STI ( gonococcal urethritis) 8to 15 years ago likely to develop urethral stricture
Does straining improve stream when urinating
Is there are a decrease in the width of your stream
Has a catheter being passed through your urethra or suprapubic region? Are you still having the catether
Have you had a trauma to your pelvis or pelvic fracture
Have you had a straddle injury
Are you able to urinate now
Urethral stricture cont
PMSH: has a catheter being passed in your urethra or suprapubic area? Are you still having the catether in you
- has a urethral instrument being passed in you
Past surgical operations
- are you diabetic, asthmatic, hypertensive, sickle cell, syphyllis, tuberculosis DASST Her
- DH: are you on any medications at the moment
Do you take herbal medications
Any food or drug allergies
FH: Has anyone had a urethral stricture in your family
Anyone with DASST Her
SH: tobacco and cigarette smoking don’t put you at risk
Prostate cancer hx
- age greater than 60
- hometown; where are you from- patient has to be from an African descent since it is common amongst Africans
- residence: schistosoma
PC : difficulty in voiding 3 to 6 months of duration
Hpc: have you lost weight, feel dizzy, have palpitations, pedal swelling, itching
RSP- do you cough, feel chest pain, hemoptysis
eyes: jaundice
Musculoskeletal: hip joint pain, waist pains, weak limbs, paralysis, back ache
Have you fractures any bone
CNS: Diplopia, visual disturbance, headache,loss of consciousness
GU: hematospermia, abdominal distension
Are you able to pass out urine
Prostate cancer hx cont
PMSH: have you had the cancer before
Has your prostate being biopsied before
Have you done a urethral surgery
Have you urinated a stone before
DH: current medication and side effects ( erectile dysfunction)
Any Food and drug allergies
Do you take herbal medications
FH: do the males in your family have prostate or colorectal cancer
Do the females in your family have ovarian, breast, endometrial and colorectal cancer
SH: have you smoked before
Benign prosper hyperplasia hx
Age : 40-60 yrs old
Pc: difficulty in voiding
Hpc: do you have a urethral or suprapubic catherization. Is it still there
For BPH, urethral catetherization is done mostly
Do you strain when urinating
Prior to catetherization did you experience WISE FUN
This is a disease of exclusion
For history ask
Demographics: NASIMORA
Pc: please what brought you to the hospital? Difficulty in voiding- 3 to 6 months duration
LUTS of a duration
Inability to pass out urine two to three months ago
HPC: how did it start
How did it progress
What symptoms did you experience before this
What did you do to relieve yourself before coming to the hospital
What was done for you in the hospital
Diagnosis
Lower urinary tract symptom: no catether
Lower urinary tract obstruction: catether present
Lower urinary tract obstruction secondary to urethral stricture/ BPH/ prostate cancer
In catetherization
Urethral catether: Lidocaine + KY Gel acting as anaesthesia to decrease the patient’s pain
Suprapubic catetherization: Lidpcaine
If a catether cannot be passed
- poor technique
- lack of anesthesia
- traumatization of the urethra or urethral stricture
- in advanced prostate cancer
A prostate can be
- organ confined: age, familial
- symptomatic or asymptotic:
- locally advanced or metastatic
