Urology

Question 1

Prostate gland functions

Answer 1

Production of seminal fluid
Supplies nutrition to sperm, alkali
Protective role, zinc

Question 2

Prostate conditions

Answer 2

☛Prostatitis - An inflammation of the prostate gland and surrounding tissue usually due to an infection
❃Risk factors -
•Altered PH
•Manipulation of prostate
•Altered prostate secretory functions i.e. decreased zinc, antibacterial factor
❃ Classification
• Cat I - Acute bacterial prostatitis (ascending infection or urine reflux)
•Cat II Chronic bacterial prostatitis (recurrent episodes of UTI)
•Cat III Chronic Prostatitis/ Chronic pelvic pain syndrome - most form of prostatitis
Inflammatory vs non inflammatory
•Cat IV - asymptomatic inflammatory prostatitis

☛ BPH
☛Prostate cancer

Question 3

Acute vs Chronic bacterial prostatitis

Answer 3

Acute - constitutional symptoms
•Fever • Chills •Malaise •Myalgia

Specific
Acute - localised pain •voiding diff •nocturia
Chronic -Voiding diff •low back pain • perineal and suprapubic discomfort

Physical exam
Acute - Swollen •tender •tense
Chronic - Tender •boggy

Question 4

Common Pathogens - Prostatitis

Answer 4

• E.Coli
• K. pneumonia
• P. mirabilis
• P. Aeruginosa
• Enterobacter sp
• Serratia sp

Question 5

Chronic Prostatitis/Pelvic Pain Syndrome

Answer 5

Most common form of prostatitis
defined as genitourinary pain and LUTS present for at least three months over the last six months, in the absence of documented UTI with a urinary tract pathogen

Question 6

Prostate Tests

Answer 6

‣DRE - enlargement (BPH), lumps(Cancer), nodules (cancer/bPH) tenderness (prostatitis)
‣PSA -blood test. normal 0-4ng/mL. refer if ≥3
‣ Prostate ultrasound
‣ Prostate biopsy

Question 7

Benign Prostate Hyperplasia

IPSS

Answer 7

•BPH is a histologic diagnosis defined as an increase in the total number of stromal and glandular epithelial cells within the transition zone of the prostate gland. This hyperplasia causes formation of large, discrete prostatic nodules.
•The correct term for the diagnosis of an enlarged prostate, felt on digital rectal examination (DRE) is benign prostatic enlargement (BPE).
• International prostate symptom score - grade severity
➻Mild <7
➻Moderate 8-20
➻Severe >20

Question 8

BPH Complications

Answer 8

• Bladder stones
• UTIs Haematuria •Acute Urinary Retention •Bladder decompensation• Urinary incontinence• Upper urinary tract deterioration and azotaemia (Post-renal)

Question 9

Prostate cancer diagnosis

Answer 9

•PSA - not specific
•imaging with multi-parametric MRI (MP-MRI)
•TRUS transrectal ultrasound-guided biopsy - gold standard
Gleason score - histological grading