urology Flashcards
presentation BPH
- weak/ intermittent flow
- straining
- hesistancy
- terminal dribbling
- incomplete empying
- urgency
- frequency
- incontinence
- nocturia
- acute urinary retention
BPH- investigations?
Digital rectal exam!
+/- PSA or urinalysis
BPH management?
First line= Alpha-1- antagonists (TAMSULOSIN)
2nd- 5- alpha reductase inhibitor (e.g. finasteride)
Surgical- TURP (transurethral resection of prostate)
alpha-1- antagonist (tamsulosin) SE
- postural hypotension
- dry mouth
- retrograde ejaculation
- depression
5- alpha reductase inhibitors (e.g. finasteride) SE
- erectile dysfunction
- gynaecomastia
presentation of acute urinary retention?
- subacute onset of anuria
- suprapubic pain/discomfort
- palpable distended bladder
investigations acute urinary retention?
-prompt decompression with catheterisation
UROLOGICAL EMERGENCY
most common cancer in adult men?
-prostate cancer
what type of cancer is prostate cancer?
95% adenocarcinoma
presentation of prostate cancer?
DRE- asymmetrical, hard, nodular enlargement
Raised PSA
- largely asymptomatic
- LUTS
- haematuria
- haematospermia
- pain in back, perineum or testes
- ED
- weight loss
- bone pain
investigations for prostate cancer?
DRE- asymmetrical, hard, nodular enlargement
PSA- raised
First line investigation= multi parametric MRI (compared to traditional method of TRUS)
Multiple biopsy’s (at least 10 required)
what grading system is used for prostate cancer?
Gleason’s grading (used for prognosis)
treatment for localised prostate cancer (T1/T2)
Conservative:
-active monitoring and observation appropriate if low Gleason’s or elderly with significant co morbidities
- radical prostatectomy
- radical radiotherapy
treatment for localised advanced prostate cancer (T3/T4)
- hormonal therapy if not fit for radical therapy
- radical prostatectomy
- radical radiotherapy
Presentation of metastatic prostate cancer?
Suspect metastatic disease if anorexia, weight loss and bone pain
- classically osteosclerotic bone lesions (haematological spread)
- local invasion to seminal vescles
- lymphatic spread occurs first
investigations- metastatic prostate cancer
- isotope bone scan +/- Xray
- CT/ MRI for staging
treatment of metastatic prostate cancer?
Hormonal therapy:
- synthetic GnRG agonist (GOSERLIN)
- Anti androgen (CYPROTERONE ACETATE)
- bilateral orchidectomy
radiotherapy can also be used in palliative setting
anti androgen is given to prevent testosterone rise from synthetic GnRH agonist
bladder cancer associated with smoking and >50 years
transitional cell cancer (90%)
bladder cancer associated with chronic schistosomiasis infection
squamous cell carcinoma
presentation of bladder cancer?
-painless macroscopic haematuria +/- LUTS
investigations bladder cancer?
- flexible cytoscopy with biopsy
- pelvic MRI for local invasion
- CT for metastasis +/- PET
bladder cancer treatment
T2: radical cystectomy
T4: palliative
investigation for >50 with macroscopic haematuria
CT urography + flexible cytoscopy
investigation macroscopic haematuria <50
-renal/bladder USS + flexible cytoscopy
+/- CT urography if no cause found
investigation macroscopic haematuria in pregnant woman
MR urography
