Urology Flashcards
Medical name for viagra
Sildenafil
Where are receptors for phosphodiesterase inhibitors?
Corpus cavernosum
also arteries of lungs (good for primary pulmonary hypertension)
What meds may interact with viagra?
No - other nitrates, poppers
Careful - alpha-blockers and CCBs (hypotension)
Symptoms for referral under 2WW
DRE reveals hard nodular prostate Raised or rising PSA in elderly Symptomatic and raised PSA Painless macroscopic haematuria >45 Persistent microscopic haematuria (despite UTI treatment)
(always rule out UTI first)
Mx in primary care of borderline PSA in asymptomatic pt
Can repeat PSA in 1-3 months
Refer urgently if subsequent PSA is rising
What should be refrained from prior to PSA?
UTI within last month PR exam in last week prostate biopsy within 6 weeks ejaculation within 48h heavy exercise
Normal PSA ranges
50-59 <3
60-69 <4
>70 <5
Describe stress incontinence to pt
Usually due to weak muscles in the pelvic floor and occurs when coughing, sneezing and laughing as this causes the pressure in the bladder to increase….
Describe urge incontinence to pt
Due to an overactive bladder when the muscle wall of the bladder contracts when it isn’t meant to. This causes an urgent desire to pass urine
Medical mx of symptomatic BPH
Alpha-blockers (-osin)
5-alpha reductase inhibitor if large prostate (>30 g)
Medical mx over-active bladder
Anticholinergics
Medical mx nocturia (unlicensed)
Late afternoon loop diuretic Oral desmopressin (if medical causes excluded - measure Na after 3 days and stop if too low)
Organisms causing acute prostatitis
E.coli
Staph
Chlamydia
Gonorrhoea
(Usually from urinary tract but can be blood-bourne cause)
What are the LUTS?
Difficulty/ hesitancy starting to urinate
Poor stream
Dribbling post-micturition
Frequency and nocturia
Why can untreated BPH lead to acute urinary failure?
large distended bladder
