Urology Flashcards
What is the MOA for Tamsulosin or doxazosin
and side effects?
Selective alpha blocker - relaxing the smooth muscle of the prostate and sphincters and bladder neck - decreasing resistance of urine.
Side effects - postural hypotension, diziness, dry mouth and retrograde ejaculation
What is the MOA of Finasteride and side effects?
5a - reductase inhibitor
reduces the conversion of testosterone to dihydritestosterone usually responsible for prostate growth - reduces growth and obstruction to outflow
6-9 months to shrink prostate
Side effects - reduce libido, erectile dysfunction and ejaculation problems
What is Oxybutnin and the side effects?
Given for storage symptoms and reduces urinary bladder spasm
- M2 and M3 receptor antagonist
What non medical interventions can be made for storage and voiding problems?
If medical management fails and surgery is not appropriate
- Long derm indwelling urethral catheterisation (urethral or supra-pubic)
for those who cant self catheterise
If they have skin wounds, pressure ulcers or irriation that are being contaminated by urine
What surgical intervention can be made if there are voiding problems/ obstruction
Cure BPH with TURP - transurethral resection of the prostate.
Complications - problematic incontinence, retrograde ejactulation and a degree of erectile dysfunction
What is BPH?
Benign prostatic hyperplasia - common in males > 45
Non malignant enlargement of the prostate gland.
- inc in both stromal and glandular components.
- Transitional zone is the most prone to BPH and surrounds the urethra causing such symptoms
What are the symptoms of BPH
Voiding and storage
Voiding
- Inc hesitancy, straining, intermittent flow, terminal dribble, incomplete emptying
Storage
- Inc frequency
- nocturia inc
- incontinence - leakage of uria
Infection
- Haematuria
- Dysuria - painful urinary burning and stinging
Complications of BPH?
Haematuria UTI difficult to control LUTs Stone formation overflow incontinence Acute and chronic urinary retention Obstructive renal failure - high pressure retention
What investigations would be done when looking at BPH?
DRE + external genitalia
Abdo exam - palpable bladder
Looking for enlarged prostate, deeper sulcus, smooth to touch.
Check for stool or blood on finger too
Urine Dip
Bloods - U&E, creatinine and PSA
PSA (not straight after DRE)
Urinary Flowmetry and residual volume estimation Cystoscopy, transrectal USS and guided biopsy, renal ultrasound
What is the scoring system for BPH
International prostate symptoms score + bothersome score
= grade of LUTs and determines management for BPH
Includes voiding symptoms
Score:
- Mild - 0-7
- Moderate - 8-19
- Severe - 20-35
What is the management for BPH?
Conservative - reduce caffeine and alcohol
Medication - Finesteride and Tamsulosin
Surgical - TURP
(risk - hyponatraemia = cerebral oedema)
- Open retropubic prostatectomy
- Transurethral incision in the prostate
- Bladder neck incision
- Minimally invasive laser prostatectomy
What are the different types of urinary incontinence?
Stress - leak on inc abdominal/ intravesical pressure when laughing, coughing and sneezing, lifting
Overflow - chronic retention, stretching of the bladder, distended and inc pressure = dribble
Urge - urgency to urinate, inc frequency, cannot make it in time. Leakage due to strong desire to void
Mixed Stress and urgency
What is the cause of stress incontinence?
leakage when inc intravesical pressure
- incompetent external sphincter and bladder neck mechanism
- pelvic floor muscles weakened (child birth)
- Obesity, post menopause or TURP
Tx - tension free vaginal tape, suspension of the bladder neck
What is schistosomiasis?
A parasitic flat worm/fluke worm infection of the bladder. Can lie dormant for years.
Can cause:
- Bladder cystitis
- Bladder calcification
- Fibrosis and stenosis of the vesicoureteric junction
- Bladder cancer
What is urinary retention?
Inability to pass urine/void when you have the desire to.
Can lead to long term bladder damage or back pressure can lead to renal/kidney failure.
Comes on suddenly after longstanding symptoms of outflow obstruction
Acute or Chronic
