UROLOGY - Bladder + Prostate Flashcards
What type of cancer are 90% of bladder cancers?
TCC;s
RF bladder cancer/TCC (4)
Smoking
Aromatic amines
Chronic cystitis
Pelvic irradiation
PS TCC/bladder cancer (4)
Painless haematuria +/- clots
Recurrent UTI/’cystitis’
Voiding Sx
Haematuria –> anaemia
Mx TCC in situ/T1
TURBT @ cystoscopy _ intravesical chemotherapy
Mx TCC T2-3
Radical cystectomy + pre op chemo
Ix TCC
Urine MCS
Cystoscopy + biopsy = GOLD STANDARD
CT/MRI - assess spread
Mx TCC T4
Palliative
Mx of intraperitoneal bladder rupture
Laparotomy + suturing of bladder
Mx of extraperitoneal bladder rupture
Prolonged urethral/suprapubic catheter
Bladder outlet obstruction - luminal causes
Bladder tumour
Bladder outlet obstruction - mural causes (3)
Urethral stricture
Congenital abnormalities
Neuropathic bladder
Bladder outlet obstruction - extra mural causes (2)
BPH/carcinoma
Phimosis/paraphimosis
CF Bladder outlet obstruction
Suprapubic pain
Hesitancy + diminished force of stream
Terminal dribbling
Overflow incontinence
Signs infection - stasis urine
Signs - bladder outlet obstruction (3)
Palpable full bladder
Loin tenderness
Enlarged prostate PR
Ix Bladder outlet obstruction (4)
Bloods - FBC/U+E
Urine dip/MCS
USS
CT/MRI
What is BPH
Benign proliferation of glandular layers of the prostate –> enlargement of inner transitional zone
What % of >70s have BPH
70%
Sx BPH (8)
Freq (1st noticed as nocturia)
Urgency
Hesitancy
Poor/int stream
Post void dribbling
Strangury
Retention w/ overflow incontinence/acute retention
Occasionally - haematuria
Ix BPH (8)
PR
IPPS
Freq/vol chart
Bloods incl FBC/U+E/PSA
Urinalysis
Uroflowmetry
Bladder USS
Transrectal USS + biopsy
Norm PSA value
<4
Apart from BPH/Prostate cancer, what other conditions cause PSA to rise (5)
Inflammation
Infection
Trauma
Ejaculation
Ageing
Acute Mx BPH
Attempt urethral catheter drainage
Lifestyle mods BPH (4)
Avoid alcohol
Relax when voiding
void twice in a row
Bladder retraining
Medical Tx BPH
Alpha blockers 0 tamulosin, doxasosin
5a reductase inhibitors - finasteride