Urology - Chronic Conditions Flashcards
what pathological cell change occurs in BPH? describe?
hyperplasia
increase in amount of cell tissue (more cells)
which part of the prostate enlarges in BPH?
stroma (outside)
what are the predominant receptors in stromal tissue?
alpha 1A receptors
features of BPH?
frequency nocturia uregency incontinence dribble straining
Ix for BPH?
PR (smooth and equal)
PSA (non specific)
Tx for BPH?
bladder training
alpha blocker
5 alpha reductase
surgery (TURP)
e.g of alpha blocker
5 alpha reductase
and how long does each take to work?
side effects?
alpha blocker
- doxasosin, alfuzosin
- days
- low BP, headache, faint
5 alpha reductase inh
- finasteride
- months
- low libido, ED
what are the types of urinary incontinence?
urge
stress
overflow
mixed
risk factors for urinary incontinence?
female age obese pregnancy dementia stroke caffeine diuretics faecal incontinence
features of urge incontinence?
frequncy
small volume
provoked
enuresis
features of stress incontinence?
during increased abdo pressure
features of overflow incontinence?
huge palpable bladder
leaking
wet at night
causes of each type of incontience?
stress - pelvic floor damage
urge - detrusor overactivity
overflow - BPH/outflow obstruction
Ix for urinary incontinence?
abdo exam PV/PR uroflowmetry stress test urinalysis
Tx for overflow incontinence?
treat CAUSE
catheterise
laxatives if constipated
Tx for stress incontinence?
wt loss stop smoking reduce caffeine kegels duloxetine surgery (retropubic colpospension)
Tx for urge incontinence?
bladder retraining kegels anticholinergics (oxybutinin) mirabegron topical oestrogen botox injections
e.g of anticholinergics used for urge incontinence? how do they work? side effects?
oxybutynin
tolteradine
block muscarinic receptors on detrusor
dry mouth, blurred vision, constipated
risk factors for vaginal prolapse?
age
parity
postmenopausal
CTD
features of a vaginal prolapse?
dragging urinary/bowel symptoms dyspaerunia mass pressure bulge
Ix for vaginal prolapse?
PV/PR
US
mRI
what fixed point is used for prolapse staging?
hymenal ring
what are the stages of vaginal prolapse?
0 - none I - 1cm above hymen (-) II - -1 and +1 to hymen III - >1cm beyond (+) IV - complete vaginal eversion
Tx for vaginal prolapse?
pessaries changed 6 monthly +/- oestrogen
sacrospinous fixation
sacrohysteropexy
what is an anterior prolapse? features?
bladder through vagina
cystocele
bulge, pressure, urinary features
what is a middle prolapse? features?
vaginal vault prolapse
enterocele
bulge, pressure, urinary features, painful sex
what is a posterior prolapse? features?
rectocele
bulge, pressure, difficulty defecating
