Urology - Chronic Conditions

Question 1

what pathological cell change occurs in BPH? describe?

Answer 1

hyperplasia

increase in amount of cell tissue (more cells)

Question 2

which part of the prostate enlarges in BPH?

Answer 2

stroma (outside)

Question 3

what are the predominant receptors in stromal tissue?

Answer 3

alpha 1A receptors

Question 4

features of BPH?

Answer 4

frequency
nocturia
uregency 
incontinence
dribble
straining

Question 5

Ix for BPH?

Answer 5

PR (smooth and equal)

PSA (non specific)

Question 6

Tx for BPH?

Answer 6

bladder training
alpha blocker
5 alpha reductase
surgery (TURP)

Question 7

e.g of alpha blocker
5 alpha reductase

and how long does each take to work?

side effects?

Answer 7

alpha blocker

• doxasosin, alfuzosin
• days
• low BP, headache, faint

5 alpha reductase inh

• finasteride
• months
• low libido, ED

Question 8

what are the types of urinary incontinence?

Answer 8

urge
stress
overflow
mixed

Question 9

risk factors for urinary incontinence?

Answer 9

female
age
obese
pregnancy
dementia
stroke
caffeine
diuretics
faecal incontinence

Question 10

features of urge incontinence?

Answer 10

frequncy
small volume
provoked
enuresis

Question 11

features of stress incontinence?

Answer 11

during increased abdo pressure

Question 12

features of overflow incontinence?

Answer 12

huge palpable bladder
leaking
wet at night

Question 13

causes of each type of incontience?

Answer 13

stress - pelvic floor damage
urge - detrusor overactivity
overflow - BPH/outflow obstruction

Question 14

Ix for urinary incontinence?

Answer 14

abdo exam
PV/PR
uroflowmetry 
stress test
urinalysis

Question 15

Tx for overflow incontinence?

Answer 15

treat CAUSE
catheterise
laxatives if constipated

Question 16

Tx for stress incontinence?

Answer 16

wt loss
stop smoking 
reduce caffeine
kegels
duloxetine 
surgery (retropubic colpospension)

Question 17

Tx for urge incontinence?

Answer 17

bladder retraining 
kegels
anticholinergics (oxybutinin)
mirabegron 
topical oestrogen 
botox injections

Question 18

e.g of anticholinergics used for urge incontinence? how do they work? side effects?

Answer 18

oxybutynin
tolteradine

block muscarinic receptors on detrusor

dry mouth, blurred vision, constipated

Question 19

risk factors for vaginal prolapse?

Answer 19

age
parity
postmenopausal
CTD

Question 20

features of a vaginal prolapse?

Answer 20

dragging 
urinary/bowel symptoms
dyspaerunia 
mass
pressure
bulge

Question 21

Ix for vaginal prolapse?

Answer 21

PV/PR
US
mRI

Question 22

what fixed point is used for prolapse staging?

Answer 22

hymenal ring

Question 23

what are the stages of vaginal prolapse?

Answer 23

0 - none
I - 1cm above hymen (-)
II - -1 and +1 to hymen
III - >1cm beyond (+)
IV - complete vaginal eversion

Question 24

Tx for vaginal prolapse?

Answer 24

pessaries changed 6 monthly +/- oestrogen
sacrospinous fixation
sacrohysteropexy

Question 25

what is an anterior prolapse? features?

Answer 25

bladder through vagina
cystocele

bulge, pressure, urinary features

Question 26

what is a middle prolapse? features?

Answer 26

vaginal vault prolapse
enterocele

bulge, pressure, urinary features, painful sex

Question 27

what is a posterior prolapse? features?

Answer 27

rectocele

bulge, pressure, difficulty defecating