Urology - LUTs, Scrotum and Genitalia Flashcards
how common is prostate cancer
very
most common cancer in men 50+ peak at 65-70
what is the function of the prostate
produces 30% ejaculate volume
what is PSA
prostate specific antigen
what are key risk factors for prostate cancer
age
FHx
genetics
ethnicity - afrocarribean
diet - sat fat and dairy
how does localised prostate cancer present
PSA, incidental symptoms
how does locally advanced prostate cancer present
bleeding, local pain, priapism, rectal obstruction
how does metastatic prostate cancer present
fracture, leg swelling, DVT, pain, weight loss, cord compression
diagnosis of prostate cancer
history
DRE
PSA
biopsy
what does a normal prostate feel
small, smooth, rubbery
how does an abnormal prostate feel
asymetrical, craggy, noduler
what 2 things should the person avoid before PSA
no sex
no bike riding
what system is used to grade prostate cancer
gleason score
what is the staing of prostate cancer
what is the scoring of low, intermediate and high risk prostate cancer
Low risk
PSA < 10 ng/ml
Gleason 6
Clinical stage T1c-T2a
Active surveillance may be appropriate treatment option
Intermediate risk
PSA 10-20 ng/ml
Gleason 7-8
cT2b
High risk
PSA > 20 ng/ml
Gleason 9-10
>cT2c
what is treatment for localised prostate cancer
surgery - to remove it - radical resections
watch and wait
what are other treatment methods for prostate cancer
radical radiotherapy
Cryotherapy
High intensity ultrasound
Brachytherapy – less good
list drugs that improve survival of metastatic prostate cancer
Docetaxel
Cabazitaxel
Abiraterone
Enzalutamide
Sipuleucel-T
Alpharadin
what is the bladder made of
detrusor muscles
where does spinal cord finish
L2 (Below this is corda equina)
what are the 2 parts of the autonomic nervous system
sympathetic T10-L2
parasympathetic S2-S4
where in the brain does realisation of need to pee happen
cerebral cortex - doesnt really work before potty trained
what does parasympathetic nerves causes
detrusor contraction
relaxation of outflow tracs
what does sympathetic nerves cause
relaxation of detrusor contraction
contraction of outflow traks
why do you pee yourself when scare
sympathetic - fight or flight (storage)
lymbic system can turn messages to cortex off - back to prepotty training
What can go wrong with The Detrusor Muscle if the neurology is disrupted?
DETRUSOR CONTRACTS TOO MUCH
Failure of Detrusor to store at low pressure
Sustained high pressure throughout filling – POOR COMPLIANCE
Phasic rise in detrusor pressure – DETRUSOR OVERACTIVITY; Neurogenic vs. Idiopathic
Leakage, high pressure transmitted to upper tracts
DETRUSOR DOESN’T CONTRACT ENOUGH
Failure of Detrusor to contract during emptying
Incomplete emptying
Urinary Retention
LUTS, UTI’s, high pressure retention
What can go wrong with urethral sphincter mechanism if the neurology is disrupted?
DOESN’T CONTRACT ENOUGH
Failure / inadequate contraction during storage phase
Leakage – STRESS URINARY INCONTINENCE
SPHINCTER DOESN’T RELAX
Failure of sphincter to relax adequately/ in a co-ordinated fashion during emptying phase
Detrusor contracts against a closed sphincter – CONTRACTS AT WRONG TIME
DETRUSOR-SPHINCTER-DYSSYNERGIA
Incomplete emptying (inefficient), high pressure transmitted to upper tracts
what causes inflammtion and stiff bladder
ketamine
radiotherapy
surgery and scar tissue
what nerve sensation for urology
S4
ureteric colic how do you image - good osce Q
USS - cheap, harmless - see if theres a stone ureter if blocking)
x ray - lower dose - radioopaque calcium stones
