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Y2 Renal > Male problems > Flashcards

Male problems Flashcards

1
Q

What is benign prostate hyperplasia

A

Common benign condition in men caused by hyperplasia of the stromal and epithelial cells of the prostate

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2
Q

Benign prostate hyperplasia most commonly affect

A

older men, 40-80 years olds
Black ethnicity

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3
Q

Symptoms of benign prostate hyperplasia

A

Nocturia (most common early symptom)
Hesitation in initiating urination
Reduced force of urination
Retention of urine
Incontinence (overflow, urgency incontinence)
Post-urination dribbling

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4
Q

Because BPH causes bladder outflow obstruction, it can also lead to

A

Recurrent UTI
Impaired renal function
Haematuria

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5
Q

What score is used to classify the symptoms of BPH

A

IPSS (International prostate symptoms score)

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6
Q

Investigations for BPH

A

Urine dipstick
U+E
PSA (prostate specific antigen)
Rectal exam
US pelvis with post-void bladder volume - see extent of obstruction
Urinary frequency-volume chart

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7
Q

What conditions can raise PSA

A

Prostate cancer
BPH
Prostatitis
Ejaculation

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8
Q

What would the rectal exam for benign prostate hyperplasia be like

A

Smooth, symmetrical prostate enlargement

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9
Q

Management of benign prostatic hyperplasia

A

Reassurance and monitor
If IPSS >8
- alpha-1 antagonists (tamsulosin, alfuzosin)
If significantly enlarged prostate
- 5 alpha-reductase inhibitors (finasteride)

Alpha-1 antagonist + 5 alpha-reductase inhibitor if moderate-severe voiding symptoms + prostatic enlargement

Surgery If needed

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10
Q

Examples of alpha-1 antagonists

A

Tamsulosin
Alfuzosin

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11
Q

Function of alpha-1 antagonists in managing BPH

A

Promotes relaxation of the smooth muscle of the prostate and bladder to reduce voiding symptoms

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12
Q

Side effects of alpha-1 antagonists

A

Dizziness
Postural hypotension
Dry mouth
Depression

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13
Q

Function of 5-alpha reductase inhibitors

A

Blocks the conversion of testosterone to di-hydrotestosterone to REDUCE the size of the prostate

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14
Q

Does alpha-1antagonists reduce the size of the prostate

A

No

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15
Q

Why is it helpful to block the production of di-hydrotestosterone in managing BPH

A

Because di-hydrotestosterone induces growth of prostate

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16
Q

Example of 5-alpha reductase inhibitors

A

Finasteride

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17
Q

Does finasteride (5-alpha reductase inhibitor) work immediately

A

No, it takes around 6 months to see improvement

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18
Q

Side effects of 5-alpha reductase inhibitors

A

Erectile dysfunction
Reduced libido
Ejaculation problems
Gynaecomastia

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19
Q

When are 5-alpha reductase inhibitors indicated

A

If there is significant enlargement of the prostate

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20
Q

What is the name of surgery for BPH

A

Transurethral resection of the prostate (TURP)

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21
Q

Which form of malignancy is prostate cancer part of

A

Adenocarcinoma

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22
Q

Prostate cancer mostly affects

A

> 40 years olds

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23
Q

Risk factors of prostate cancer

A

Increasing age
Afro-Carribean ethnicity
Obesity
Family history
Cadmium batteries

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24
Q

Is BPH a pre-malignant condition of prostate cancer

A

No, it does not increase the risk of prostate cancer. Both can occur in a patient at the same time

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25
Q

What are the 3 zones of the prostate

A

Central zone
Peripheral zone
Transitional zone

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26
Q

Where is the central zone located at

A

Surrounds the ejaculatory ducts

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27
Q

Where is the transitional zone located at

A

Surrounds the prostatic urethra

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28
Q

Where is the peripheral zone located at

A

Posterolaterally

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29
Q

Prostate cancer most commonly arise from

A

Peripheral zone

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30
Q

What condition most commonly occurs in the transitional zone

A

BPH

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31
Q

Symptoms of prostate cancer

A

Asymptomatic at early stage
Late stages
- haematospermia
- haematuria
- obstruction - urinary hesitancy, reduced flow
- bone pain (metastasis)
- weight loss, fatigue, anorexia

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32
Q

Why is prostate cancer usually asymptomatic at early stages

A

Because it occurs at the peripheral zone so it is unlikely to cause obstructive symptoms early on

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33
Q

Prostate cancer usually metastasises to

A

Bones and lymph nodes

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34
Q

Investigations for prostate cancer

A

Multiparametric MRI (replaced transrectal ultrasound guided biopsy)
Bloods - PSA
PR exam
Bone scan

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35
Q

What may PR exam show in prostate cancer

A

Enlarged, hard, irregular, asymmetrical prostate

36
Q

What is the scoring used for the results of multi parametric MRI

A

Likert scale

37
Q

If Likert scale is >/3, you should

A

Offer a multi-parametric MRI influenced prostate biopsy

38
Q

Management of prostate cancer

A

If early (T1, T2)
- Observation and follow ups

if late
- anti-androgen therapy
- radical prostatectomy
- radiotherapy

If metastatic - anti-androgen therapy

39
Q

What is a common side effect of radical prostatectomy

A

Erectile dysfunction

40
Q

Radiotherapy may increase the risk of

A

Bladder, colon and rectal cancer following radiotherapy for prostate cancer

41
Q

What are the agents in hormonal therapy used for prostate cancer

A

GnRH agonist - Goserelin
Bicalutamide
Cryproterone acetate
Abiraterone

42
Q

Bicalutamide is a

A

non-steroidal anti-androgen which blocks the androgen receptor

43
Q

Cryproterone acetate is a

A

steroidal anti-androgen

44
Q

Abiraterone is a

A

androgen synthesis inhibitor

45
Q

Testicular cancer is the most common malignancy affecting

A

Men 20-30 years old

Younger age group compared to prostate cancer

46
Q

Risk factors of testicular cancer

A

Infertility
Cryptorchidism
FH
White caucasians
Klinefelter’s syndrome

47
Q

What is cryptorchidism

A

When one or both testicles fail to descend (undescended testicles)

48
Q

Testicular cancer is usually a ____ cell tumour

A

Germ cell tumour

49
Q

Testicular cancer can also be non-germ cell tumour. What are the non-germ cell tumours called

A

Leydig cell tumours
Sarcomas

50
Q

What are leydig cells

A

Cells in seminiferous tubules that produce testosterone

51
Q

What are the types of germ cell tumours

A

Seminoma
Teratoma
Yolk sac tumour
Choriocarcinoma
Embryonic

52
Q

What is seminoma

A

germ cell tumours that arise from seminiferous tubules

53
Q

Which type of germ cell tumour is more common

A

Seminoma

54
Q

Which types of germ cell tumours have worse prognosis

A

Teratoma
Embryonal cell carcinoma

These metastasise quicker

55
Q

Describe the prognosis of seminoma

A

95% cure rate, very responsive to radiotherapy

56
Q

Teratomas are rarely

A

Rarely occur on their own, usually associated with other non-seminomatous tumours

57
Q

Describe the age groups commonly affected by seminoma and teratoma

A

Seminoma - >30 years old

Teratoma - <30 years old

58
Q

Symptoms of testicular cancer

A

Painless lump
Hydrocele
Gynaecomastia

59
Q

What are the signs of advanced testicular cancer

A

Neck lumps
Bone pain
Abdominal mass

60
Q

How does testicular cancer cause gynaecomastia

A

Due to increase in oestrogen:androgen ratio

61
Q

What are the investigations for testicular cancer

A

Bloods
- AFP
- hCG
- LDH
US testicle (first line)
CT chest, abdomen

62
Q

Describe the presence of tumour markers in seminoma/non-seminoma testicular cancer

A

Seminoma - raised hCG in 20% but AFP is NOT RAISED

Non-seminoma - raised hCG in 80% and raised AFP

63
Q

Management of testicular cancer

A

Radical inguinal orchidectomy
Re-check tumour markers 1 week post operation
Chemotherapy post op

64
Q

Risk factors of penile cancer

A

50-60 years old
Asian, African
HPV
Smoking
Phimosis causing chronic inflammation

65
Q

What is phimosis

A

the inability to retract the foreskin of the penis causing inflammation due to poor hygiene

66
Q

Most common form of penile cancer

A

Squamous cell carcinoma

67
Q

investigation for penile cancer

A

biopsy

68
Q

Management for penile cancer

A

if on foreskin - Circumcision
If on glans (head) - glans resurfacing or glansectomy

69
Q

What is hydrocele

A

Collection of fluid between the two layers (parietal and visceral) of the tunica vaginalis

70
Q

Causes of hydrocele

A

Communicating: Patency of processus vaginalis -> peritoneal fluid drain down into the scrotum

Non-communicating: Excessive fluid production

71
Q

Communicating hydrocele is common in

A

newborn babies

72
Q

Symptoms of hydrocele

A

Soft, smooth, non tender swelling around one of the testes
Transilluminate with pen torch

73
Q

Investigation for hydrocele

A

Usually clinical
US if indicated

74
Q

When is US indicated for hydrocele

A

In adult patients to exclude underlying malignancy (testicular cancer can cause hydrocele

75
Q

Management of hydrocele

A

Communicating hydrocele in babies can resolve spontaneously within first few months
If not -> surgical repair

Non-communicating hydrocele usually resolve in 2 years

76
Q

What is varicocele

A

abnormal enlargement of the testicular veins

77
Q

What are the testicular veins called

A

Pampiniform plexus

78
Q

Varicocele is more common on the left / right

A

Left

79
Q

Why is varicocele more common on the left

A

Due to increased resistance to flow because left gondola vein needs to drain into the left renal vein first whereas the right drains straight into inferior vena cava

80
Q

What can cause varicocele

A

Dilation of superior mesenteric artery -> compresses the left renal vein

81
Q

Symptoms of varicocele

A

Usually asymptomatic
looks like “bag of worms”
Subfertility

82
Q

Varicocele may be seen in

A

renal cell carcinoma - tumour invading left renal vein can cause blockage hence engorgement of downstream veins

83
Q

Investigations for varicocele

A

US kidneys, ureters and bladder

84
Q

Management of varicocele

A

No treatment
Surgery if pain

85
Q

What is spermatocele

A

Fluid-filled cyst that develops at the head of epididymis

Y2 Renal (12 decks)

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