case 8 - structure and function of the prostate gland

Question 1

what is benign prostate enlargement

Answer 1

clincal

Question 2

what is benign prostatic hypertrophy

Answer 2

histologic - increase in size

Question 3

what is benign prostatic hyperplasia

Answer 3

histologic - increase in the number of the cells

Question 4

what is benign prostatic obstruction

Answer 4

urodynamic

Question 5

what are the storage/irritative LUT symptoms

Answer 5

frequency
Nocturia - definition: voiding more than two times at night
Urgency
Urge incontinence - when you actually leak urine

Question 6

what are the voiding/obstructive symptoms of

Answer 6

hesitancy
Poor steam
Straining
Intermittency
Feeling of incomplete voiding

post micturition
Feeling of incomplete emptying

Question 7

what is dysuria

Answer 7

pain

Question 8

what is haematuria

Answer 8

blood in urine - most concernng

Question 9

what is leak in the night

Answer 9

Leak in the night - enuresis - sign of incontinence and bladder is overflowing - may effect the kidney

Question 10

what is pedal oedema

Answer 10

Pedal edema (foot and ankle swelling) is one of the cardinal signs of congestive heart failure (HF) but can also be due to other systemic or local conditions, including chronic kidney disease, liver disease, thyroid disorders, venous insufficiency, and venous thrombosis1

Question 11

what can be seen in genitalia on examination

Answer 11

Genitalia - phimosis, meatal stenosis - narrowing of the opening, swelling/tenderness of testis or epidydimyis

Question 12

what is the normal finding on rectal examination

Answer 12

rubbery, smooth, midline groove

Question 13

what are the neurological examination tests

Answer 13

Neurological bulbocarvernosal reflex, lower limb reflexes - very important to check the internal sphincter

Question 14

what are the differential diagnoses

Answer 14

prostate - benign enlargement/cancer
Bladder - overactive/underactive
Urethra - stricture
Infection - cystitis/prostatitis
Psychological - anxiety

Question 15

what is the structure of the prostate

Answer 15

inverted pyramid
15-20gms
2 by 3 by 4cm
Consists of smooth muscle, stromal and glandular
Ratio changes with disease

Question 16

what are the functions of the prostate

Answer 16

fertility
Prostatic specific antigen (PSA) enzyme = semen liquefaction
Antegrade ejaculation - musculus enjaculatorious
Contributes to 25% ejaculate volume - acidic
Milieu for sperm to thrive Nutrition Antimicrobial (Zn, selenium)

Question 17

what is the pathogenesis of BPH

Answer 17

increase in number of cell vs reduced apoptosis
Androgen/oestrogen ratio - receptor signalling - older men start to produce more oestrogen
Imbalance of growth factors - EGF, KGF, IGF vs TGF (TGF is the only growth factor that reduces the growth of the prostate)
Static component - size of the gland
Dynamic component - smooth muscle action

Question 18

where does most BPH happen

Answer 18

in the transitional zone

Question 19

what are the investigations

Answer 19

urinalysis and msu for culture - infection or haematuria
Urea electrolytes and creatinine
PSA
Flowrate and post void scan
DRE does not increase PSA

Question 20

what assesses the symptom severity

Answer 20

the IPSS scale

scores: 1-7 mild, 8-19 moderate and >20 severe

Question 21

what are the other treatments used

Answer 21

medical - alpha blockers, 5 alpha reductase inhibitors, anticholinergics combinations
Catheters
Minimally invasive
Surgery

Question 22

what are examples of alpha reductase inhibtors

Answer 22

e.g finasteride, dutasteride

Question 23

what are the advantages of alpha reductase inhibitors

Answer 23

symptomatic relief
Shrink prostate
Reduce risk of retention
Promote hair growth in male pattern baldness

Question 24

what are the disadvantages of alpha reductase inhibitors

Answer 24

slow onset
Reduced libido/weak erection
Gynaecomastia
Affect PSA

Question 25

what are the surgical options

Answer 25

transurethral resection of prostate TURP
Holmium enucleation of prostate HoLEP

Question 26

what is inclusion health

Answer 26

Inclusion health is a growing discipline that aims to prevent and redress health and social equities among people in extremes of poor health due to poverty, marginalisation and multiple morbidity.

Question 27

what are the objectives of inclusion health

Answer 27

The objectives of Inclusion Health are:
* Focus: to increase the understanding and visibility of the health needs and outcomes of socially excluded groups; and to establish clear accountability at local and national levels
* Voice: to provide a strong ‘voice’ and advocacy for the most disadvantaged and those who work with them, ensuring that strategic planning and commissioning processes adequately address their needs
* Personalisation: to promote flexible and tailored responses to complex needs that bridge specialist and mainstream services and ensure continuity of care
* Quality and innovation: to drive improvements in quality and standards of services; promoting innovation in service design and delivery; and to build evidence about what works
* Recovery: to ensure services support clients to continually improve by raising health aspirations, improving continuity of care, and building capabilities and capacity for individuals to take control of their lives
* Professional development: to recognise the achievements of professionals and researchers in this demanding specialist field and support their progression; to build connections between professionals and across disciplines; and to exploit the synergies between clinical and social models of care

Question 28

what is equality

Answer 28

The assumption is that everyone benefits from the same supports. This is equal treatment

Question 29

what is equity

Answer 29

Everyone gets the supports they need (this is the concept of affirmative action thus producing equity)

Question 30

what is justice

Answer 30

The causes of the inequity was addressed. The systemic barrier has been removed.

Question 31

what is at the top of maslows hierarchy of needs

Answer 31

self acutalisation

Question 32

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