Benign Diseases of the Prostate Flashcards

1
Q

Name the different area’s of the prostate from centre outwards

A

Known as Mcneal’s Zones

Transition zone - wraps around the urethra
Central zone
Peripheral zone - where more cancers occur
Anterior fibromuscular stroma

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2
Q

What do the following stand for - BPE, BPH, BPO, BOO, LUTS

A
BPE - Benign prostatic enlargement 
BPH - ""    "" hyperplasia
BPO - ""    "" obstruction
BOO - bladder outflow obstruction
LUTS - Lower urinary tract symptoms
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3
Q

What is BPH characterised by?

A

Fibromuscular and glandular hyperplasia

Presents with LUTS

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4
Q

What zone does BPH affect?

A

Transition zone

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5
Q

Prevalence of BPH?

A

Part of ageing process in men - 50% of men will have it by 60 and 90% by 85

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6
Q

What are the LUTS?

A

Voiding:

  • Hesitancy
  • Poor Stream
  • Terminal dribbling
  • Incomplete Emptying

Storage:

  • Frequency
  • Nocturia
  • Urgency/urge incontinence

Other:

  • Intermittency
  • Straining
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7
Q

Signs on examination of a BOO?

A

Palpable bladder
External urethral meatus stricture
Phimosis
Mass on Digital Rectal Exam (mostly BPH)

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8
Q

What is phimosis?

A

Inability to retract foreskin

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9
Q

Investigations for a UTO?

A

Midstream urine sample
Flow Rate Study
Post-void bladder ultrasound (looking for residual)
Bloods:
- PSA
- U&C (only if in chronic retention)
Renal tract ultrasound
Cystoscopy - Good for BPE, cancer & strictures

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10
Q

Medical treatment of BPH?

A

Alpha blockers to relax smooth muscle

5-alpha-reductase inhibitors which reduces prostate size by metabolizing testosterone

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11
Q

Surgical treatment for BPH?

A

Trans-Urethral-Resection of prostate - TURP
Open prostatectomy
Endoscopic ablative procedures

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12
Q

What makes a BPH complicated?

A
Acute or chronic urinary retention 
Urinary Incontinence 
UTI 
Bladder Stone 
Renal Failure (due to hydronephrosis)
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13
Q

How can we treat a complicated BPH if they’re not fit for TURP?

A
  • Long term urethral catheter

- CISC (clean intermittent self Catheterisation)

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14
Q

Acute vs chronic urinary retention?

A

Acute: Painful inability to void bladder

Chronic - painless incomplete voiding, may have LUTS, UTIs or overflow incontinence (bed wetting)

Both have a palpable bladder

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15
Q

Causes of acute urinary retention?

A

Usually BPH

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16
Q

Triggers of BPH?

A

Natural ageing process

constipation or a urological procedure.

17
Q

AUR treatment?

A

Catheterise and start treatment for BPH

18
Q

Causes of chronic urinary retention?

A

Detrusor underactivity

Largely due to primary bladder failure or a longstanding BOO

19
Q

Chronic urinary retention treatment?

A

Catheterisation followed by clean intermittent self Catheterisation

TURP can be considered

20
Q

Chronic urinary retention varies from very dangerous to less dangerous - how can you tell what state patient is in?

A

High pressure retention - incontinent, raised creatinine and causes bilateral hydronephrosis

Low pressure retention is less dangerous. Its usually dry, Cr is normal and the kidneys are ok.

Both are painless

21
Q

Is TURP better for high or low pressure CUR?

A

TURP in CUR has a less successful outcome than for AUR but better in low pressure than high

22
Q

What are the major complications when you treat urinary retention?

A

Post-obstructive diuresis

Decompression haematuria

23
Q

What is post-obstructive diuresis, what does it cause5 and how do you manage it?

A

Massive UO >200ml/hr which can lead to life-threatening hypotension, weight loss and Electrolyte abnormalities

IV fluids resus and then a long term catheter, CISC or TURP.

24
Q

What is decompression haematuria?

A

Shearing of the small vessles during decompression because of different compliance between different tissue layers.
Usually self-limiting