BPH and Stones Flashcards Preview

Block 6 - Renal > BPH and Stones > Flashcards

Flashcards in BPH and Stones Deck (30):
1

What are irritative LUTS that suggest bladder outlet obstruction?

nocturia
frequency
urgency

2

What are obstructive LUTS that suggest bladder outlet obstruction?

straining
weak stream
intermittency of stream
straining

3

What specific part of the prostate does BPH occur in?

transitional zone

4

What happens to the detrussor muscle in BPH?

hypertrophy due to outflow obstruction

5

What is the static component of LUTS and BPH?

progressive obstruction of urethra from enlarging stromal and glandular growth of periurethral glands

6

What is the dynamic component of LUTS and BPH?

bladder neck, prostate and capsule have symp inn (as opposed to PS inn of bladder)
alpha adrenergic receptors present in high concentrations here
alpha 1 receptors = uroselective receptors - blocked by uroselective alpha blockers - relaxes resting tone in bladder neck

7

What meds can be used to treat BPH?

alpha blockers
5alpha reductase inhibitors (prevent testosterone -> DHT - shrinks prostate, reduces PSA, and helps LUTS) - also reduce risk of urinary retention and surgery

8

What are important values of serum PSA?

10 suspicious for prostate cancer
4-10 is grey zone - measure free:total PSA - <20% suspicious for cancer

9

How can urinary flow rate recordings be interpreted?

>15 normal
<10 suggest obstruction
10-15 require pressure flow urodynamic studies

10

How can residual urine be interpreted?

normally <30 cc
varies day to day and not specific for BPH

11

How can a pressure flow urodynamic study (UDS) be interpreted?

low voiding pressure and high flow rate - normal
low voiding pressure and low flow rate - weak detrussor
high voiding pressure and low flow rate - subvesical obstruction

12

What can cystoscopy rule out?

urethral stricture disease
bladder neck sclerosis or contracture
bladder cancer
bladder trabeculation or muscle hypertrophy
bladder diverticulum
bladder stones

13

What are the general screening recommendations for prostate cancer?

no screening men under 40
shared decision between patients and physician age 55-69
against screening men 70+ if life expectancy less than 10-15 years

14

What are the screening recommendations for prostate cancer in high risk men?

under 55
(AA or positive FH)

15

What is the next step in eval of a patient with total PSA >4 or free:total <20%?

Transrectal ultrasound guided biopsy (TRUS) - takes 6 random biopsy samples

16

If the PSA is over 10, what additional study should be done to stage cancer?

bone scan

17

What is the most common form of prostate cancer diagnosed currently?

T1c - abnormal PSA with no symptoms or abnormal DRE

18

What are the signs and symptoms of a stone?

pain (abdominal, flank)
hematuria
infection
fever
nausea and vomiting

19

What are the different types of pain with stones and what causes each?

renal colic - stretching collecting system/ureter, waxes and wanes, obstruction, compression
non colicky pain - stretching of renal capsule

20

What are the 3 physiological narrowing stones have to navigate through the ureter?

ureteropelvic junction
crossing of ureter over iliac vessels
ureterovesical junction

21

Where do stones in different locations characteristically cause pain?

costovertebral angle pain radiating around flank toward abdomen = ureteropelvic stone
lower quadrant radiating to suprapubic = mid ureteral
radiating into bladder, vulva, scrotum = distal

22

What kinds of infections are associated with stones?

obstructing - in setting of UTI is emergency!
magnesium ammonium phosphate = infection stone in alkaline medium
proteus, providencia, psuedomonas, klebsiella can split urea and make alkaline medium

23

When is a fever a medical emergency with stones and what is the treatment?

with upper tract stone
drainage and antibiotics

24

How is nausea and vomiting involved with stones?

paralytic ileus often present
requires IV fluids to restore volume and peristalsis

25

What are conditions associated with stones?

RTA
FH
GI dx
recurrent UTIs

26

How is sonography used in imaging for stones?

not very sensitive - only sees >5mm
can see hydro, but stones in ureter not diagnosed
stones of all composition seen as white spot

27

What radiolucent stones are not seen on KUB?

uric acid
cystine
xanthine

28

How is intravenous urography (IVU) used in stones?

in normal kidney
identifies obstruction
defines anatomy
radiolucent stones found by filling defect

29

How is retrograde pyelography used in eval of stones?

in nonfunctioning kidney
uncertainty persists after films
use caution - ability to stent and decompress must be available when used

30

How is percutaneous drainage and Antegrade nephrostogram (AGNG) used with stones?

with infection or sepsis with fever and elevated WBC and diagnosis by imaging
drainage from dilated collecting system
antegrade imaging of upper tract accomplished at same time even with obstruction and poorly functioning kidneys