Flashcards in BPH and Stones Deck (30):
What are irritative LUTS that suggest bladder outlet obstruction?
What are obstructive LUTS that suggest bladder outlet obstruction?
intermittency of stream
What specific part of the prostate does BPH occur in?
What happens to the detrussor muscle in BPH?
hypertrophy due to outflow obstruction
What is the static component of LUTS and BPH?
progressive obstruction of urethra from enlarging stromal and glandular growth of periurethral glands
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
What meds can be used to treat BPH?
5alpha reductase inhibitors (prevent testosterone -> DHT - shrinks prostate, reduces PSA, and helps LUTS) - also reduce risk of urinary retention and surgery
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
How can urinary flow rate recordings be interpreted?
<10 suggest obstruction
10-15 require pressure flow urodynamic studies
How can residual urine be interpreted?
normally <30 cc
varies day to day and not specific for BPH
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
What can cystoscopy rule out?
urethral stricture disease
bladder neck sclerosis or contracture
bladder trabeculation or muscle hypertrophy
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
What are the screening recommendations for prostate cancer in high risk men?
(AA or positive FH)
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
If the PSA is over 10, what additional study should be done to stage cancer?
What is the most common form of prostate cancer diagnosed currently?
T1c - abnormal PSA with no symptoms or abnormal DRE
What are the signs and symptoms of a stone?
pain (abdominal, flank)
nausea and vomiting
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
What are the 3 physiological narrowing stones have to navigate through the ureter?
crossing of ureter over iliac vessels
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
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
When is a fever a medical emergency with stones and what is the treatment?
with upper tract stone
drainage and antibiotics
How is nausea and vomiting involved with stones?
paralytic ileus often present
requires IV fluids to restore volume and peristalsis
What are conditions associated with stones?
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
What radiolucent stones are not seen on KUB?
How is intravenous urography (IVU) used in stones?
in normal kidney
radiolucent stones found by filling defect
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