Prostatic enlargement Flashcards
(37 cards)
What are the clinical features of benign prostate enlargement?
Nocturia (common early symptom) Difficulty starting Difficulty stopping/post void dribbling Poor flow Incomplete voiding
Why might the risk of micturition syncope be increased in BPH?
Increased need to push/strain
Diagnoses which should be considered and that the history should take account of?
Prostatic carcinoma Bladder carcinoma Urinary tract stones Neurogenic bladder UTI Detrusor instability
What scale can be used to rate the severity of LUTS?
International prostate symptom score (I-PSS)
Examination in suspected BPH? (3)
Abdominal exam for bladder enlargement
DRE (benign usually smooth)
Dipstick
Investigations for suspected prostatic enlargement? (5)
Urine culture Serum PSA Routine bloods inc kidney function Ultrasound imaging and biopsy (TRUS) Bladder flow studies
Drugs which lower muscle tone in the neck of the bladder?
Alpha blockers e.g. tamsulosin
Tamsulosin is most specific for which receptors?
Alpha 1a
How do finasteride and dutasteride work?
5-alpha reductase inhibitors, block synthesis of dihydrotestosterone
Why should finasteride be persisted with even if patients feel it is not helping?
Often takes several months to work
Contraindications to alpha blockers?
Postural hypotension
Micturition syncope
Opthalmic complication of tamsulosin?
Floppy iris syndrome during surgery e.g. cataract
What adverse effects do 5-ARIs have?
Adverse effects on sexual performance
What is the standard surgical approach for BPH?
Transurethral resection of the prostate (TURP)
Complications of bladder outlet obstruction?
Urinary retention Recurrent UTI Impaired kidney function Bladder stones Haematuria
Which class of drugs can precipitate urinary retention in BPH?
Antimuscarinic drugs;
drugs with antimuscarinic activity (e.g. TCAs, opiates, diuretics)
What is prostate specific antigen?
Protein which makes semen more liquid, produced by prostatic cells, found in the serum
What is serum PSA used for and what is the drawback?
Detection of prostate carcinoma and monitoring response to treatment;
Low specificity
Conditions with elevated PSA?
Acute urinary retention BPH Prostatitis Prostate cancer Catheterized patients Increases with age
All patients with a significantly raised PSA should have what test?
Prostate biopsy
Histologically, what type of cancer is prostatic cancer?
Adenocarcinoma
Presentation of local prostatic cancer?
LUTS
Acute retention
Incidental finding of hard, irregular mass on DRE
Presentation of metastatic prostatic cancer?
Back and skeletal pain/sciatica
Weight loss
Anaemia
Lymphadenopathy
Commonest site for growth of prostatic adenocarcinoma?
Peripheral zone of the prostate
