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Renal > Renal Clinical - Prostate > Flashcards

Renal Clinical - Prostate Flashcards

1
Q

How big is the average prostate?

A

15cc

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2
Q

What are the zones of the prostate?

A

Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma

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3
Q

Which zone of the prostate has the highest incidence of prostate cancers?

A

Peripheral zone

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4
Q

Which zone of the prostate has the most benign growths?

A

Central zone

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5
Q

What is BPH characterised by?

A

Fibromuscular and glandular hyperplasia

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6
Q

Which area of the prostate does BPH predominantly affect?

A

Transition zone

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7
Q

What percentage of men at 60yo have BPH?

A

50%

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8
Q

What percentage of men at 85yo have BPH?

A

90%

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9
Q

What symptoms do 50% of men which BPH have?

A

Moderate to severe LUTS

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10
Q

What may BPH result in?

A

BOO

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11
Q

What scoring system do prostate symptoms use?

A

International Prostate Symptom Score Sheet (IPSS)

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12
Q

What is the total score out of on the IPSS?

A

35

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13
Q

What is a mild score on the IPSS?

A

0-7

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14
Q

What is a moderate score on the IPSS?

A

8-19

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15
Q

What is a severe score on the IPSS?

A

> 20

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16
Q

What can you use to assess LUTS?

A

Symptom scoring systems e.g. IPSS

Frequency volume charts

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17
Q

What are voiding (obstructive) LUTS symptoms?

A

Hesistancy
Poor stream
Terminal dribbling
Incomplete emptying

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18
Q

What are storage (irritative) symptoms?

A

Frequency
Nocturia
Urgency +/- urge incontinence

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19
Q

What does a frequency volume chart measure?

A

Functional capacity of the bladder

20
Q

What physical examinations would you do on someone with prostate symptoms and why?

A

Abdomen - ?palpable bladder
Penis - ?external urethral meatal stricture/?phimosis
DRE - assess prostate size, ?suspicious nodules or firmness
Urinalysis - ?blood, ?UTI

21
Q

What is phimosis?

A

Tight foreskin

22
Q

What investigations would you do for prostate?

A 
MSSU
Flow rate study
Post-void bladder residual USS
Blood: PSA, urea and creatinine (chronic retention)
Renal tract USS
Flexible cystoscopy
Urodynamic studies
TRUS-guided prostate biopsy
23
Q

When might you do a TRUS-guided prostate biopsy?

A

PSA raised

Abnormal DRE

24
Q

What is the management for an uncomplicated BPO?

A

Watchful waiting
Medical: alpha blockers, 5 alpha reductase inhibitors
Surgical: TURP, open retropubic or transvesical prostatectomy, endoscopic ablative procedures

25
Q

What is the main treatment of LUTS due to BPO?

A

Alpha blockers

26
Q

How do alpha blockers help in LUTS due to BPO?

A

Alpha blockers cause smooth muscle relaxation and antigene the dynamic element to prostatic obstruction

27
Q

What are the main alpha blockers used in LUTS?

A

Tamsulosin and alfuzosin

28
Q

What is a potential side effect of alpha blockers used for LUTS?

A

Retrograde ejaculation

29
Q

How do 5a-reductase inhibitors help in LUTS due to BPO?

A

Work by shrinking prostate size

Reduces risk of progression of BPE

30
Q

What does 5a-reductase normally do in the prostate?

A

Converts testosterone to dihydrotestosterone and drives prostate growth

31
Q

What combination of drugs are most effective in reducing risk of progression of BPE?

A

Alpha blocks and 5a-reductase inhibitors

32
Q

What are the two 5a-reductase inhibitor drugs currently available?

A

Finasteride

Dutasteride

33
Q

What is TURP?

A

Transurethral resection of prostate

34
Q

What is the gold standard treatment for relieving BOO?

A

TURP

35
Q

What are the complications of TURP?

A

Bleeding, infection, retrograde ejaculation, stress urinary incontinence, prostatic regrowth casting recurrent haematuria

36
Q

What are the complications of BOO?

A 
Progression of LUTS
Acute urinary retention
Chronic urinary retention
Urinary incontinence (overflow)
UTI
Bladder stones
Renal failure from obstructed ureteric outflow due to high bladder pressure
37
Q

What is the treatment for complicated BOO?

A

Surgery: TURP and cystolitholapaxy (if stones)
Long term urethral/suprapubic catheterisation
CISC

38
Q

What are the residual volumes usually in acute urinary retention?

A

500ml>1l

39
Q

What is the main risk factor for acute urinary retention?

A

BPO

40
Q

What is the immediate treatment for acute urinary retention?

A

Immediate catheterisation

41
Q

What are the complications of acute urinary retention?

A 
UTI
Post-decompression haematuria
Pathological diuresis
Renal failure
Electrolyte abnormalities
42
Q

What are the residual volumes usually in chronic urinary retention?

A

400ml>2l = wide spectrum

43
Q

What is the main cause of chronic urinary retention?

A

Detrusor underactivity

44
Q

What can detrusor underactivity be cause by?

A 
Primary = primary bladder failure
Secondary = longstanding BOO e.g. BPO/urethral stricture
45
Q

What is the immediate treatment for chronic urinary retention?

A

Immediate catheterisation

Followed by CISC if appropriate

46
Q

What are pathological diuresis symptoms?

A

Urine output >200ml/hr
Postural hypotension
Weight loss
Electrolyte abnormalities

47
Q

What is the treatment for pathological diuresis?

A

IV fluids
Long term catheterisation
CISC
TURP

Renal (5 decks)

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