Week 8 GU Flashcards
(86 cards)
PSA screening
-when to begin?
Canadian Urology Association
• start at age 50 in most men
• start at age 45 if increased risk of prostate cancer (family history of first or second degree relative with prostate ca)
BC Guidelines:
-consider starting at age 55
PSA screening
-when to stop?
• If age 60 with PSA <1 ng/mL: consider discontinuing
• All other men: discontinue at age 70
If life expectancy <10 years: discontinue screening
What Gleason score indicates well differentiated tumour?
What score indicates poor prognosis?
well differentiated: 7 and under
poor prognosis:
• Gleason grade 8 and higher
• Extracapsular involvement beyond seminal vesicles
PSA >30 ng/mL
PSA
4 possible causes of non-cancerous PSA elevation?
Causes of non-cancerous elevated PSA: • BPH • Prostatitis **do not test PSA during acute inflammation* • acute urinary retention catheterization /instrumentation
Risk factors for prostate cancer
- increasing age
- african descent
- family hx prostate cancer (paternal, first degree)
- high risk hereditary gene mutation (BRCA2)
- obesity
- high testosterone levels in lifetime
men presenting with LUTS (lower urinary tract symptoms) should have what two exams?
DRE
PSA
harms associated with prostate biopsy?
harms associated with prostate cancer treatment?
20-25% of men diagnosed with prostate cancer have cancer that would not cause harm in their lifetime
biopsy: bleeding, pain, infection
treatment: erectile dysfunction, urinary incontinence
what is the role of topical estrogen in treatment of recurrent UTIs in older women?
• Topical estrogen may reduce recurrent UTIs in healthy older women
Normalizes pH, restores normal flora
first line treatment for uncomplicated cystitis?
pyelonephritis?
nitrofurantoin 100 mg BID x 5 days
*avoid if CrCl <40
if Pyelo:
cipro 500 mg BID x 7 days
common organisms responsible for UTIs in healthy men?
E coli, Proteus mirabilis, enterococci
what is guiding principle for treatment of UTI in those who have indwelling catheter?
○ Treat ONLY if typical symptoms/fever present without another obvious cause
○ UTI in patients with chronic catheter is diagnosis of exclusion
endometrial thickness of ______ is indication of need for endometrial biopsy
> 4 mm
4 mm and less has 99% negative predictive value for endometrial malignancy
what are the 4 main types of urinary incontinence in older people?
urge
stress
mixed urge and stress
nonspecific
definition of urge incontinence vs stress incontinence
urge:
- preceded by/associated with urgency
- precipitated by running water, hand washing, cold, need to rush to toilet
stress:
- leakage with effort, exertion, sneezing or coughing
- if severe sphincter damage: can be provoked by minimal or no activity
definition of overactive bladder
symptom syndrome (not specific pathologic condition)
urgency, frequency, nocturia
+/- urge incontinence
when should older adults be screened for urinary incontinence?
annual screen for all older adults!
*50% do not talk to care providers or are not asked about it
risk factors for urinary incontinence?
- age
- functional dependence
- female
- obesity
- diabetes
- stroke
- depression
- prostate surgery
- fecal incontinence
- hysterectomy
- dementia / cognitive impairment
urination
voiding occurs with (sympathetic/parasympathetic) stimulation of _____ receptors in the ____ muscle
parasympathetic stimulation
muscarinic receptors in detrusor
urination
storage of urine occurs with (sympathetic/parasympathetic) stimulation of ____ receptors in the ______
STORAGE
sympathetic stimulation
alpha-adrenergic receptors in smooth muscle sphincter –> causes contraction
beta-adrenergic receptors in detrusor –> causes relaxation
what part of the brain is the centre for suppressing urinary urgency and preventing voiding?
prefrontal cortex
micturation centre in pons
workup for urinary incontinence?
urinalysis (look for hematuria) - glycosuria in DM
PVR: consider if complex neuro disease, longstanding poorly controlled DM, marked pelvic organ prolapse, on anticholinergic meds
Meds associated with urinary incontinence
-how do NSAIDs , gabapentin and CCB cause incontinence?
other classes of meds that cause UI?
pedal edema –> nocturnal polyuria
- ETOH
- alpha-adrenergic agonists and blockers
- ACE-I (cough)
- anticholinergics (retention, constipation, impaired emptying)
- antipsychotics (anticholinergic)
- Cholinesterase inhibitors
- estrogen (worsens stress and mixed leakage in women)
- loop diuretics
- narcotics (retention, fecal impaction)
- sedative hypnotics
- TCA (anticholinergics)
Differential causes of nocturnal polyuria:
- excess fluid intake (caffeine, alcohol)
- pedal edema associated with meds
- CHF
- sleep apnea***** consider in all patients with unexplained nocturnal polyuria
what is the definition of nocturnal polyuria?
> 1/3 of total 24 hour urine production occurring during hours of sleep