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Urology Notes

Medicine Notes > Renal and Urology Notes

This is an extract of our Urology document, which we sell as part of our Renal and Urology Notes collection written by the top tier of University Of Leicester students.

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Urology Benign Prostatic hypertrophy Common in men > 60 years
- Less common in Asians Aetiology
- Unknown
- Microscopically, glandular and connective tissue hypertrophy occurs
- Enlargement of the gland stretches and distorts the urethra, obstructing bladder outflow Clinical features
- Nocturia
- Frequency
- Difficulty/delay in initiating micturition (hesitancy)
- Variability and decreased forcefulness of stream
- Post-voiding dribbling
- Acute retention may occur
- Occasionally severe haematuria may occur from rupture of prostatic veins or as a consequence of bacteriuria or stone disease
- Patients can (rarely) present with severe renal failure
- Abdominal examination for bladder enlargement together with PR is essential o Benign prostate feels smooth Management
- Assess severity of symptoms and their impact
- Management options include o Transrectal resection of the prostate (TURP) o Transurethral incision of the prostate (TUIP) - less destruction than TURP, less risk to sexual function, similar benefits - relieves pressure on the urethra o Retropubic prostatectomy (open op) o Transurethral laser induced prostatectomy (TUUP) o Medication e.g alpha blockers (tamsulosin) - decreases smooth muscle tone (prostate and bladder) S/E include drowsiness, hypotension, dry mouth, ejaculation failure
? E.g 5 alpha reductase inhibitors (finastericle) = decreased testosterone's conversion to dihydrotestosterone which is primarily responsible for prostate growth. Excreted in semen, therefore advised to use condoms
? S/E = impotence, decreased libido o Watchful waiting - risk of incontinence, renal failure or retention

Prostate Cancer Epidemiology
- Increased incidence
- Common in men > 70 years Aetiology
- Age = greatest risk factor
- 5% of cases are related to BRCA-1 inheritence
- Growth of prostate cancer relies upon androgen stimulation and doesn't occur in castrated males Pathology
- Usually in adenocarcimona
- TCC can occur in ducts
- Mostly located in posterior or peripheral part of gland (therefore delayed presentation as compression of urethra occurs late) Clinical features
- Often asymptomatic
- May have hesitancy, terminal dribbling o Urgency, nocturia, frequency o Obstruction o Urinary infections o Haemiaturia o Lower back pain (from bony mets)
- Firm irregular, enlarged glad found on PR examination Grading
- Uses the Gleason system: gives two grades based on the two commonest types of histology o 1: well differentiated, normal glands o 2: well differentiated varying size and shape of glands o 3: Moderately differentiated o 4: Poorly differentiated, fused glands o 5: Very poorly differentiated no/minimal gland formation Staging
- TNM o T0 - occult tumour o T1 - intracapsular o T2 - doesn't breach capsule o T3 - extends outside prostate o T4 - involves adjacent organs
- Metastatic spread is commonly to bones and common to iliac and external iliac nodes Investigations
- PR examination
- PSA
- Transrectal biopsy

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