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Urology Notes

Medicine Notes > Renal and Urology Notes

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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
- Transrectal biopsy

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