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Summary Urology summaries
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  • The University Of Edinburgh (ED)

Summary of urological conditions and surgery. Covers clinical features, risk factors/causes, relevant diagnostic features and investigations and management guidelines for all the conditions. Cross referenced with passmed/zero to finals/NICE guidelines - relevant for medical school finals

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Document information

  • November 20, 2023
  • 15
  • 2022/2023
  • Summary

Subjects

  • urology
  • surgery
  • medicine
  • clinical medicine

Written for

  • The University of Edinburgh (ED)
  • Unknown
  • Unknown

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saskiahogan

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UROLOGY




Microsoft Office User
[COMPANY NAME] [Company address]

, BENIGN PROSTATIC HYPERPLASIA



EPIDEMIOLOGY AND AETIOLOGY PATHOPHYSIOLOGY
Aetiology unknown, dihydrotestosterone required – Hyperplasia of the stroma and epithelium of the
converted from testosterone by 5-alpha reductase transition zone of the prostate. Tone of the smooth
 Age-related muscle also plays key role
 Extremely common Increase in proportion of the transition zone volume
o 50% of 50 year olds compared to the total prostate volume  increase in
o 80% of 80 year olds BOO  increased LUTS

PRESENTATION
Can be voiding symptoms or storage symptoms or INVESTIGATIONS
mixed History
Voiding symptoms  LUTS assessed using IPSS
 Bladder diary
 Obstructive LUTS: hesitancy, straining, poor
 Relevant PMHx – CCF, CKD, CVA, spinal injury,
stream, incomplete emptying, intermittency,
pelvic surgery, medication, alcohol
terminal dribbling
 Decreased urine flow rate Examination
 Impaired detrusor contractility and outflow  DRE
obstruction  Abdomen – palpable bladder
Storage symptoms  Neuro examination
 Frequency Urinalysis to exclude UTI
 Urgency Bloods – UEs, PSA
Urine flow studies and PVT
COMPLICATIONS AND RELATED
CONDITIONS
 Acute urinary retention (palpable bladder)
 Haematuria
 Hydronephrosis and renal compromise
 UTI
 Bladder stones

MANAGEMENT
Conservative/lifestyle
 Watchful waiting
 Lifestyle changes: alcohol/caffeine restriction, evening fluid restriction, avoid cold environment,
optimisation of other medical conditions
Management
 Alpha antagonists: tamsulosin, alfuzosin
 5-alpha reductase inhibitors: finasteride/dutasteride
 Anti-cholinergics: for associated storage symptoms – no evidence of increase in AUR if no previous AUR
 Mirabegron (beta-3 adrenergic agonist) for storage LUTS
AEs: retrograde ejaculation, dizziness, postural hypotension, headache, nasal congestion, ED, asthenia
(weakness), reduced libido (5-alpha reductase inhibitors)
Surgical
Aims to remove obstructing prostate transitional zone adenoma, with cauterising loop or laser
TURP – trans-urethral resection of the prostate – removed with cauterising loop
Laser prostatectomy – either Ho Laser enucleation of the prostate, or KTP prostatectomy


AEs: retrograde ejaculation (dry ejaculation) in 75%, ED in 10%, long-term UI in 1%

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