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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, 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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