Podcast
Questions and Answers
What is a common early symptom of Lower Urinary Tract Symptoms (LUTS)?
What is a common early symptom of Lower Urinary Tract Symptoms (LUTS)?
In Benign Prostatic Hyperplasia (BPH), post-micturition LUTS are resolved after TURP.
In Benign Prostatic Hyperplasia (BPH), post-micturition LUTS are resolved after TURP.
False
What examination can differentiate between BPH and prostate cancer?
What examination can differentiate between BPH and prostate cancer?
Digital rectal examination
The sensation of poor bladder ___ is one of the voiding obstructive symptoms.
The sensation of poor bladder ___ is one of the voiding obstructive symptoms.
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Match the following symptoms with their classification:
Match the following symptoms with their classification:
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What is a common clinical feature of a patent urachus?
What is a common clinical feature of a patent urachus?
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All abnormal urachal conditions require surgical management.
All abnormal urachal conditions require surgical management.
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What are the complications associated with a urachal cyst?
What are the complications associated with a urachal cyst?
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A urachal sinus can lead to ______ from the umbilicus.
A urachal sinus can lead to ______ from the umbilicus.
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Match the urachal abnormality with its associated complication:
Match the urachal abnormality with its associated complication:
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What is a common complication associated with Ileal conduit urinary diversion?
What is a common complication associated with Ileal conduit urinary diversion?
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Partial cystectomy involves the removal of the prostate in males.
Partial cystectomy involves the removal of the prostate in males.
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What are one of the indications for a partial cystectomy?
What are one of the indications for a partial cystectomy?
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A ________ urinary diversion uses ileum to create a neo-bladder.
A ________ urinary diversion uses ileum to create a neo-bladder.
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Match the following urinary diversion types with their characteristics:
Match the following urinary diversion types with their characteristics:
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What is the common composition of endogenous prostatic stones?
What is the common composition of endogenous prostatic stones?
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Acute prostatitis is primarily caused by multiple episodes of acute infections.
Acute prostatitis is primarily caused by multiple episodes of acute infections.
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What term describes the precursor lesion for prostatic stones?
What term describes the precursor lesion for prostatic stones?
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The __________ examination of acute prostatitis reveals a tender, boggy prostate.
The __________ examination of acute prostatitis reveals a tender, boggy prostate.
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Match the type of prostatitis with its characteristics:
Match the type of prostatitis with its characteristics:
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What is a common symptom associated with Benign Prostatic Hyperplasia (BPH)?
What is a common symptom associated with Benign Prostatic Hyperplasia (BPH)?
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Neurogenic bladder is associated with decreased bladder pressure.
Neurogenic bladder is associated with decreased bladder pressure.
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What age decade is often associated with the occurrence of Benign Prostatic Hyperplasia?
What age decade is often associated with the occurrence of Benign Prostatic Hyperplasia?
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The International Prostate Symptom Score for moderate symptoms ranges from ___ to ___.
The International Prostate Symptom Score for moderate symptoms ranges from ___ to ___.
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Match the following descriptions with their corresponding terms:
Match the following descriptions with their corresponding terms:
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What is considered a normal PSA level in men aged 50 to 69 years?
What is considered a normal PSA level in men aged 50 to 69 years?
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Transrectal biopsy has a lower risk of infection compared to transperineal biopsy.
Transrectal biopsy has a lower risk of infection compared to transperineal biopsy.
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What is the significance of PSA velocity greater than 0.75 ng/ml/year?
What is the significance of PSA velocity greater than 0.75 ng/ml/year?
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A urine flow rate of less than ______ ml/sec is considered low.
A urine flow rate of less than ______ ml/sec is considered low.
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Match the following biopsy types with their characteristics:
Match the following biopsy types with their characteristics:
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Study Notes
Benign Prostatic Hyperplasia (BPH) & Prostate Cancer
- Both BPH and prostate cancer present with lower urinary tract symptoms (LUTS).
- LUTS can be categorized as voiding (obstructive) and storage (irritative) symptoms.
- Voiding symptoms include hesitancy, poor flow, intermittent stream, dribbling, sensation of poor bladder emptying and episodes of near retention.
- Storage symptoms include frequency, nocturia, urgency, urge incontinence, and nocturnal incontinence.
- In BPH, post-micturition LUTS like dribbling and incomplete emptying are not corrected even after transurethral resection of the prostate (TURP).
Work Up to Confirm Diagnosis
-
Digital rectal examination:
- BPH: Rubbery, mobile mucosa
- Cancer: Hard, fixed mucosa
-
Urine examination:
- Urine routine & microscopy
- Urine glucose
- Urine culture & sensitivity
- A 3-tube test involves collecting urine from the first void (VB1), urine after prostate massage (VD2), and prostate secretions after massage (EPS).
Urachal Abnormalities
- The urachus is a tube connecting the bladder to the umbilicus during fetal development.
-
Patent urachus:
- Urine leakage from umbilicus when straining or crying.
- Management: Excision.
- Complications: Risk of adenocarcinoma.
-
Urachal cyst:
- Fluid-filled sac within the urachus.
- Management: Excision.
- Complications: Infection.
-
Urachal sinus:
- Open connection between the umbilicus and bladder.
- Discharge from the umbilicus.
- Management: Excision.
- Complications: Prone to infections.
-
Urachal diverticulum:
- Outpouching from the bladder into the urachus.
- Management: Excision.
Urology - Surgery
-
Partial cystectomy:
- Indications: Small tumors, Carcinoma on the dome of bladder, Carcinoma away from ureteric orifice
- Structures removed: Bladder
-
Radical cystectomy:
- Structures removed: Bladder, Prostate (male), Urethra + Uterus (female), Ilia + Obturator Lymph Nodes (LN)
-
Urinary diversion:
- Divert ureter post cystectomy
- Types:
-
Non-continent urinary diversion:
- Uretersigmoid anastomosis (obsolete)
- Ileal conduit (most common)
- Complications: Hyperchloremic, hypokalemic metabolic acidosis, Stenosis, Stricture, Recurrence.
-
Continent urinary diversion:
- Neobladder using ileum
-
Non-continent urinary diversion:
- Important Prognostic Factor: Depth of invasion (T-stage).
Prostate: Part 1
-
Capsule of Prostate:
- Prostatic venous plexus: Can bleed during TURP if the capsule is invaded
- Carries metastases to bones and the vertebral column.
-
Corpora amylacea:
- Precursor lesion for prostatic stones.
-
Prostatic stones:
- Endogenous (20%): Formed in the prostate, common composition: CaPO₄, Incidental diagnosis, No further treatment needed
- Exogenous: Formed elsewhere (e.g., kidney), No further treatment needed.
Diseases of the Prostate
-
Acute Prostatitis vs Chronic Prostatitis:
- Etiology:
- Acute: E.coli (most common organism), Secondary to UTI
- Chronic: Multiple episodes of acute prostatitis
- Clinical features:
- Acute: Fever, Pain
- Chronic: Dull perineal pain (Prostatodynia)
- Digital rectal examination:
- Acute: Tender, boggy prostate
- Chronic: Tender prostate
- Ix:
- Acute: Urine microscopy: Threads & neutrophils
- Chronic: 3 tube test
- Rx:
- Acute: Antibiotics for 2-3 weeks
- Chronic: Antibiotics for 4-6 weeks
- Etiology:
Neurogenic Bladder vs. Obstruction in Bladder
-
Bladder Outlet Obstruction:
- Bladder pressure: ↑
- Flow rate: ↓
- Marion disease: Due to hypertrophy of the internal sphincter, causing LUTS but no BPH or cancer.
BPH: Benign Prostatic Hyperplasia
- Occurs in the 5th decade.
- Affects the transitional zone of the prostate.
- Obstruction leads to increased pressure in the bladder and increased residual urine.
- Narrowing of the prostatic urethral lumen increases the curve, making catheterization difficult and leading to diverticulae and trabeculae.
International Prostate Symptom Score (IPSS)
- 0-7: Mild severity
- 8-19: Moderate severity
- 20-35: Severe severity: Requires medical or surgical intervention.
Components of BPH
- Normal prostate structure
- Hyperplastic prostate: Increased prostate bulk with static and dynamic components.
- Dynamic components are mediated by adrenergic receptors.
Work Up for BPH
-
Ultrasound (USG) KUB:
- Prostatic size
- Prostatic volume
- Residual urine
-
Prostate-specific antigen (PSA):
- Free PSA better than protein bound PSA
- PSA velocity: > 0.75 ng/ml/year
- BPSA (Nicked) & IPSA (Intact): Raised in benign prostatic conditions
- Pro PSA: Raised in cancer
-
Evaluation:
- At 50 to 69 years
-
PSA levels:
- 0-3 ng/ml: Normal. Rule out prostatitis.
- 0-3 ng/ml: BPH or Prostatitis. Manage prostatitis if present with antibiotics.
-
3-4 ng/ml: BPH, Cancer, or Prostatitis. Start BPH management. Biopsy. Repeat PSA after 6 weeks. If PSA is normal, rule out cancer.
-
Prostate biopsy:
- Minimum 12 cores to be taken.
- Transperineal biopsy: Anterior lobe, Under general anesthesia (GA), Reduced risk of infection. Performed if PSA elevated but transrectal ultrasound (TRUS) biopsy is negative.
- Transrectal biopsy: Posterior lobe, Under local anesthesia (LA), Increased risk of infection.
- Minimum 12 cores to be taken.
-
Uroflowmetry (urine flow rate):
-
15 ml/sec: Normal
- 10-15 ml/sec: Equivocal
- < 10 ml/sec: Low
-
-
Bladder pressure:
- < 60 cm of H₂O: Normal
- 60-80 cm of H₂O: Equivocal
-
80 cm of H₂O: High
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Description
Test your knowledge on Benign Prostatic Hyperplasia (BPH) and prostate cancer, focusing on lower urinary tract symptoms and diagnostic procedures. Learn about the differences in LUTS presentation and the work-up necessary to confirm a diagnosis. This quiz will help reinforce your understanding of key concepts in urology.
