MEDI7302 Study Guide - Final Guide: Urothelium, Pelvic Floor, Bone Scintigraphy

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apricotchimpanzee245

23 Jun 2018

School

Department

Medicine

Course

MEDI7302

Professor

multiple

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Prostatic Conditions

Learning

objectives

Contrast the presentation of benign prostatic hyperplasia with prostatic

adenocarcinoma

Detail the investigative work up of prostatism/ obstructive voiding sx (bladder

outlet obstruction)

Detail a step-wise management approach to benign prostatic hyperplasia

Recognise controversies surrounding prostate cancer detection and management

Contrast the treatment options for localized prostate cancer

Anatomy Location It wraps inferiorly around bladder neck just superior to

external urethral sphincter

Rectum sits posterior to prostate (facilitates DRE)

Structure Prostate is the largest accessory gland in the male reproductive

system (walnut size)

Prostate lobes

Anatomical Inferoposterior

Inferolateral

Superomedial

Anteromedial

Histological Central zone (10-20%)

It surrounds ejaculatory

ducts

Transitional zone (5-10%)

Central location, it

surrounds prostatic urethra

Glands in this region

typically undergo BPH

Peripheral zone (65%)

Main body of gland,

posterior location (felt in DRE)

Ducts of glands from this

zone are vertically emptying into prostatic urethra,

hence may permit reflux

Prone to acute and chronic

inflammation, and prostate cancer development

Fibromuscular stroma/ fourth zone

Anterior to prostate gland

Secretory pathway

Prostate secretions leave via prostatic ducts that open

into the prostatic urethra via 10-12 openings on each side of seminal

colliculus

Neurovascular Prostatic arteries (via internal iliac arteries, sometimes internal

pudendal and middle rectal arteries)

Prostatic venous plexus (drains into internal iliac veins)

Inferior hypogastric plexus (SNS, PSNS, sensory)

Function It produces proteolytic enzymes, proteins and fructose for

semen

PSA production (breakdown into liquid; serum marker for

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prostate health)

Benign prostatic

hyperplasia

Benign phenomenon with no associated risk of developing prostate cancer

Risk factors - age, black race, family hx BPH

Pathophysiology

Prostate gland sits just below bladder neck surrounding urethra

At puberty, testosterone induces prostate gland enlargement via

hyperplasia (increased cell #) & hypertrophy (increased cell size)

Prostate gland size is highly variable amongst men of same age &

individual men during their life

Dysregulation of stromal growth factors (FGF, IGF-1, TGFb),

overproduction of testosterone/DHT, increase in androgen receptors

Clinical features

Symptoms Asymptomatic

Obstructive voiding sx

Hesitancy

Weak stream (slow, intermittent spraying

and forking)

Straining to initiate voiding or during

voiding

Terminal dribbling

+/- urinary retention (acute painful

retention OR chronic painful retention with overflow

incontinence)

Irritative voiding sx

Urgency

Frequency

Nocturia

Other sx

Recurrent UTI - incomplete emptying, urine

stasis becomes infected

Hematuria (TCC unless proven otherwise,

requires cystoscopy of bladder) - vascular gland or bladder stones

formation (irritates urothelium) due to incomplete emptying and

residual urine in bladder resulting from BPH obstruction

Other history Full hx of voiding sx (obstructive/ irritative)

Family hx of BPH

Medications that affect voiding - anti-cholinergics

O/E DRE - benign prostate is soft (tip of nose), non-

tender

Rule out malignant transition (firm,

nodular, asymmetrical, tender)

Estimate size (usually inaccurate)

Investigations Investigate prostatism/ obstructive voiding sx

(bladder outlet obstruction)

FBC, creatinine, eGFR

Urine m/c/s - rule out infection, microscopic

hematuria

Elevated or fluctuating levels of PSA

Renal tract US - rule out asymptomatic UT

dilatation due to incomplete emptying & pressure changes; assess

prostate volume; rule out bladder calculi

Management

Introduction To decide whether to treat patient, weigh up

bothersome sx VS complications of intervention

Majority of BPH sx impact on QoL and usually don't

produce harm

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Document Summary

Contrast the presentation of benign prostatic hyperplasia with prostatic adenocarcinoma. Detail the investigative work up of prostatism/ obstructive voiding sx (bladder outlet obstruction) Detail a step-wise management approach to benign prostatic hyperplasia. Recognise controversies surrounding prostate cancer detection and management. Contrast the treatment options for localized prostate cancer. It wraps inferiorly around bladder neck just superior to. Prostate is the largest accessory gland in the male reproductive system (walnut size) Main body of gland, posterior location (felt in dre) Ducts of glands from this zone are vertically emptying into prostatic urethra, hence may permit reflux. Prone to acute and chronic inflammation, and prostate cancer development. Prostate secretions leave via prostatic ducts that open into the prostatic urethra via 10-12 openings on each side of seminal colliculus. Prostatic arteries (via internal iliac arteries, sometimes internal pudendal and middle rectal arteries) Prostatic venous plexus (drains into internal iliac veins) It produces proteolytic enzymes, proteins and fructose for.

MEDI7302 Study Guide - Final Guide: Urothelium, Pelvic Floor, Bone Scintigraphy

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