International prostate symptom score (IPSS)
IFIUWSN
- Incomplete voiding 排尿不濟
- Frequency 尿頻
- Intermittency 排尿斷續
- Urgency 尿急
- Weak stream 尿流無力
- Straining 排尿費力
- Nocturia 夜尿次數
Urodynamic studies
Study function of LUT
Parameters measured
- Intravesical and Rectal pressure
- Detrusor (deduced)
- Uroflow rate
- Sphincter function EMG
- Bladder volume
Cystogram and reflux (video)
Pressure flow study
- “Low uroflow rate with high detrusor pressure” = BOO
BOO = Urodynamic Dx
PSA cutoff value
Prostate-specific-Ag
- 40-49y = 2.5 (ng/mL)
- 50-59y = 3.5
- 60-69y = 4.5
- 70-79y = 6.5
In general
- <4 is normal
- 4-10 has 20% chance of cancer, consider biopsy
- > 10 has 50% cancer, biopsy indicated
- Detection rate of PSA on CA prostate is not as high as in books
Absolute indication and Cx of TURP for BPH
Rev
- Refractory urinary retention
- Recurrent urinary infection from BPH
- Recurrent gross hematuria from BPH
- Bladder stone from BPH
- Obstructive uropathy
Cx
- Bleeding
- Infection/sepsis
- Incontinence (1%)
- Retrograde ejaculation (90%!!; can’t have kids)
- Erectile dysfunction (>50%)
- Late urethral stricture
- Late bladder neck stenosis
- (TUR syndrome)
Urinary stones
Rev
M>F (2:1)
RF
HT, DM, Menopause, HyperPTH, obesity, gout, Crohn’s…
Urgent drainage if sepsis (pyonephrosis)
NCCT for Ix
IVU + KUB for planning intervention and FU
3 most common for stones to lodge (narrowest parts)
Rev
- PUJ (Pelvic-ureteric junction)
- UVJ (Ureterovesicular junction)
- When ureter touches pelvic brim
Absolute indications for intervention for Urinary stones
Rev
- Obstructive: Pyelonephritis, may need ABX, if fail, drainge with PCN/JJ +/- ICU for shock
- Unremitting pain
- Deterioration of RFT
- Anuria due to ureteric obs
Surgical intervention for urinary stones
Rev
Nephrectomy for non-functioning kidney
PCNL vs ESWL
- ESWL only <2cm; 1-2cm not lower pole ones
CA kidney
Triad: Pain, Mass, Hematuria
Most discovered on routine CT/USG (small tumors)
Paraneoplastic
- High ESR
- HT
- Anemia
- LOW
- Abnormal liver function
M:F 2:1
RF
- Smoking
- Dialysis
- Obesity
- Von Hipple-Lindau syndrome
- Exposure to asbestos, cadmium
Tx
Radical for big
Partial for small polar ones,
esp exophytic (<3cm)
Cyto-reductive nephrectomy for big tumors, then targeted therapy (TKI: Sunitinib)
CA bladder
Rev
RFs
- Smoking
- Occupation: aromatic amines
- Chemo, e.g. Cyclophosphamide
- Hereditary
M>F 3:1
Tx
- Superficial papillary TCC, i.e. non-muscle invasive –> Endoscopic tx (TURBT) –> +/- intravesical BCG instillation
- Invasive –> aggressive, i.e. Cystectomy and urinary diversion (Total cystectomy with ileal conduit)
RT/Chemo for Adju/Neoadj/unfit for surgery
PSA high in
BPH Prostatitis AROU UTI Within 48h after ejaculation
CA prostate
Dx by elevated PSA +/- abnormal DRE
Ix: TRUS + prostate biopsy
Multiparametric MRI
Bone scan
Tx: Radical prostatectomy / RT
Active surveilance
Advanced –> Hormonal therapy (LHRH analog, bil orchidectomy)
Cx for radical prostatectomy
- Stress incontinence
- Erectile dysfunction
