Urology

Question 1

Tx of HPB (5)

Answer 1

• Finasteride (5alpha-reductase inhibitor)
• alpha1-antagonists (Terazosin, Tamsulosin)
• antimuscarinics (Tolteradine, Oxybutynin)
• Phosphodiesterase type 5 inhibitors (Tadalafil)
• Surgical procedures

Question 2

Describe: Finasteride (5alpha-reductase inhibitor) (2)

Answer 2

• 6-12 months for sx improvement
• side effects: decrease libido, erectile dysfunction

Question 3

Describe: alpha1-antagonists (Terazosin, Tamsulosin) (2)

Answer 3

• relax bladder, prostate, urethra
• side effects: HTO, dizziness

Question 4

Describe: Antimuscarinics (Tolteradine, Oxybutynin) (2)

Answer 4

• for irritable bladder sx
• avoided in high post-void residual volume -> relaxing bladder can increase urinary retention)

Question 5

Describe: Phosphodiesterase type 5 inhibitors (Tadalafil) (1)

Answer 5

especially in concurrent erectile dysfunction

Question 6

Prostatic adenocarcinoma most commonly occurs where? (1)

Answer 6

Posterior peripheral zone (far from urethra), grow quite large before urinal sx

Question 7

Describe metastasis of prostatic adenocarcinoma (3)

Answer 7

• plexus veineux vertébral (atteintes os axial)
• sx: dlr hanche ou dorsal, worst at night, not relieved by rest or position change
• lésions osteoblastique ou sclérotique

Question 8

Name tumor markors of prostatic adenocarcinoma (2)

Answer 8

• Prostatic acide phosphatase (PAP)
• PSA
  
  • low free:total PSA ratio -> higher risk

Question 9

How to dx metastatic disease in prostatic adenocarcinoma? (2)

Answer 9

• Scintigraphie osseuse for bone lesions
• if present, ⬆️ serum alkaline phosphatase

Question 10

Describe tx: Prostatic adenocarcinoma? (4)

Answer 10

• Prostatectomy
• Radiotherapy
• Hormonal therapy
  
  • Leuprolide: GnRH analog
  • Flutamide: androgen receptor antagonist
• Active surveillance: low stage, non-metastatic cancer