Urology
Prostate cancer
Risk factors ➢ PSA isn’t specific for prostate cancer but it’s
• Increasing age useful in follow-up & monitoring TTT
➢ Before PSA test, men should NOT have:
• Male, black Afro-Caribbean - An active UTI
• 1st degree relative with prostate cancer - Ejaculated in the past 48h
Presentation - Exercised vigorously in the past 48h
• Lower urinary tract symptoms (LUTS) are NOT specific for - Had a prostate biopsy in the last 6 weeks
prostate cancer
• LUTS include voiding or obstructing symptoms such as hesitancy, urgency, poor and/or intermittent stream,
straining, prolonged micturition, feeling of incomplete bladder emptying, dribbling
Investigation
• Initial → DRE (hard, irregular & nodular) + PSA Biopsy-related prostatitis
• Normal ⟶ E. coli
- ≥2 ng/ml at age 40-49 years
• Immunocompromised ⟶ Pseudomonas aeruginosa
- ≥3 ng/ml at age 50-69 years
- ≥5 ng/ml at age 70 years or older
• Definitive → Biopsy Leuprolide is a GnRH analog:
Management • If used in pulsatile fashion → agonist
➢ Leuprolide, used in a continuous manner • If used in a continuous fashion → antagonist
Local disease Locally invasive Metastatic
• Raised PSA on screening • Hematuria • Bone metastasis → hypercalcemia → thirst
• LUTS • Hematospermia • Bone pain or sciatica
• UTI • Obstruction of ureters, • Paraplegia 2ry to spinal cord compression
causing loin pain, anuria, • LN enlargement
symptoms of AKI or CKD • Lethargy (anemia, uremia)
• Weight loss
➢ KUB US
➢ MRI
Metastatic spinal cord compression
➢ An oncological emergency and an urgent MRI should be requested within 24h
➢ 20% of patients with spinal metastasis
Features
• Neurological symptoms like radicular pain, limb weakness, difficulty in walking, sensory loss or bladder or
bowel dysfunction
• Neurological signs of spinal cord or cauda equina compression
➢ DO NOT confuse between metastatic spinal cord compression and spinal • Spinal metastasis + symptoms of
metastasis. Spinal metastasis presents with pain in the thoracic or upper decompression → MRI
cervical spine, progressive lumbar spine pain or nocturnal spinal pain • Spinal metastasis WITHOUT symptoms
of compression→ Isotope scan
preventing sleep. Spinal metastasis isn’t considered emergency
➢ Most frequent sites for metastasis for prostate cancer are bone (by hematogenous spread) and lymph nodes of
the obturator fossa, internal, external and common iliac arteries and presacral regions
• Prostate cancer → Bone + LN
• Testicular cancer → LN + Lungs
PLABverse - 1
, Urology
Benign Prostatic Hyperplasia (BPH)
➢ An old male complaining of LUTS
➢ DRE reveals a large, firm and smooth prostate
Interstitial cystitis
Features
• Recurrent suprapubic pain
• Worsened by bladder filling
• Relieved by voiding but returns when bladder fills again
• LUTS: urine frequency, urgency & nocturia
• In women, symptoms are often worse during menstruation
Investigation
• Cystoscopy, to exclude bladder malignancy
- 10% have Hunner’s ulcers, they’re reddened mucosal areas
associated with small vessels radiating towards a central scar
- Glomerulations (petechial red areas)
Management
• 1st line
- Bladder training
- Pelvic floor relaxation techniques (avoid pelvic floor exercises)
- Avoid triggers like coffee, citrus fruits or smoking which can exacerbate symptoms
- Analgesics such as NSAIDs
• 2nd line
- Amitriptyline
- Oxybutynin
- Gabapentin
Pyogenic cystitis
- LUTS
- Fever
- Nitrates and leukocytes in urine
Bladder stones are rare in women
PLABverse - 2
Prostate cancer
Risk factors ➢ PSA isn’t specific for prostate cancer but it’s
• Increasing age useful in follow-up & monitoring TTT
➢ Before PSA test, men should NOT have:
• Male, black Afro-Caribbean - An active UTI
• 1st degree relative with prostate cancer - Ejaculated in the past 48h
Presentation - Exercised vigorously in the past 48h
• Lower urinary tract symptoms (LUTS) are NOT specific for - Had a prostate biopsy in the last 6 weeks
prostate cancer
• LUTS include voiding or obstructing symptoms such as hesitancy, urgency, poor and/or intermittent stream,
straining, prolonged micturition, feeling of incomplete bladder emptying, dribbling
Investigation
• Initial → DRE (hard, irregular & nodular) + PSA Biopsy-related prostatitis
• Normal ⟶ E. coli
- ≥2 ng/ml at age 40-49 years
• Immunocompromised ⟶ Pseudomonas aeruginosa
- ≥3 ng/ml at age 50-69 years
- ≥5 ng/ml at age 70 years or older
• Definitive → Biopsy Leuprolide is a GnRH analog:
Management • If used in pulsatile fashion → agonist
➢ Leuprolide, used in a continuous manner • If used in a continuous fashion → antagonist
Local disease Locally invasive Metastatic
• Raised PSA on screening • Hematuria • Bone metastasis → hypercalcemia → thirst
• LUTS • Hematospermia • Bone pain or sciatica
• UTI • Obstruction of ureters, • Paraplegia 2ry to spinal cord compression
causing loin pain, anuria, • LN enlargement
symptoms of AKI or CKD • Lethargy (anemia, uremia)
• Weight loss
➢ KUB US
➢ MRI
Metastatic spinal cord compression
➢ An oncological emergency and an urgent MRI should be requested within 24h
➢ 20% of patients with spinal metastasis
Features
• Neurological symptoms like radicular pain, limb weakness, difficulty in walking, sensory loss or bladder or
bowel dysfunction
• Neurological signs of spinal cord or cauda equina compression
➢ DO NOT confuse between metastatic spinal cord compression and spinal • Spinal metastasis + symptoms of
metastasis. Spinal metastasis presents with pain in the thoracic or upper decompression → MRI
cervical spine, progressive lumbar spine pain or nocturnal spinal pain • Spinal metastasis WITHOUT symptoms
of compression→ Isotope scan
preventing sleep. Spinal metastasis isn’t considered emergency
➢ Most frequent sites for metastasis for prostate cancer are bone (by hematogenous spread) and lymph nodes of
the obturator fossa, internal, external and common iliac arteries and presacral regions
• Prostate cancer → Bone + LN
• Testicular cancer → LN + Lungs
PLABverse - 1
, Urology
Benign Prostatic Hyperplasia (BPH)
➢ An old male complaining of LUTS
➢ DRE reveals a large, firm and smooth prostate
Interstitial cystitis
Features
• Recurrent suprapubic pain
• Worsened by bladder filling
• Relieved by voiding but returns when bladder fills again
• LUTS: urine frequency, urgency & nocturia
• In women, symptoms are often worse during menstruation
Investigation
• Cystoscopy, to exclude bladder malignancy
- 10% have Hunner’s ulcers, they’re reddened mucosal areas
associated with small vessels radiating towards a central scar
- Glomerulations (petechial red areas)
Management
• 1st line
- Bladder training
- Pelvic floor relaxation techniques (avoid pelvic floor exercises)
- Avoid triggers like coffee, citrus fruits or smoking which can exacerbate symptoms
- Analgesics such as NSAIDs
• 2nd line
- Amitriptyline
- Oxybutynin
- Gabapentin
Pyogenic cystitis
- LUTS
- Fever
- Nitrates and leukocytes in urine
Bladder stones are rare in women
PLABverse - 2
