Урология - BPH. Prostatic cancer

 Urgency

As the internal sphincter mechanism is deranged due to invasion of the prostate into the bladder, a little urine escapes into the prostatic urethra, which is highly sensitive and causes an intense desire to urination.

 Haematuria

It is due to rupture of dilated veins at the base of the bladder which are apt to rupture during straining.

Occasionally gross haematuria may occur.

Other causes: cystitis, calculi, erosion of a portion of intravesical part of enlarged prostate.

Pain

The causes of pain are due to secondary changes caused by prostatic enlargement.

There are:

1.cystitis, which causes variable suprapubic pain;

2.acute retention;

3.hydronephrosis, which causes dull ache in the loin;

4.due to greatly enlarged prostate giving rise to a feeling of weight in the perineum or fullness in the rectum.

 Retention of urine

1. Acute retention may cause intense pain due to sudden blockage of urination by enlarged median lobe obstructing the internal urethral orifice or enlarged lateral lobes blocking the urethral opening due to oedema.

This often occur after a heavy drink of alcohol or after cold.

The symptoms can be classified into 2 groups:

Obstructive

Poor flow, dribbling, hesitansy.

Irritative

Increased frequency, urgency, nocturnal incontinence.

Clinic

1 stage – total evacuation of urine from vesical bladder, compensatory changes of detrusor (hypertrophy), nicturia 2 times and more, weak urine stream, urination at exertion, compensated stage of chronic renal failure.

2 stageresidual urine volume > 70 ml, distrophy of detrusor, dilation of urinary tract, difficult micturition, compensated or intermittent stage of chronic renal failure

3 stage – decompensation of vesical bladder and upper urinary tract, intermitting CRF, paradoxal ishuria

Physical signs

General examination – should be performed to exclude renal insufficiency.

Blood pressure and heart should be examined by a cardiologist to make the patient risk-free for operation.

Examination of the nervous system is important to eliminate neurological lesions

(tabes dorsalis, disseminated sclerosis, diabetes mellitus)

Local examination.

Abdominal examination may only reveal a full bladder.

Rectal examination – the surface of enlarged prostate is usually smooth and convex. It is usually firm in consistency. A sulcus should be felt in the midline between the two lobes. The rectal mucosa can be easily moved over the enlarged prostate.

Carcinoma of the prostate

Is the 4th most common cause of death from malignant disease in men.

It is the commonest malignant condition in men over the age of 60 years.