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Abdominal examination Abdominal examination is usually normal. In patients with chronic retention, a distended bladder will be found on palpa tion, on percussion and sometimes on inspection with loss of the transverse suprapubic skin crease. General physical e...

Acute retention The management of retention is discussed in detail in Chapter 83 . Once the bladder has been drained by means of a catheter, the patient’s fitness for treatment is determined. If retention was not caused by drugs or constipation, then prostat...

BENIGN PROSTATIC HYPERPLASIA Aetiology Hormones Serum testosterone levels slowly but significantly decrease with advancing age; however, levels of oestrogenic steroids are not decreased equally . According to this theory , the prostate enlarges because of inc...

BENIGN PROSTATIC HYPERPLASIA OR BLADDER OUTFLOW OBSTRUCTION Strong indications for treatment (usually prostatectomy) include: - /uni25CF Acute retention (see Chapter 83 ) in fit men with no other cause for retention (drugs, constipation, recent oper - ation, et...

BLADDER OUTFLOW OBSTRUCTION CAUSED BY THE BLADDER NECK Aetiology This condition usually occurs in men but can rarely a ff ect children of both sexes and women. It may be due to muscular hypertrophy or fibrosis of the tissues at the bladder neck following TURP ...

Bladder outflow obstruction This is a urodynamic concept based on the combination of low flow rates in the presence of high voiding pressures. It can An essay on the shaking palsy in 1817. be diagnosed definitively only by pressure–flow studies. This is because s...

Blood tests Serum creatinine, electrolytes and haemoglobin should be measured.

Bone scan Once the diagnosis has been established, if metastatic spread is suspected (on the basis of a high PSA [>10 /uni00A0 ng/mL], locally /uni00A0 advanced disease or presence of Gleason 7 or higher) - a bone scan should be carried out. If, however, the...

CARCINOMA OF THE PROSTATE Carcinoma of the prostate is the most common malignant tumour in men over the age of 65 years. In the UK in 2017, more than 48 000 men were diagnosed with, and more than figures in the USA were 190 000 and 33 000, respectively . If ...

Chronic prostatitis Many urologists find the diagnosis of chronic prostatitis and ‘prostatodynia’ very di ffi cult as many men present with perigenital pain, testicular pain, prostatic pain exacerbated by sexual intercourse or pain that apparently renders sexual...

Clinical features Prostatic calculi are usually symptomless, being discovered on TRUS, on radiography of the pelvis, during prostatectomy or associated with carcinoma of the prostate or chronic prostatitis. In cases associated with severe chronic prostatic i...

Clinical syndromes Owing to muscle hypertrophy or dyssynergia Marion described a series of cases in which muscular hyper- trophy of the internal sphincter in a young person had resulted in the development of a vesical diverticulum or hydro- thought that dys...

Complications of prostatec tomy Local Haemorrhage is a major risk following prostatectomy what - ever the surgical approach. Care should be taken in applying diathermy to arterial bleeding points after TURP , and to any bleeding vessels at the bladder neck; th...

Considerations for elective treatment in men with LUTS secondary to BPH The following questions should be answered before considering a surgical treatment: /uni25CF Have they failed a preliminary trial of medical therapy? Commonly , men will have been treated...

Corpora amylaceae Corpora amylaceae are tiny calcified lamellated bodies found in the glandular alveoli of the prostates of elderly men and apes, but not in the prostates of animals lower in the phylo - genetic /uni00A0 scale than anthropoids. Corpora amylac...

Counselling men undergoing prostatectomy Men undergoing prostatectomy need to be advised about the following: /uni25CF Retrograde ejaculation or anejaculation . This occurs in about 65–85% of men after prostatectomy . /uni25CF Erectile dysfunction . This occu...

Cross-sectional imaging with magnetic resonance imaging and transrectal ultrasound MRI with a high-tesla magnet (1.5–3 /uni00A0 T) is the most accurate method of staging local disease. mpMRI is used preoperatively to assess pelvic lymph nodes as well as local...

Cystourethroscopy Inspection of the urethra, the prostate and the urothelium of the bladder should be done immediately prior to prosta - tectomy to exclude a urethral stricture, a bladder carcinoma and the occasional non-opaque vesical calculus. This should ...