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Prostate-specific antigen This is discussed earlier in this chapter. It is good at follow ing the course of advanced disease; however, it is lacking in sensitivity and specificity in the diagnosis of early localised prostate cancer. Nevertheless, the finding of...

Prostatic abscess In addition to the foregoing symptoms and signs, the advent of a prostatic abscess is heralded by the temperature rising steeply with rigors. Antibiotics disguise these features. Severe, unremitting perineal and rectal pain with occasional t...

Prostatic biopsy If there is suspicion of prostate cancer, because of local findings, a raised PSA or metastatic disease, then a prostate biopsy using an automated gun under TRUS guidance is recommended ( Figure 84.18 ). This is usually performed Donald F Gl...

Prostatodynia This diagnosis is made by the presence of perigenital pain in the absence of any objective evidence of prostatic inflam - mation. Whether the syndrome has any relationship with the prostate is unclear. The syndrome is part of the chronic pelvi...

Radiological examination Radiographs of the chest may reveal metastases in either the lung fields or the ribs. An abdominal radiograph may show the characteristic sclerotic metastases in lumbar vertebrae and pelvic bones ( Figure 84.19 ). The bone appears dens...

Rectal examination Rectal examination can detect nodules within the prostate and advanced disease. Irregular induration, characteristically stony hard in part or in the whole of the gland (with obliteration of the median sulcus), suggests carcinoma. Extension ...

Screening for prostate cancer Prostate cancer screening with PSA is controversial and the test does not fulfil the World Health Organization’s (WHO) criteria for an adequate screening programme. Screening trials are limited by contamination of patients who hav...

Serum prostate-specific antigen After suitable counselling, measurement of serum PSA may be helpful. Men in whom a diagnosis of early prostate cancer might influence treatment option (such as those under 70 years or those with a positive family history who migh...

Staging using the tumour–node– metastasis (TNM) system The TNM staging system for prostate cancer is shown in Figure 84.14 . /uni25CF T1a , T1b and T1c . These are incidentally found tumours in a clinically benign gland after histologi - cal examination of a ...

Summary of treatment for carcinoma of the prostate /uni25CF Low-risk disease . For men in their seventies, conser - vative treatment would usually be the correct approach. Radical surgical treatment might be considered in younger (<70 years) men with this form...

The nervous system The nervous system is examined to eliminate a neurological lesion. Diabetes mellitus, tabes dorsalis, disseminated sclerosis, cervical spondylosis, Parkinson’s disease and other neuro logical states may mimic prostatic obstruction. If these...

Treatment of prostatic calculi Prostatic calculi usually require no treatment. Conservative measures Associated chronic prostatic infection may be treated by means of ciprofloxacin or trimethoprim. Transurethral resection Transurethral resection will often rel...

Treatment The management of these patients depends on achieving an accurate diagnosis. For this, urodynamic investigation is often necessary , which should demonstrate raised voiding pressures and diminished flow rate. Drugs The presence of α -adrenergic recep...

Upper tract imaging Most urologists no longer carry out imaging of the upper tract in men with straightforward symptoms. Obviously , if infection or haematuria is present, then the upper tract should be imaged by means of intravenous urogram/CT urography or ...

of chronic retention Men with chronic retention who have relatively low volumes of residual urine and who do not have symptoms suggestive - of coexisting infection and with good renal function do not necessarily require catheterisation before proceeding to p...

ACKNOWLEDGEMENT The author is grateful to Pankaj M Joshi MBBS, MS, DNB Urology (Gold Medal), Reconstructive Urologist, Kulkarni Reconstructive Urology Center, India, for his input to this chapter.

Anatomy The female urethra is around 4 /uni00A0 cm long, extending from the bladder neck to the meatus. The entire length of female urethra is sphincter active. There is extra support from the surrounding pelvic floor musculature. - Abnormalities of the femal...

Balanoposthitis Inflammation of the prepuce is known as posthitis; inflamma tion of the glans is balanitis. The opposing surfaces of the two structures are often involved, hence the term balanoposthitis ( Figure 85.18 ). In mild cases, the only symptoms are i...