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PBL 10 Glasgow 2012

Benign prostatic hyperplasia, Cervical Smear, Criteria for screening programmes

Sometimes, BPH is referred to as benign prostatic hypertrophy. Why is this inaccurate? As hypertrophy is an increase in size of a tissue or organ by the ENLARGEMENT of its cells rather, hyperplasia which is acheived by cell multiplication without an increase in size of cells.
What is BPH? A increase in size of the prostate gland without malignancy present, normal with advancing age. As it enlarges it places pressure on the bladder and urethra.
Does BPH increase the rise of prostate cancer? NO
Signs and symptoms of BPH which affect urination? Difficulty in starting urination Weakens the flow of urine, or cause hesitancy Strain when passing urine Frequently need to urinate Waking up during the night to urinate Urinacy urgency in fear of incontenance Incomplete bladder
In the late stages, BPH can cause? Urinary tract infections (UTI) Acute Urinary retention (AUR) Blood in the urine
Acute urinary tract infections UTI? If you are unable to empty your bladder properly, there is a risk that bacteria will get flushed out and instead will spread through the urine to cause UTI
Acute Urinary Retention Sudden Inability to pass any urine. AUR should be treated as a medical emergency because, without prompt treatment, urine may be passed up into the kidneys which can damage them
What is the pathophysiology of BPH? Exact causes of BPH is unknown, but research suggests that hormones play an important role in the development of the condition?
What hormones are susepected to be involved in the development of BPH? dihydrotestosterone (DHI) Testosterone and oestrogen
How is dihydrotestosterone suspected to contribute to BPH? As men get older, the levels of dihydrotestosterone increases, which may stimulate the growth of the prostate.
How is the levels of testosterone and oestrogen thought to contribute to BPH? In younger men, testosterone levels are higher than oestrogen levels. However, with age levels of testosterone decreases meaning there is a higher proportion of oestrogen whoch may contribute to prostate enlargement.
Why should a holistic approach be taken when diagnosing BPH? As BPH is common in older men, it should not be looked as the only possible pathology in patients presenting LUTS(lower urinary tract symptoms). Also, BPH show similar symptoms to prostate cancer.
What is the international prostate symptom score (IPSS)? Is a quantitive and validated technique based on eight questions and further quality of life questions. Results are then summated to give a figure of degree of severity of BPH
After your GP has used the IPSS to assess. Name the other examinations which are used to asses BPH? Urine test Rectal examination Prostate-Specific antigen (PSA) test Transrectal ultrasound Intravenous Urography Voiding charts Uroflowmetry
Urine Tests Can be used to check if symptoms are caused by an infection in your urinary system, such as kidneys or bladder infections
Rectal examination BPH can cause the prostate gland to become hard and bumpy. A healthcare professional will insert their finger into your rectum and because the rectum is close to the prostate gland they can check if the surface of the gland has changed.
PSA test (prostate specific antigen test) blood test used to measure the amount of portate specific antigen protein that is produced by the prostate. A raised PSA indicates enlargement of the prostate and a significantly raised level may indicate prostate cancer.
Transrectal Ultrasound (TRUS) a TRUS is a type of ultrasound scan that is specifically designed to study the prostate and the area surrounding the prostate. A ultrasound probe is placed into your rectum and uses sound to build a detailed image of the prostate
Intravenous urography (IVU) An IVU is an x-ray used to study the enhanced Urinary tract (kidneys, bladder, ureter). Used to check for blockages such as bladder stones and also damage in the UI. During IVU, patient injected with harmelss radioactive dye, which appears on x-ray.
Voiding charts A voiding chart is a urination diary, which is kept for 24 hours in which the patient is asked to record how often they urinate as well as details about how you urinate. Good way to find out more about symptoms and the type of treatment to be used.
Uroflowmetry measures the pressure of bladder+how well your bladder works when urinating. Local anaesthetic and a catheter is inserted into urethra and moved up into bladder. water is then inhected into your bladder. A connected connected to bladder measures pressure.
Treatment for BPH Lifestyle changes Bladder training Medication Insertion of a stent surgery
What lifestyle changes may you be advised to change if you have BPH? Stop drinking any liquids 1/2 hours before bed. Experiment with the time you take prescription medication Stop or limit the consumption of alcohol +caffeine Exercise regularly Join a patient support group
Bladder training Exercise programme to increase the time between urination and to increase the amount of urine your bladder can hold. Patient uses a bladder training chart and does exercises such a breathing, muscle exercises to keep mind off urinating.
Medication Medication along with lifestyle changes is recommend to treate moderate to severe symptoms. medications include: Finasteride and duateride Alpha blockers
What is the purpose of Finasteride and duateride for treating BPH? Block effects of a hormone called DHT on the prostate gland, which can reduce the size of the prostate
What is the purpose of alpha blockers for treating BPH? help relax the muscles of your bladder, making it easier to pass urine. Tamulosin and alfisozin used.
Insertion of a stent? For patients not fit for surgery. A stent is inserted into urethra to help the patient urinate.
What are the three types of surgery available to patients with moderate to severe symptoms? Trans-urethral resection of prostate (TURP) Trans-urethral incision of prostate (TIP) Prostatectomy
TURP(trans-urethral resection of prostate) surgical procedure where excess prostate tissue is removed to reduce pressure on bladder
TIP (trans-urethral incision of the prostate) an alternative to TURP for men who: have a small or moderatly enlarged prostate, poor health and not suitable for TURP. Instead of removing tissue two cuts are made to widen bladder.
What are the benefits of TIP over TURP? lower risk of experiencing retrograde ejacuatlion, important for men who are considering having children.
prostatectomy incision is made in your tummy and outer portion of prostate is removed. However, there is a higher risk of wound healing or a blood clot.
Epidemiology of BPH? 40% men in their 5th decade 90% men in their 9th decade unusual before 45 men of afro-American origin more severely than white men. does not occur in castrated men
what is a cervical smear? A cervical screening test, or smear, is a method of detecting abnormal cells in the cervix in order to prevent cervical cancer.
What does the smear test itself consist of? usually takes five minutes. An instrument called a specululm will be inserted gently into vagina to hold the walls of the vagina open so your cervix is visible. A small brush-like instrument will be used to take some cells form the surface of your cervix.
What are changes in the cells of the cervix caused by? HPV (human papilloma virus), of which there is over 100 types and can cause genital warts
When should women normally be invited for a smear test? At the age of 25 invitation first received Women aged 23-49 are invited for screening every 3 years. Women aged 50-64 are invited every 5 years Women aged 65> are only screened if they have not been screened since they were 50
When is a smear test not needed? Sexually inactive women, who have never had sex Women over 65 Women who have had a hysterectomy
What are the different types of results you will get from a smear test? Normal- no abnormal cells Inadequate- test needs repeated Borderline- some abnormal cells are detected Abnormal
If you have abnormal results what might you be told you have? Mild or slight dyskaryosis Moderate dyskaryosis Severe dyskaryosis
What is dyskaryosis? Used to describe the change in cells
Results may also infer to CIN, what is this? Cervical intra-epithelia neoplasia which can lead to cancer
What are the next stages if further testing is needed? Colposcopy- a simple examination that uses a microscope called a colposcope. Identifies the extent of cell abnormality
what is the treatment available for cervical abnormalities? LLETZ- fine wire and electric current to cut away the affected area Cone biopsy- small operation, cute cone shape away from cervix
What are screening programmes? a public health service in which members of a defined population, who do not necessarily perceive they are at risk of, or are already affected by a disease or its complications, are asked or offered a test, which identifies who is most likely at risk.
Wilson and jungner criteria for screening? Knowledge of disease Knowledge of test Treatment for disease Cost considerations
what does the Wilson and Junger criteria address? The condition, the test, the treatment and the screening programme
What should be taken into consideration about the condition for screening programmes? Should be an important health problem. The epidemiology and natural history of the condition, including development from latent to declared disease, should be adequately understood and should be a detectable risk factor.
What should be taken into consideration about the test for screening programmes? Simple, safe precise and validated screening test. Distribution of test values in the target population should be known and suitable cut-off level agreed. The test should be acceptable to the population.
The test for screening programmes cont.... An agreed policy on the further diagnostic investigations of the individuals with a positive test result and on the choices available to those individuals.
What should be taken into consideration about the treatment for screening programmes? Should be an effective treatment or intervention for patients identified through early detection, with evidence of early treatment, rather than late treatments, leading to better outcomes.
what should be taken into consideration about the screening programme itself? Evidence from high-quality randomised trials that the screenign programme is effective in reducing mortality or morbidity.
Screening programme cont.. Where screening is aimed soley at providing information to allow the person being screend to make an informed choice, there must be evidence from high-quality trail that the test accurately measures risk and this information is given to patient/understood
Limitations of screening? screening can reduce the risk of developing a condition or its complications but it cannot offer a guarantee of protection. Irreducible minimum of false positive and false negative results, screening is therefore presented as risk reduction
Potential dangers of screening issues with false positive results, or being branded as a "postive family" causing unnecessary stress. Misintrepration of results can lead to a false sense of security. Costs to society. May have undesirbale results such as psychological.
Screening programmes currently present in the UK? Diabetic retinopathy, Breast cancer, Cervical Cancer, Bowel Cancer.
Created by: Taryn Miller