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UROLOGY -part 4


Pus cells (infection)
Red cells (infection, stones, malignancy)
Proteins (infection, stones, malignancy, CRF)
Culture and ABST
Blood urea and Serum clectrolytes (s. creatinine if the B urea remains high after hydration)
Chest X-ray
If there are ECG changes, abnormalities in the chest X-ray, if the history and the examination warrant.

Exercise tolerance
Is the best way to assess the cardiac and pulmonary functions and the Hb level.

X-ray KUB (kidney, ureter, bladder)
After bowel preparation with 4 tablets of Bisacodyl for 3 nights to see any
Osteosclerotic deposits (carcinoma prostate)

Ultrasound scan – KUB. A full bladder is a necessity. If the patient is on a catheter, clamp it.
Detect the size of the prostate
Any residual urine
Any hydroureter or hydronephrosis

Prostate specific antigen (PSA)
This is organ specific, not tumour specific.
Equivocal results necessitate prostatic biopsy.

Urodynamics are usually not done.
Urine flow rate
Micturating cystourethrography

TRUS (Transrectal ultrasonography) is not freely available.
To assess the size of the prostate
For guided biopsy

Management of BPE
Watch policy
Interventional radiology

Watch policy
The patients are old with multiple co-morbid factors. Unless the symptoms are interfering his life style it is rational to keep them under surveillance to detect complications.

Drug therapy
Alpha blockers -Prazosin, Terazosin.
These drugs will affect the functional component of the disease
i.e. relaxes the smooth muscles of the prostate. There will be a symptomatic improvement.

The problems are:
Side effects
High cost
Poor compliance
Prolonged therapy

5á reductase inhibitors
5á reductase is necessary for the synthesis of 5-hydroxy testosterone in the prostate gland. These drugs will inhibit the synthesis of 5-hydroxy testosterone. The prostate gland will
reduce in size, the symptoms will improve. Effective in patients
With a large prostate gland (20 g).

Surgical intervention
Endoscopic (TURP)

continue read… Part 5

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