Showing posts with label Urology. Show all posts
Showing posts with label Urology. Show all posts

What are the arteries seen after middle lobe resection during a TURP.. Badenoch's arteries

What are the arteries seen after middle lobe resection during a TURP?
A- Capsular arteries.
B- Badenoch's arteries***
C- Floch's arteries.
D- Branches of the internal pudendal artery.
E- Branches of the superior vesical artery.

Answer B:
The arteries seen at 5 and 7 o clock after middle lobe resection are urethral branches of the inferior vesical artery known as Badenoch's arteries.

The smaller arteries seen at 2 and 10 clock are known as Floch's arteries.

The urethra is a channel that starts from the bladder level and ends at the level of the urinary bladder, mainly used to expel the urine.

Male urethra differs from female urethra: first, it is the longest (15-20 centimeters to 4-5 centimeters from the female urethra); second, it also acts as a conduit for sperm passage (in women, urethra has an exclusive urinary function).

From a histological point of view, it offers different appearances - including the so-called thethomylium (or transitional epithelium) - and two tonics: mucosa and muscle tarton.

The most common known disease that can affect the urethra is the narrowing of the urethra - urethral stenosis - and urethritis - inflammation, often on the basis of infection, of the urethra.

What is urethra?
The urethra is the tube that connects the bladder to the so-called urinary mucosa (or external urethral opening), which is used to expel some bodily fluids (mainly urine) from the body.

In anatomy, the term "mucus" refers to a hole that connects the inner part of the body to the outside and through which it passes in some cases liquid.

In the human body, there are many mumps: urethral urethra, a hole in which every ureter flows in the bladder.

The external auditory molar, a separate hole between the wing and the drum membrane. And so on.

What is the risk of erectile dysfunction after TURP.. 6%

What is the risk of erectile dysfunction after TURP?
A- 36%
B- 30%
C- 20%
D- 16%
E- 6%***

Answer E:
The national prostatectomy audit quotes a rate of 31% however it appears the risk is much lower. Wasson's TURP vs watchful waiting study found no difference in the rates of ED between the 2 groups and Marberger's BJU 1999 meta-analysis indicated a rate of 6.5%.

Transurethral prostatectomy takes less than 90 minutes.
General or topical anesthesia can be used.
During the operation, the surgeon places a thin tube resembling the telescope (called a cutting lens) in the penis through the urethra until it reaches the prostate gland.
Then an electric loop is used at the end of the endoscope to remove the prostate tissue that blocks the duct and the flesh of the blood vessels.
The area is purified and all tissue removed.
It is usually required to stay in the hospital for three days.
During this period the catheter will remain in place to remove the urine and any remaining traces of surgery.

TURP is recommended for patients with complications from benign prostatic hyperplasia such as inability to urinate, bleeding from the urethra, kidney damage caused by urine retention; recurrent urinary tract infections and bladder stones.

There are many potential risks and complications associated with anesthesia, including respiratory or heart failure. Other complications include:
Bleeding, which requires transfusion
- Infections that require antibiotics, and in some cases stay in hospital.
- Inequality between fluids and salts During and immediately after surgery, light grade will not need to be treated, severe degree can lead to coma.
Problems with urinary flow control (urinary incontinence) and urethral distress.
- Difficulty erecting and maintaining (erectile dysfunction).
Infertility.
- emptying the semen into the bladder instead of coming out of the urethra (tossing back also called "dry ecstasy")
Risks, such as long-term stiffness and narrowing of the bladder neck leading to poor urination, can be reduced by following the surgeon's instructions before and after surgery.

Which alpha-blocker has the strongest association with floppy iris syndrome.. Tamsulosin

Which alpha-blocker has the strongest association with floppy iris syndrome?
A- Alfuzosin
B- Indoramin
C- Prazosin
D- Tamsulosin***
E- Doxasosin

Answer D:
Although described as a class effect, the incidence of floppy iris syndrome with tamsulosin is approx 85%-90%.

The iris represents the colored part of the eyes and is often stiff and solid. However, if the infection is present, the iris becomes flexible. If the person is infected with white water and requires cataract surgery, this syndrome is dangerous to the eyes and prevents him from This procedure is performed, where the muscles of the eyes become flexible.
Tesosolucin is often the cause of the syndrome. If the condition is not treated, it can develop and lead to loss of vision. If a person is in the process of cataract surgery, it is necessary to stop taking these drugs for a long period of time. It does not cause any damage when doing surgery.

Intraoperative flotation iris syndrome (IFIS) is one of the complications that may occur during the extraction of white water in some patients. This syndrome is characterized by the presence of soft iris, which evaporates in response to fluid currents within the normal eye. This flexible iris tends to shrink to the white water extraction area during surgery, and the pupil narrowes during the operation, despite procedures to prevent it.
Transmissive iris syndrome has been associated with tamosolucin (eg, fluomox), a drug widely prescribed for urinary symptoms associated with benign prostatic hyperplasia (BPH).
Tacholin is a drug that works on alpha receptors selectively and works to relax the bladder and smooth prostatic muscles.
As such, it relaxes the extended muscle of the iris by connecting the endothelial nerve endings.
Many substances bind to different alpha receptors, but tamsolucin has a stronger association than others.
A joint statement by the two ophthalmologists states that the other major class of drugs to treat benign prostatic hyperplasia of alpha-5-reducing enzyme inhibitors does not appear to cause progressive iris syndrome.
 5-ARIs include finasteride, a drug commonly used as a first-line treatment for benign prostatic hyperplasia and androgenic pumpkin, and is also associated with white water formation.
The severity of the condition is not associated with the duration of thamsolucin intake.

What is the embryological origin of the transition zone.. Mesoderm

What is the embryological origin of the transition zone?
A- Mesoderm***
B- Ectoderm
C- Endoderm
D- Mullerian duct
E- Mesonephric duct

Answer A:
Transition zone arises from mesoderm, peripheral zone arises from endoderm and central zone appears to be embryologically distinct possibly mullerian in origin.

The mesoderm, as opposed to the endoderm and the ectoderm, is the intermediate cell sheet of the triploblastic metazoan embryo that develops at the time of gastrulation. Only Bilaterians have it, poriferous (sponges) and cnidarians (jellyfish, corals, hydra, sea anemones, etc.) are deprived of it. On the other hand, they have a mesoglea, which is not an embryonic leaflet but a cell-poor tissue with a large extracellular matrix.
The cells that derive from the mesoderm form all or part of the internal organs with the exception of the nervous system (derived from the ectoderm), and organs of the digestive and respiratory systems (from the endoderm). Thus, in the Cordés, the mesoderm gives birth:
To the notochord (or chord, or axial mesoderm), regressing in humans and whose remnants form part of the nucleus proposed.
Para-axial mesoderm, giving it metamerized somites which in turn give rise to vertebrae and ribs (by the sclerotome), to skeletal muscles of the back (through the myotome) and to the connective dermis (by the dermatome);
At the intermediate mesoderm which gives it the kidneys (pro-, meso-, metanephros), the medulla of the gonads, the genital tract, and the ureters.
At the lateral mesoderm divided into somatopleura and splanchnopleure, between the two is created a cavity, the intraembryonic coelom, which fuses temporarily with extraembryonic coelom. During plication, the intraembryonic coelome closes, becomes a closed cavity and surrounds the viscera, forming notably the serosa and the mesentery:
Somatopleure, blade in contact with the ectoderm, giving bones and limb tendons (derived from mesenchymal cells and adrenal cortex.
Splanchnopleure, a blade in contact with the endoderm, giving blood vessels and blood cells, as well as visceral muscles, pericardium, pleura, myocardium and endothelium (which constitute the circulatory system).
Diagram showing mesoderm after delimitation (embryo closure)
Mesoderm also limits serous cavities (or coelomic cavities) of mesoblastic origin.
The mesoderm is thus the embryonic leaflet that produces a large part of the connective tissues (the majority of bones, the dermis ...), muscle tissue and the chord.

What is the arterial supply of the prostate.. Superior vesical artery

What is the arterial supply of the prostate?
A- Superior vesical artery***
B- Obturator artery
C- Inferior vesical artery
D- Inferior epigastric artery
E- External iliac artery

Answer A:
The inferior vesical artery supplies the prostate-as it approaches the gland it divides into urethral and capsular branches.

Prostate is a small gland present in the reproductive system of each man, characterized by growing as it grows, and the greater the age the greater the size, and works on the secretion of semen.

Prostate diseases:
Multiple prostate diseases, as follows:

- Prostate inflammation:
It is a type of inflammation that affects the gland strongly and to varying degrees. This symptom affects the patients any man at any age and not as some believe wrongly that it affects the elderly only, and there is often no symptoms of this inflammation, a result of bacterial infection, and chronic prostatitis Most men are affected by aging, but they are also threatening the young, during which the patient feels pain when urinating, in addition to pain in the testicles and the penis, and with ejaculation, with excretions coming out of the urethra. Suffering from frequent infections of the body, ka Inflammation almonds, kidney inflammation and sinuses, and urinary tract, and intercourse with someone pregnant disease gangbang Calcelan, and suffering the patient in this acute inflammation of the frequent urination and severe heartburn when coming off, the hottest body, the man Mona has shot accompanied by blood, or urinating accompanied also with blood.

- Prostate congestion:
It is the most common symptom of the disease, which affects the gland in a state of severe congestion and may swell in some cases. The most common symptom of this problem is severe male pain, ejaculation with some blood, difficulty urinating, severe burning and rapid ejaculation.

- benign prostatic hyperplasia:
It is a very common symptom among all groups, especially the elderly, because the gland here is swollen by benign carcinoma, as men age, which hampers the process of urination.

Causes of Prostate Disease:
There are many factors that cause inflammation of the prostate gland, and must be avoided:
- The most important frequent viewing of sexual stimuli of pornographic films and pictures.
- Practice masturbation from an early age and very overly.
- Excitement without libel often, which is happening to many young people, which is one of the most serious reasons.
- Smoking, alcohol and alcohol and excesses in them, is very dangerous to the sexual health of men.
- Ejaculation outside the vagina continuously is one of the most prominent reasons.
- Excessive sexual intercourse between unmarried couples.
- Spacing periods of intercourse between married, either for marital differences, or for reasons of pregnancy and childbirth and others.
- Not urinating before and after intercourse is one of the most important factors of injury.
- Excessive drinking of caffeine in carbonated water, coffee, tea and stimulants of all kinds.
- Neglecting the treatment of any inflammatory symptoms in the prostate leading to disease.
- Abnormal sexual practice of coming from behind, as well as sexual intercourse between the owners of venereal diseases.
Obesity is the most prominent causes of prostate diseases.

What is the change in symptom score in the placebo arm of the PLESS study.. 1.3 decrease

What is the change in symptom score in the placebo arm of the PLESS study?

A- 3.3 increase
B- 1.3 decrease***
C- 1.0 decrease
D- 1.3 increase
E- 3.3 decrease


Answer B:

Patients in the placebo arm noticed a 1.3 point improvement/decrease in their symptom score versus a 3.3 improvement on finasteride. The fact that symptoms improved on placebo is useful to remember in discussions about treatment in the viva.

Regarding the natural history of BPH, what is the average decline in peak urinary flow rate

Regarding the natural history of BPH, what is the average decline in peak urinary flow rate?

A- 0.1mls/sec/year
B- 0.2mls/sec/year***
C- 0.3mls/sec/year
D- 0.4mls/sec/year
E- 0.5mls/sec/year

 Answer B:

You are required to be aware of the natural history of BPH and the Olmstead study showed an average decline of 0.2mls/sec/year in patients with BPH.

What is the risk of retention in a 70-79 year old with moderate lower urinary tract symptoms

What is the risk of retention in a 70-79 year old with moderate lower urinary tract symptoms?

A- 3 per 1000 person years
B- 9 per 1000 person years
C- 18 per 1000 person years
D- 26 per 1000 person years
E- 34 per 1000 person years***

Answer E:

This data comes from the Olmstead County Study (required reading) which showed that men aged 70-79 with moderate/severe symptoms had a retention risk of 34.7 /1000 person years.

Which of the following is not assessed on the IPSS questionaire.. Incontinence

Which of the following is not assessed on the IPSS questionaire?

A- Incomplete emptying
B- Frequency
C- Quality of life
D- Incontinence***
E- Straining

Answer  D:

The following symptoms are assessed
incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia. In addition there is a quality of life score

In the PLESS study what is the effect of finasteride on acute urinary retention versus placebo.. Associated with a risk reduction of 57%

In the PLESS study what is the effect of finasteride on acute urinary retention versus placebo?

A- Reduces retention by 30%
B- Reduces retention by 55%
C- Associated with a risk reduction of 57%***
D- Associated with a risk reduction of 50%
E- Reduces rention by 57%

Answer C:

 99 (7%) patients in placebo group compared to 42(3%) in finasteride group suffered acute urinary retention– Risk reduction of 57%.

Which of the following was not defined as clinical progression in the MTOPS study.. Recurrent haematuria

Which of the following was not defined as clinical progression in the MTOPS study?

A- Recurrent haematuria***
B- Renal failure
C- Increase of 4 points in the AUA symptom score
D- Urinary incontinence
E- Recurrent urinary tract infection

Answer A:

 Clinical progression was defined in the MTOPS study as

Increase of 4 points in the AUA symptom score
Acute urinary retention
Renal failure
Urinary incontinence
Recurrent urinary tract infection
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