General Surgery
Bladder, Prostate and Lower Urinary Tract
MBBS surgery notes on bladder and prostate: benign prostatic hyperplasia, urinary retention, prostate cancer and bladder cancer, mapped to NMC codes SU29.7 to SU29.11.
MedNext Academy | 3 min read
Bladder, Prostate and Lower Urinary Tract
MBBS surgery notes on bladder and prostate: benign prostatic hyperplasia, urinary retention, prostate cancer and bladder cancer, mapped to NMC codes SU29.7 to SU29.11.
This chapter covers the bladder, prostate and lower urinary tract. It centres on benign prostatic hyperplasia and urinary retention, prostate cancer, and bladder cancer presenting with haematuria.
High-yield: Bladder, Prostate and Lower Urinary Tract
- Benign prostatic hyperplasia causes lower urinary tract symptoms such as hesitancy, poor stream, nocturia and terminal dribbling.
- Lower urinary tract symptoms are grouped into voiding, storage and post-micturition types.
- Acute urinary retention presents as a sudden painful inability to pass urine with a palpable, tender bladder.
- Chronic retention is often painless, presents with overflow incontinence and can cause obstructive renal impairment.
- The first step in acute urinary retention is urethral catheterisation to relieve the obstruction.
- Alpha blockers relax the bladder neck and 5 alpha reductase inhibitors shrink the prostate in medical management of benign prostatic hyperplasia.
- Transurethral resection of the prostate is the standard surgical treatment for troublesome benign prostatic obstruction.
- Prostate cancer is usually an adenocarcinoma arising in the peripheral zone and may be felt as a hard nodule on rectal examination.
- Prostate-specific antigen is used, with its limitations, in the assessment of prostate cancer.
- Prostate cancer commonly metastasises to bone, producing sclerotic bony lesions.
- Bladder cancer is usually a transitional cell carcinoma and presents with painless visible haematuria.
- The strongest risk factors for bladder cancer are smoking and occupational exposure to aromatic amines.
- In endemic areas, chronic schistosomiasis is linked to squamous cell carcinoma of the bladder.
- Cystoscopy is the key investigation for haematuria and for diagnosing and treating bladder tumours.
- A urethral stricture causes a poor stream and straining and can be shown on a retrograde urethrogram.
Lower urinary tract symptom groups
- **Voiding:** Hesitancy, poor stream, straining and terminal dribbling; suggest obstruction.
- **Storage:** Frequency, urgency and nocturia; suggest an overactive or irritated bladder.
- **Retention:** Acute is painful with a tender bladder; chronic is painless with overflow.
- **First step in retention:** Urethral catheterisation to relieve the obstruction.
NMC competencies in this chapter
- **SU29.7:** Benign prostatic hyperplasia and lower urinary tract symptoms
- **SU29.8:** Acute and chronic urinary retention
- **SU29.9:** Prostate cancer
- **SU29.10:** Bladder cancer
- **SU29.11:** Urethral stricture and bladder outlet disease
Frequently Asked Questions
What symptoms does benign prostatic hyperplasia cause?
Voiding symptoms such as hesitancy, poor stream and terminal dribbling, and storage symptoms such as frequency, urgency and nocturia, together called lower urinary tract symptoms.
What is the first step in acute urinary retention?
Urethral catheterisation to relieve the painful obstruction and drain the bladder, after which the underlying cause is assessed and treated.
How does prostate cancer commonly spread?
Prostate cancer characteristically metastasises to bone, producing sclerotic lesions, and it may be felt as a hard irregular nodule on digital rectal examination.
How does bladder cancer usually present?
With painless visible haematuria. Smoking and occupational aromatic amine exposure are the main risk factors, and cystoscopy is the key investigation.
Continue reading
MBBSAll General Surgery chapters
Continue through the General Surgery chapter map.
Continue studying General Surgery
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans