29. disorders of prostate

Question 1

what is prostatitis?

Answer 1

infection of prostate gland - becomes enlarged and inflamed - can result in urinary retention due to inflammation constricting urethra

Question 2

what are the main pathogens that cause acute prostatits?

Answer 2

E coli, Proteus and Staphylococcus species, and sexually transmitted pathogens including C. trachomatis and Neisseria gonorrhoeae.

Question 3

In acute prostatitis is inflammation focal or diffuse?

Answer 3

Inflammation can be focal or diffuse.

Question 4

What do patients present with in acute prostatitis?

Answer 4

• General symptoms: malaise, rigors and fever

* Local symptoms: difficulty in passing urine, dysuria and perineal tenderness

Question 5

What can usually lead to acute prostatitis?

Answer 5

UTI

Question 6

What will be revealed in rectal examination of acute prostatitis?

Answer 6

Rectal examination revels a soft, tender and enlarged prostate

Question 7

What causes chronic prostatitis?

Answer 7

• Results from inadequately treated infection.
• Can occur because some antibodies cannot penetrate the prostate effectively. Often a history of recurrent prostatic and urinary tract infections.
Causative pathogens are the same for acute prostatitis

Question 8

What are symptoms of chronic prostatitis?

Answer 8

Some patients are asymptomatic. Will present with no preceding acute phase

Question 9

How is chronic prostatitis diagnosed and treated?

Answer 9

• Chronic prostatitis is difficult to diagnose and treat. Diagnosis confirmed by:
• Histological examination showing neutrophils, plasma cells and lymphocytes
• A positive culture from a sample of prostatic secretion

Question 10

What is CHRONIC NON-BACTERIAL PROSTATITIS?

Answer 10

• Most common type of prostatitis, results in enlargement of the prostate.

Question 11

What causes chronic non bacterial prostatitis?

Answer 11

• Often no history of recurrent UTIs.

* Usual pathogen is C. trachomatis, so typically sexually active men are affected.

Question 12

What will Histological examination show in chronic non bacterial prostatitis?

Answer 12

fibrosis as a result of chronic inflammation

Question 13

What is BENIGN PROSTATIC HYPERTROPHY (BPH)?

Answer 13

• Non-neoplasic enlargement of the prostate gland, can eventually lead to bladder outflow obstruction

Question 14

Who are BPH common in?

Answer 14

Detectable in nearly all men over the age of 60.

Question 15

What causes BPH?

Answer 15

Cause is unknown but may be related to levels of male sex hormones (testosterone). Enzyme 5a-reductase levels increase as men age and it causes testosterone to be converted to DHT which is stronger and causes enlargement of prostate

Question 16

When do symptoms develop in BPH?

Answer 16

Symptoms develop as the enlarging prostate gland compresses on the prostatic urethra.

Question 17

What are the symptoms of BPH?

Answer 17

Men present with obstructive lower urinary tract symptoms:
• Difficulty or hesitancy in starting to urinate
• A poor stream
• Dribbling postmicturition
• Frequency and nocturia

Question 18

What will be revealed in digital rectal examination in BPH?

Answer 18

Digital rectal examination for the prostate, which is firm, smooth and rubbery

Question 19

What can untreated BPH lead to?

Answer 19

• Untreated BPH can present with acute urinary retention, which is accompanied by a distended and tender bladder and a desperate urge to pass urine.
• Alternatively the patient may have progressive bladder distension, leading to chronic painless retention and overflow incontinence.
• Can lead to bilateral upper tract obstruction and renal impairment, with the patient presenting in CKD

Question 20

What are the treatment options for BPH?

Answer 20

• alpha blockers - relax smooth muscle at bladder neck and within prostate
• Finasteride (5a-reductase inhibitor) presents the conversion of testosterone to the more potent androgen dihydrotestosterone
• Surgical treatment - Transurethral resection of the
prostate (TURP)