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Senior - Urology > 3 - Prostate Conditions > Flashcards

3 - Prostate Conditions Flashcards

1
Q

Prostate anatomy

A

7-8

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2
Q

Acute bacterial prostatitis is MC?

A

Gram-neg rods

  • e. Coli
  • pseudomonas
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3
Q

Acute bacterial prostatitis caused by?

A

Typically ascending infection from urethra and reflux of infected urine into prostatic ducts

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4
Q

Presentation of acute bacterial prostatits?

A

Abrupt onset of:

  • perineal, sacral or suprapubic pain
  • fever
  • irritative voiding

Prostate swells
- obstruction/urine retention

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5
Q

PE for prostatitis?

A

High fever
Warm/inflammed/tender prostate
- gentle DRE

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6
Q

Acute bacterial prostatitis pts do not get?

A

Prostatic massage

- risk of septicemia

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7
Q

Labs for acute bacterial prostatitis?

A

UA

  • pyruria
  • bacteriuria
  • hematuria

CBC
- leukocytosis

Urine culture
- agent

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8
Q

Acute bacterial prostatitis tx?

A

Abx (culture sensitivity)

Hospitalization if:

  • septicemic
  • comorbid
  • bad patient

Broad spectrum abx (ampicillin + aminoglycoside)

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9
Q

MC abx for acute bacterial prostatitis?

A

IV
- fluoroquinolone + aminoglycoside

PO

  • fluroquinolone
  • septra

4-6 weeks of therapy

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10
Q

If urinary retention developes (acute bacterial prostatitis)

A

Urethral catheter is contraindicated
- septicemia

Percutaneous suprapubic tube is indicated

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11
Q

Post tx acute bacterial prostatitis pts need?

A

F/o culture

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12
Q

Chronic bacterial prostatitis comes from?

A

Same route as acute

May or may not have hx of acute

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13
Q

Presentation of chronic bacterial prostatitis

A
  • irritative voiding
  • low back pain
  • perineal pain
  • hx of UTI
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14
Q

PE for chronic bacterial prostatitis?

A

Unremarkable (afebrile)

Prostate can be:

  • normal
  • boggy,
  • indurated
  • palpable prostatic calculi
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15
Q

Labs for chronic bacterial prostatitis?

A

UA and culture
- likely normal

Prostatic secretions

  • H leukocytes
  • culture

CBC
- leukocytosis

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16
Q

Unlike acute, chronic bacterial prostatitis needs?

A

Prostatic massage
- get the secretions

Pics on slide 20

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17
Q

chronic bacterial prostatitis tx?

A

Difficult to attain therapeutic abx levels

Abx

  • septra
  • fluoroquinolone
  • other (dont care, slide 21)

Symptoms

  • NSAID
  • sitz baths
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18
Q

chronic bacterial prostatitis prognosis?

A

Difficult to cure

Recurrent disease

Infected prostate stone may develope

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19
Q

chronic bacterial prostatitis may need? (tx)

A

Suppressive abx to control symptoms and recurrent UTI

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20
Q

MC prostatitis?

A

Chronic nonbacterial prostatitis

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21
Q

Chronic nonbacterial prostatitis is?

A

Prostate inflammation
- w/o infection

Ukn cause

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22
Q

Chronic nonbacterial prostatitis clinical presentation?

A

Similar to chronic

- no h/o UTI

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23
Q

Labs for Chronic nonbacterial prostatitis?

A

H leukocytes on expressed secretions
- inflammation not infection

Neg cultures

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24
Q

Chronic nonbacterial prostatitis tx?

A

Trial of abx against atypicals
- erythromycin

NSIADS

Sitz baths

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25
Q

Chronic nonbacterial prostatitis sequela?

A

None, its annoying but not a big deal

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26
Q

Prostatodynia is?

A

Non-inflammatory d/o
Young/middle aged males

Causing voiding dysfunction and pelvic floor musculature dysfunction

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27
Q

With Prostatodynia?

A

Prostate is normal

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28
Q

Prostatodynia presentation?

A

Same ssx as chronic prostatitis
No h/o UTI
NO fever
Poss hesitancy and flow interruption

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29
Q

Labs and PE for Prostatodynia?

A

Unremarkable/normal

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30
Q

Prostatodynia tx?

A 
Alpha blocker
- bladder neck and urethral spasms
Diazepam 
- pelivc floor dysfunction
Sitz baths 
- symptomatic relief
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31
Q

Prostatodynia that is unresponsive to empiric tx?

A

Urodynamic testing

- r/o dysfunctional voiding

32
Q

High speed prostate chart?

A

Slide 29

33
Q

BPH pathogenesis?

A

Not understood

  • maybe endocrine
  • maybe multifactorial
34
Q

factors for developing BPH?

A
  • Dihydrotestosterone (DHT)

- Age

35
Q

Pathology for BPH?

A

5-alpha-reductase converts testosterone to DHT -> promotes prostate cell proliferation -> BPH

Hyperplatic process
- high cell #

Nodular growth pattern
- variable stroma or epithelium

36
Q

BPH occurs in the?

A

Transition zone

- pic on 34

37
Q

BPH causes?

A

Hyperplasia

  • mechanical obstruction of urethra
  • bladder outlet resistance

Big Prostate size on DRE

38
Q

With BPH size?

A

Doesnt matter

- but seriously it correlates poorly w symptoms

39
Q

BPH symptoms

A

Obstructive

  • hesitancy
  • Low force/caliber of stream
  • incomplete emptying
  • double voiding
  • straining to urinate
  • postvoid dribbling

Irritative

  • urgency
  • freq
  • nocturia
40
Q

most important tool for BPH eval?

A

AUA (americal urological association) symptoms index

  • self-administered questionnaire
  • ID pts who need hterapy

7 questions to quantify severity of obstuctive irritative complaints

Pic on 40

41
Q

BPH hx questions?

A

Prostate ca
UTI
Neurogenic bladder
Urethral stricture

42
Q

BPH PE

A

DRE

  • prostate size and consistency
  • smooth, firm, elastic enlargement of prostate

Abdominal exam
- bladder distention

43
Q

If prostate is indurated?

A

Further w/o to r/o cancer

  • PSA
  • TRUS (transrectal ultrasound)
  • biopsy
44
Q

BPH labs?

A

UA - exclude

  • hematuria
  • infection

Serum PSA

Seum BUN/creat
- r/o obstructive uropathy (postrenal azotemia)

Optional

  • urodynamic
  • PVR (post void residual)
45
Q

BPH imaging/

A 
Renal US/CT if:
- concomitant UT disease
- BPH complications
— hematuria
— UTI
— CKD
— H/O stones
46
Q

BPH ddx?

A

Obstructive conditions
UTI
Bladder ca
Neurogenic bladder

47
Q

Mild symptoms (AUA 0-7) tx?

A

Watchful waiting

  • risk is uncertain
  • progression is not inevitable
  • f/u interval not defined
48
Q

Moderate to severe BPH sx tx?

A

Options

  • watchful waiting
  • surgery
  • med therapy
49
Q

Absolute surgical indications

A
  • refractory urine retention
  • large bladder diverticula
  • BPH sequellae
50
Q

BPH sequelae?

A
  • recurrent UTI
  • recurrent/persistent gross hematuria
  • bladder stones
  • CKD
51
Q

Pharmacotherapy for BPH?

A

Alpha blockers

  • prazosin
  • doxazosin
  • terazosin

Alpha-1a blockers - receptor-specific and fewer s/e than alapha blockers

  • tamsulosin
  • alfuzosin

5-a-reductase inhibitors

  • finasteride
  • dutasteride

PDE-5 inhibitors
- tadalafil (pts w BPH and ED)

Phytotherapy

52
Q

How do 5-a-reductase inhibitors work?

A

Block conversion of test - DHT

Improves symptoms

53
Q

Combo therapy for BPH?

A

Alpha-blocker + 5-a-reductase inhibitor

Dozxazosin + finasteride

54
Q

Wha tis phytotherapy?

A

Plants/extracts for medical purposes

  • saw palmetto berry
  • phygeum africanum bark
  • pollen extract
  • echinacea purpurea root
  • hypoxis rooperi root

No good trials to prove efficacy

55
Q

Minimally invasive therapy for BPH?

A

TULIP: transurethral laser-induced prostatectomy

TUNA: transurethral needle ablation of the prostate

Transurethral electrovaporization of the prostate

Microwave hyperthermia

Implant to open prostatic urethra

56
Q

Conventional surgery for BPH?

A

TURP - transurethral resection of the prostate

  • can be endoscopic (95%)
  • 1-2 days in hospital

TUIP - Transurethral incision of the prostate
- open simple prostatectomy (when prostate is too large to remove endoscopically)

57
Q

Other options for BPH tx?

A

Botox injection

- off label

58
Q

Prostate cancer stages?

A

Slide 61

Stage I - stage IV

59
Q

Prostate cancer usually has? (Symptoms)

A

Asymptomatic
- if symptomatic - wt loss, bone pain etc

Prostatic induration on DRE

PSA elevation

60
Q

prostate cancer factoids

A

MC non-cutaneous cancer detected in US

2nd leading cause on cancer related death

61
Q

Risk factors for prostate cancer?

A

Age
AA
Fam hx
High fat intake

62
Q

Prostate ca ssx?

A

Early - asymptomatic
Late/metastatic - symptoms
- lumbar spine pain (red flag)

Obstructive/irritative symptoms

63
Q

PSA numbers?

A

Normal <4ng/mL

Confined to prostate <10ng/mL

Advanced >40ng/mL

But… no level absolutely excludes or diagnoses ca

64
Q

PSA testing cannot?

A

Determine tx decisions

- refer for US/biopsy

65
Q

Other labs for prostate cancer?

A

Urinary retention

  • H BUN
  • H creatinine

Skeletal metastases

  • H alk phos
  • Hypercalcemia
66
Q

If your pt has an abnormal DRE or PSA they are getting?

A

TRUS guided biopsy
- transrectal ultrasound

Definitive diagnosis

67
Q

Imaging for prostate cancer?

A

MRI
- prostatic lesions and regional lymph nodes

Radionuclide bone scan
- detect skeletal metastasis

68
Q

Indications for radionuclide bone scan

A
  • advanced local lesion
  • symptoms of metastases
  • high grade disease
  • H PSA (>20ng/mL)
69
Q

Tx for prostate ca

A

Controversial
- survival benefit of tx is not conclusive

Most pts w expected survival in excess of 10 yrs should be considered for tx
- otherwise active surveillance

70
Q

Prostate cancer treatment options?

A

Radical prostatectomy
- seminal vesicles, prostate, and ampulle of vas removed (stage T1 and T2)

Brachyotherapy
- perm/temp radioactive stuff in prostate

Cryosurgery
- freeze/destroy tissue

Androgen deprivation
- hormonal therapy

71
Q

Prostate cancer prognosis?

A

CAPRA nomogram

- big complicated paper thing to calculate slides 76-78

72
Q

Prostate cancer prevention

A 
Antioxidants
- lycopene
Cruciferous veggies
- broccoli
Vitamin D
Omega 3 fa

So eat veggies and fruit if you want your dick to work in the old folks home

L BMI
Dont smoke
High fiber/low fat diet
Green tea
L ETOH
73
Q

Prostate ca screening?

A

Begin at age 50 for:
- average risk whites

Begin at 45 for:

  • blacks
  • fam hx
  • BRACA 1

Stop screening when life expectance is <10 yrs

74
Q

PSA and age/?

A

PSA gradually increases w age

75
Q

Slides i skipped

A

82-86 its more screening bs

76
Q

Prostate cancer screening tests?

A

PSA velocity

  • serial PSA
  • PSA change >0.75ng/mL per yr is cancer

PSA density (free PSA/total PSA)

  • free PSA >25% - ca unlikely
  • Free PSA<10% - 50% chance of ca
77
Q

I bought some shoes from a drug dealer, i’m not sure what he laced them with but…

A

I’ve been tripping all day

Senior - Urology (7 decks)

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