4 - Prostate Flashcards
When performing the rectal prostate exam you should rotate your finger _______.
clockwise
Normal prostate should feel _______ and _______.
rubbery and nontender
These 2 factors are essential for the development of BPH.
- age
- functional Leydig cells
Prostate biopsy is prompted by these 2 findings:
- asymmetric or nodular gland on DRE
- increased PSA level
What are the 3 behavioral interventions that can be done for the treatment of BPH?
- avoid fluids prior to bedtime
- reducing consumption of diuretics
- double voiding to empty the bladder more completely
What is the most prescribed medicine for BPH?
Alpha-1 antagonist (Tamsulosin)
Side effects of alpha-1 antagonists (e.g. Tamsulosin) include these 3 things.
- hypotension
- dizziness
- ejaculatory dysfunction
How do the 5-alpha-reductase inhibitors (e.g. Finasteride) work?
they reduce the size of the prostate gland by decreasing the effects of androgens on the prostate
For 5-alpha-reductase inhibitors (e.g. Finasteride) to work how long is treatment needed?
6-12 months
This medication can be used as monotherapy for irritative symptoms (e.g. frequency, urgency, incontinence)
anticholinergic agents (e.g. oxybutynin)
This medication can be used to treat erectile dysfunction.
phosphodiesterase-5 inhibitors (Tadalafil)
In men with large prostates with very severe symptoms what is the combination therapy indicated?
- alpha 1 antagonist (Tamsulosin)
- 5-alpha-reductase inhibitor (Finasteride)
When is a surgical referral indicated?
failed medical treatment for 12-24 months
What are the 4 complications of prostate surgery?
- Bleeding
- sexual dysfunction
- urethral stricture
- urinary incontinence
This type of prostatitis is defined as a persistent bacterial infection of the prostate lasting > 3 months.
chronic bacterial prostatitis
This is defined as urologic pain in the pelvic region associated with urinary symptom or sexual dysfunction.
chronic pelvic pain syndrome
What % of patients with chronic prostatitis develop chronic pelvic pain syndrome?
10%
A patient presents with dysuria, urinary frequency and low back pain. On physical exam you notice a tender and swollen prostate gland. What is the diagnosis?
acute bacterial prostatitis
A patient presents with frequency, urgency, and dysuria. He also notes low back pain. The prostate exam is unremarkable. What type of prostatitis do you suspect he has?
chronic prostatitis
what are the 2 most common complications of prostatitis?
- acute urinary retention
- prostatic abscess
What is the first line agent for acute prostatitis?
FQs for 4-6 weeks
What combination therapy is indicated for men with low PVR urine volume and irritative symptoms?
- alpha 1 antagonist (Tamsulosin)
- anticholinergic (Oxybutynin)
