4 - Prostate

Question 1

When performing the rectal prostate exam you should rotate your finger _______.

Answer 1

clockwise

Question 2

Normal prostate should feel _______ and _______.

Answer 2

rubbery and nontender

Question 3

These 2 factors are essential for the development of BPH.

Answer 3

• age

- functional Leydig cells

Question 4

Prostate biopsy is prompted by these 2 findings:

Answer 4

• asymmetric or nodular gland on DRE

- increased PSA level

Question 5

What are the 3 behavioral interventions that can be done for the treatment of BPH?

Answer 5

• avoid fluids prior to bedtime
• reducing consumption of diuretics
• double voiding to empty the bladder more completely

Question 6

What is the most prescribed medicine for BPH?

Answer 6

Alpha-1 antagonist (Tamsulosin)

Question 7

Side effects of alpha-1 antagonists (e.g. Tamsulosin) include these 3 things.

Answer 7

• hypotension
• dizziness
• ejaculatory dysfunction

Question 8

How do the 5-alpha-reductase inhibitors (e.g. Finasteride) work?

Answer 8

they reduce the size of the prostate gland by decreasing the effects of androgens on the prostate

Question 9

For 5-alpha-reductase inhibitors (e.g. Finasteride) to work how long is treatment needed?

Answer 9

6-12 months

Question 10

This medication can be used as monotherapy for irritative symptoms (e.g. frequency, urgency, incontinence)

Answer 10

anticholinergic agents (e.g. oxybutynin)

Question 11

This medication can be used to treat erectile dysfunction.

Answer 11

phosphodiesterase-5 inhibitors (Tadalafil)

Question 12

In men with large prostates with very severe symptoms what is the combination therapy indicated?

Answer 12

• alpha 1 antagonist (Tamsulosin)

- 5-alpha-reductase inhibitor (Finasteride)

Question 13

When is a surgical referral indicated?

Answer 13

failed medical treatment for 12-24 months

Question 14

What are the 4 complications of prostate surgery?

Answer 14

• Bleeding
• sexual dysfunction
• urethral stricture
• urinary incontinence

Question 15

This type of prostatitis is defined as a persistent bacterial infection of the prostate lasting > 3 months.

Answer 15

chronic bacterial prostatitis

Question 16

This is defined as urologic pain in the pelvic region associated with urinary symptom or sexual dysfunction.

Answer 16

chronic pelvic pain syndrome

Question 17

What % of patients with chronic prostatitis develop chronic pelvic pain syndrome?

Answer 17

10%

Question 18

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?

Answer 18

acute bacterial prostatitis

Question 19

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?

Answer 19

chronic prostatitis

Question 20

what are the 2 most common complications of prostatitis?

Answer 20

• acute urinary retention

- prostatic abscess

Question 21

What is the first line agent for acute prostatitis?

Answer 21

FQs for 4-6 weeks

Question 22

What combination therapy is indicated for men with low PVR urine volume and irritative symptoms?

Answer 22

• alpha 1 antagonist (Tamsulosin)

- anticholinergic (Oxybutynin)