9.3 Disorders Of The Prostate

Question 1

What is prostatitis?

Answer 1

Inflammation of the prostate

Question 2

What are the 3 different types of prostatitis?

Answer 2

Acute
Chronic
Chronic non-bacterial

Question 3

What are the 2 most common disorders of the prostate?

Answer 3

Prostatitis

Benign prostatic hypertrophy

Question 4

How do we investigate the prostate gland?

Answer 4

Digital rectal examination (DRE)

Question 5

What is acute prostatitis?

Answer 5

Infection of the prostate gland causing it to become large and inflamed. Inflammation can be focal or diffuse across the prostate

Question 6

What are general symptoms of acute prostatitis?

Answer 6

• General symptoms: malaise, rigors and fever

* Local symptoms: difficulty in passing urine, dysuria and perineal tenderness, urinary retention / hydronephrosis

Question 7

What pathogens commonly cause acute prostatitis?

Answer 7

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

Question 8

How does an acute prostatitis appear on a DRE?

Answer 8

Rectal examination revels a soft, tender and enlarged prostate

Question 9

What commonly causes an acute prostatitis?

Answer 9

UTI

Catheterisation

Question 10

What is chronic prostatitis?

Answer 10

Inadequately treated acute prostatitis. Recurrent infections of prostate and urinary tract by the same causative agents. Antibodies cannot penetrate the prostate effectively.

Question 11

How do we diagnose acute prostatitis?

Answer 11

Urine analysis for possible pathogens

Finding of a soft tender and enlarged prostate by a DRE

Question 12

How do we diagnose chronic prostatitis?

Answer 12

Histological examination showing neutrophils, plasma cells and lymphocytes
Positive culture from a sample of prostatic secretion

Question 13

What is chronic non-bacterial prostatitis?

Answer 13

Usually caused by chlamydia trachomatis, s typically affects sexually active men. No history of recurrent UTIs.
Histological examination shows fibrosis and chronic inflammation

Question 14

What is the most common cause of prostatitis?

Answer 14

Chronic non-bacterial prostatitis

Question 15

How do we diagnose chronic non-bacterial prostatitis?

Answer 15

Analysis of WCC on histological slide

Question 16

What is benign prostatic hypertrophy?

Answer 16

Enlargement of the prostate gland over time. Present in most men over 60. Non-neoplastic enlargement of the prostate gland eventually leads to bladder outflow obstruction.

Question 17

What is the cause of BPH?

Answer 17

Unknown. Related to levels of testosterone.
Levels of Enzyme 5-alpha reductase increases with age. 5-alpha reductase acts to covert testosterone into dihydrotestosterone, a far more powerful androgen.

Question 18

What are the consequences of BPH

Answer 18

Acute Urinary retention (tender distended bladder, pain, desperate urge to pass urine)
Chronic urinary retention (painless, progressive bladder distension, overflow incontinence)

Bilateral upper tract obstruction (Hydronephrosis, Post renal failure, AKI)
CKD

Question 19

How do men with BPH present?

Answer 19

Changes to urine stream/ obstructive lower urinary symptoms:
• Difficulty or hesitancy in starting to urinate
• A poor stream
• Dribbling postmicturition
• Frequency and nocturia

Question 20

How does a prostate with BPH feel on DRE?

Answer 20

Firm smooth and rubbery

Question 21

How is BPH medically treated?

Answer 21

Enlarge the ureter/remove occlusion

1. Alpha-blockers, relax smooth muscle at bladder neck and within prostate
2. Finasteride (5a-reductase inhibitor) presents the conversion of testosterone to the more potent androgen dihydrotestosterone

Question 22

How is BPH surgically treated?

Answer 22

Transurethral resection of the prostate (TURP)

- physically enlarge the size of the prostate.