9.3 Disorders Of The Prostate Flashcards
What is prostatitis?
Inflammation of the prostate
What are the 3 different types of prostatitis?
Acute
Chronic
Chronic non-bacterial
What are the 2 most common disorders of the prostate?
Prostatitis
Benign prostatic hypertrophy
How do we investigate the prostate gland?
Digital rectal examination (DRE)
What is acute prostatitis?
Infection of the prostate gland causing it to become large and inflamed. Inflammation can be focal or diffuse across the prostate
What are general symptoms of acute prostatitis?
- General symptoms: malaise, rigors and fever
* Local symptoms: difficulty in passing urine, dysuria and perineal tenderness, urinary retention / hydronephrosis
What pathogens commonly cause acute prostatitis?
E. coli, Proteus
and Staphylococcus species, and sexually transmitted pathogens
including C. trachomatis and Neisseria
gonorrhoeae.
How does an acute prostatitis appear on a DRE?
Rectal examination revels a soft, tender and enlarged prostate
What commonly causes an acute prostatitis?
UTI
Catheterisation
What is chronic prostatitis?
Inadequately treated acute prostatitis. Recurrent infections of prostate and urinary tract by the same causative agents. Antibodies cannot penetrate the prostate effectively.
How do we diagnose acute prostatitis?
Urine analysis for possible pathogens
Finding of a soft tender and enlarged prostate by a DRE
How do we diagnose chronic prostatitis?
Histological examination showing neutrophils, plasma cells and lymphocytes
Positive culture from a sample of prostatic secretion
What is chronic non-bacterial prostatitis?
Usually caused by chlamydia trachomatis, s typically affects sexually active men. No history of recurrent UTIs.
Histological examination shows fibrosis and chronic inflammation
What is the most common cause of prostatitis?
Chronic non-bacterial prostatitis
How do we diagnose chronic non-bacterial prostatitis?
Analysis of WCC on histological slide
What is benign prostatic hypertrophy?
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.
What is the cause of BPH?
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.
What are the consequences of BPH
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
How do men with BPH present?
Changes to urine stream/ obstructive lower urinary symptoms:
• Difficulty or hesitancy in starting to urinate
• A poor stream
• Dribbling postmicturition
• Frequency and nocturia
How does a prostate with BPH feel on DRE?
Firm smooth and rubbery
How is BPH medically treated?
Enlarge the ureter/remove occlusion
- 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
How is BPH surgically treated?
Transurethral resection of the prostate (TURP)
- physically enlarge the size of the prostate.