Benign Prostate Disease

Question 1

where do most prostate cancers arise

Answer 1

peripheral zone - acinar tissue, posterior surface

Question 2

where does BPH occur

Answer 2

transition zone - surrounds urethra

Question 3

what is BPH

Answer 3

benign prostatic hyperplasia
proliferation of epithelial and smooth muscle cells within the transition zone of prostate.

Question 4

what is a nonmalignant adenomatous overgrowth of periurethral prostate gland

Answer 4

BPH

Question 5

what are the symptoms of BPH

Answer 5

bladder outlet obstruction: weak stream, hesitancy, urinary frequenzy, urgency, urge or overflow incontinence

Question 6

how is BPH diagnosed

Answer 6

DRE and symptoms
cytoscopy
transrectal US
urodynamics or other imaging

Question 7

what are the tx options of BPH

Answer 7

5-alpha-reductase inhibitors
alpha blockers
tadalafil
surgery

Question 8

what are lower urinary tract symptoms (LUTS)

Answer 8

often progressive:
urinary frequency
urgency
nocturia
hesitancy
intermittency

Question 9

what can straining to void cause with BPH

Answer 9

congestion of superficial veins of prostatic urethra and trigone, which may rupture and cause hematuria
Acutely: vasovagal syncope
Chronically: dilation of hemorrhoidal veins or inguinal hernias

Question 10

what causes urinary retention

Answer 10

prolonged attempts to postpone voiding
immobilization
exposure to cold
use of anesthetics, anticholinergics, sympathomimetics, opioids or alcohol

Question 11

what are behavioral modifications for the tx of BPH

Answer 11

decreased fluid intake
decreased caffeine intake
void in seated position
double voiding
examine/modify med list if possible - long list of meds can cause urinary retention
voiding diary (include ins and outs)

Question 12

what is the first line medical management of BPH treatment

Answer 12

alpha blockers.

Question 13

how do alpha blockers work

Answer 13

relax the smooth muscle in the prostate to facilitate urine flow through the prostatic portion of the urethra

Question 14

what are the main side effects of alpha blockers

Answer 14

dizziness, fatigue

Question 15

what are the common alpha blockers

Answer 15

terazosin, doxazosin, *tamsulosin, alfuzosin, silodosin

Question 16

what is the MOA of 5ARI drugs

Answer 16

decreased production of DHT (Dihydrotestosterone) which causes growth of acinar cells. usually used in combo with alpha blockers

Question 17

what is the use of 5ARI

Answer 17

reduce risk of urinary retenetion and need for future prostate surgery

Question 18

what are the 5ARI meds

Answer 18

finasteride, dutasteride

Question 19

what are the sexual side effects of 5ARI meds

Answer 19

reduction in ejaculatory volume, decrease in libido

Question 20

what type of drug is tadalafil (Cialis)

Answer 20

PDE5i (phosphodiesterase - 5 inhibitors)

Question 21

what is the standard surgical treatment of BPH

Answer 21

transurethral resection of prostate (TURP)

Question 22

what is the most common cause of urethritis

Answer 22

n.gonorrheae and c trachomatis

Question 23

what is the presentation of urethritis

Answer 23

urethral discharge (purulent or mucopurulent), dysuria, pain at meatus

Question 24

what labs are done with urethritis

Answer 24

urethral swab (or urine testing)

Question 25

what are the male complications of urethritis

Answer 25

epididymitis, disseminated gonococcal infection, Reiter’s syndrome (cant see, cant pee, cant climb a tree..)

Question 26

what are the female complications of urethritis

Answer 26

PID, ectopic pregnancy, infertility

Question 27

what is the tx of urethritis

Answer 27

ceftriaxone (tx of chlamydia)
azithro + doxy

Question 28

what is the clinical presentation of prostatitis

Answer 28

vary by category but typically involve some degree or urinary or obstruction and pain
irritation: frequency and urgency, obstruction, etc
pain typically in perineum but may be at tip of penis in lower back or testes

Question 29

what is the presentation of acute bacterial prostatitis

Answer 29

flu-like symptoms PLUS urinary symptoms, possible fever
NO DRE - risk of sepsis

Question 30

what labs are done with acute bacterial prostatitis

Answer 30

U/A (WBC, hematuria)
CBC (WBC - possible left shift)
PSA - expect to be extremely elevated - not a good time to check this
Urine C&S may be negative

Question 31

what is the treatment of acute bacterial prostatitis

Answer 31

abx, bed rest, analgesics, stool softeners, hydration (FLuoroquinolones) 30 days!

Question 32

what is the tx of chronic bacterial prostatitis

Answer 32

PO abx (fluoroquinolones)
NSAIDs, muscle relaxants, alpha blockers, sitz bath