Chapter 21: Prostate Flashcards
Hematoceles of the the tunica vaginalis are uncommon but may be seen in what 2 conditions?
- Following testicular torsions
- Pts w/ systemic bleeding disorders
Accumulation of lymph in the tunica vaginalis that is almost always found in pts w/ elephantitis
Chylocele
Varioceles (aka dilated vein in speramtic cord) is often times asymptomatic but have been implicated as contributing factor to what?
Infertility
In which anatomic zone of the prostate do most hyperplasias arise?
Where do most carcinomas arise?
- Hyperplasias in the transitional zone (TZ)
- Carcinomas in the peripheral zone (PZ)
4 most common organisms implicated in acute bacterial prostatits?
1) E. coli
2) Gram (-) rods
3) Enterococcus spp.
4) Staphylococci
How does acute bacterial prostatitis present clinically (sx’s)?
Diagnosed how?
- Fever + chills + dysuria
- Dx: urine culure
Chronic bacterial prostatitis may present with what sx’s?
Pts often have a hx of what?
- Low back pain + Dysuria + Suprapubic/perineal discomfort
- May also be asymptomatic
- Often have a hx of recurrent UTI’s (cystitis, urethritis)
Diagnosis of chronic bacterial prostatitis is made how?
- (+) leukocytosis in prostatic secretions
- (+) bacterial cultures
What is the most common type of prostatitis?
Chronic abacterial prostatitis
How does chronic abacterial prostatitis differ from chronic bacterial prostatitis based off of history and cultures?
- No hx of recurrent UTI’s
- (+) leukocytosis of prostatic secretions w/ negative bacterial cultures
What is the most common cause of Granulomatous Prostatitis seen in the US?
Fungal granulomatous prostatitis seen in whom?
- Instillation of BCG for tx of superficial bladder cancer = attenuated mycobacterial strain
- Fungal causes is typically only seen in immunocompromised pts
Which method of diagnosis for men w/ sx’s of acute or chronic bacterial prostatitis is contraindicated as it may lead to sepsis?
Biopsy
Is nodular hyperplasia of the prostate considered a pre-malignant lesion?
No
What % of individuals w/ microscopic evidence of BPH have clinically detectable enlargement of the prostate?
50%
What is the believed to be the ultimate cause of BPH and which cells are proliferating and which cells have impaired cell death?
- DHT-induced GF’s act by increasing proliferation of stromal cells
- Act by decreasing the death of epithelial cells, which causes increased accumulation of sensecent cells
Which cells of the prostate are responsible for the production of DHT from T; thus responsible for the androgen-dependent prostatic growth?
Via what enzyme?
- Stromal cells
- Type 2 5α-reductase
Is there increased epithelial cell proliferation in BPH?
No clear evidence of increased epithelial cell proliferation
Binding of DHT to AR’s in stromal and epithelial cells leads to an increase in which 2 important GF’s?
1) TGF-β
2) FGF
Nodular hyperplasia of the prostate originates almost exclusively where?
Inner periurethral (transition zone)
In some cases of BPH, nodular enlargement may project up into the floor of the urethra as a hemispheric mass directly beneath mucosa of urethra, which is termed?
Median lobe hypertrophy
What is the major clinical problem in those with BPH?
Urinary obstruction
The inability to empty the bladder in BPH causes an increased risk for?
Infections
Can diagnosis of BPH be made with a needle biopsy?
No, biopsies are too small and do not usually sample the TZ
What has been the gold standard invasive procedure for moderate to severe cases of BPH that are not responding to other therapies or in circumstances of recurrent urinary retention?
Transurethral Resection of the Prostate (TURP)
