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DipGUM > Chronic prostatitis/pelvic pain syndrome > Flashcards

Chronic prostatitis/pelvic pain syndrome Flashcards

1
Q

What proportion of men are affected by prostatitis at some point in life?

A

35-50%

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2
Q

What are the 4 classifications of prostatitis?

A

I Acute bacterial prostatitis
II chronic bacterial prostatitis
III chronic prostatitis/chronic pelvic pai syndrome
IV asymptomatic inflammatory prostatitis

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3
Q

There are 2 subclasses of chronic prostatitis/CPPS - what are they? Describe them.

A

IIIa inflammtory CPPS - WBC in semen

IIIb non-inflammatory CPPS - NO WBC

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4
Q

Describe the difference between chronic prostatitis/CPPS and chronic bacterial prostatitis

A

No demonstrated infection in CPPS, can be inflammatory though

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5
Q

What areas can be affected by pain in prostatitis?

A 
Perineum
Suprapuic
Testicles
Penis inc tip
Lower abdomen/back
Inguinal region
Rectum
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6
Q

Which site is pain most often reported in prostatitis?

A

PErineum 63%

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7
Q

In what situations may a person experience pain caused by prostatitis?

A

Micturition

Ejaculation

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8
Q

What voiding or storage symptoms may present in prostatitis?

A 
weak stream
straining
hesitancy
urgency
increased urinary frequency
nocturia
dysuria
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9
Q

What other lower urinary tract symptoms may occur in prostatitis (other than void or storage)?

A

urethral burning with or without micturition
Haematospermia
Recurrent UTI

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10
Q

What sexual dysfunction symptoms may be present in prostatitis?

A

erectile OR ejaculatory dysfunction

decreased libido

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11
Q

Describe EARLY stage CBP or CP/CPPS

A

less than 6 months

antibiotic naive

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12
Q

Describe LATE stage CBP or CP/CPPS

A

more than 6 months

refractory to initial pharmacotherapy

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13
Q

What physical examination should take place for prostatitis?

A

Abdominal
Genital exam
DRE

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14
Q

What samples are taken for microscopy and culture to establish if bacterial cause for prostatitis

A

voided bladder 1, 2 and 3 samples

expressed prostatic secretions after massage

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15
Q

In addition to MSSU, which other tests should be performed as part of initial work up for prostatitis?

A

PSA

STI testing

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16
Q

Indications for PSA testing?

A

Abnormal prostate on DRE
symptoms suggestive of bladder outlet obstruction
patient concern about prostate cancer

17
Q

What are the 3 components of the NIH-CPSI questionnaire for assessing prostatitis?

A

Pain
Voiding
Impact on QoL

18
Q

When should alpha-adrenergic antagonists be used for prostatitis?

A

those with voiding symptoms

19
Q

Why should uroselective alpha-adrenergic antagonists be used for prostatitis?

A

less systemic side effects

20
Q

What impact do alpha-adrenergic antagonists have for people with prostatitis?

A

reduce urinary symptoms and pain

improved QoL

21
Q

When should antibiotics be used in prostatitis?

A

Early stage

Bacterial cause found

22
Q

How long should antibiotics be given for in CBP or CP/CPPS?

A

4-6 weeks

Repeat if partial response and bacterial cause identified

23
Q

What antibiotic class should be considered first line for prostatitis?

A

Quinolones - ciprofloxacin

24
Q

When should NSAIDs be used for prostatitis?

A

early stage

inflammatory flares

25
Q

What is the limit on NSAID used for prostatitis?

A

4-6 weeks if no improvement of symptoms

26
Q

What treatments can be considered for prostatitis with neuropathic origin?

A

gabapentinoid
TCA
SSRI
SNRI

27
Q

Are 5-alpha reductase inhibitors useful in prostatitis?

A

Lack of evidence

May be given if benign prostatic enlargement a factor

28
Q

What specific enquiry should take place for patients with refractory symptoms in CBP or CP/CPPS?

A

history of past trauma

- physical, emotional or sexual

29
Q

Who might be part of an MDT for chronic prostatitis?

A 
urologist
pain specialist
nurse specialist
physiotherapist
GPs
psychologist
sexual health specialist
30
Q

What therapies may be offered by physiotherapy?

A

relaxation/coordination/reeducation pelvic floor muscles
myofascial trigger point release
TENS
acupuncture

31
Q

When should surgical intervention be offered for CBP or CP/CPPS?

A

Only if clinical trial

no evidence to support use as current treatment

DipGUM (39 decks)

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