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Clin Med III - GU/Renal > Diseases of the Prostate > Flashcards

Diseases of the Prostate Flashcards

1
Q

Describe Overactive Bladder Syndrome (OAB)

A
  • Not holding what it should

- Results in urinary urgency w/ or w/o incontinence, frequency, nocturia

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2
Q

Describe BPH

A

Asymptomatic microscopic detection of prostatic hyperplasia

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3
Q

Describe storage vs. voiding in LUTS

A

Storage: bladder issue
Voiding: prostate issue

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4
Q

1st line treatment of OAB

A

Behavioral and education (bladder training, biofeedback, pelvic floor muscle therapy)

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5
Q

2nd line treatment of OAB

A

Anticholinergic/antimuscarinics

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6
Q

3rd line treatment of OAB

A

Surgery

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7
Q

MC benign tumor in men?

A

BPH

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8
Q

What is the major hormone responsible for proliferation a/w BPH?

A

Dihydrotestosterone (DHT)

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9
Q

What is the single most important tool used in evaluation of patients for BPH?

A

American Urological Association Symptoms Index (higher score is more severe symptoms)

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10
Q

Treatment of BPH

A
  • Based on severity
  • Watchful waiting
  • Meds (alpha blockers, 5a reductase inhibitors)
  • Surgery
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11
Q

Pharm treatment of BPH

A
  • 1st line: alpha blockers and 5a-reductase inhibitors

- 2nd line: PDE-5 inhibitors

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12
Q

How do alpha blockers work in BPH?

A

Relax smooth muscle in bladder neck and prostate gland (reducing obstruction and increasing urinary flow rates)

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13
Q

How do 5a-reductase inhibitors work in BPH?

A
  • Blocks conversion of testosterone to DHT

- Decreases prostate size, increasing flow rate

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14
Q

How do PDE-5 inhibitors work in BPH?

A

Enhances smooth muscle relaxation in prostate, bladder, urethra

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15
Q

Etiology of acute bacterial prostatitis

A

Gram negative rods (E coli, Pseudomonas)

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16
Q

Pathophys of acute bacterial prostatitis

A
  • Ascent of bacteria up the urethra

- Reflux of infected urine into prostatic ducts

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17
Q

Presentation of nonbacterial prostatitis

A

Identical to chronic bacterial prostatitis EXCEPT NO hx of urinary tract infections

18
Q

Etiology of nonbacterial prostatitis

A

Unknown - diagnosis of exclusion

19
Q

Mechanisms of ED

A
  1. Failure to initiate
  2. Failure to fill
  3. Failure to store adequate blood volume w/in lacunar network
20
Q

Weak flow of urine suggests?

A

Prostate problem

21
Q

Voiding small amounts of urine or more frequently suggests?

A

Bladder problem

22
Q

Pharm agents used to treat OAB

A
  • Oxybutinin
  • Fesoterodine
  • Tolterodine
  • Solifenacin
23
Q

When is watchful waiting best for BPH?

A

Patients with mild disease (AUA Symptoms Index score 0-7)

24
Q

What is the place of combo therapy in BPH?

A

alpha blocker + 5a reductase inhibitors have been shown to reduce risk of progression

25
Q

What is the conventional surgical therapy of BPH?

A
  • Transurethral resection of prostate (TURP)
  • Transurethral incision of prostate (TUIP)
  • Open simple prostatectomy
26
Q

What are minimally invasive surgeries to treat BPH?

A
  • Laser therapy (ablation)
  • Transurethral needle ablation (TUNA)
  • Electrovaporization
  • Hyperthermia
27
Q

What does CBC show for acute bacterial prostatitis?

A

Leukocytosis with a left shift

28
Q

What does urinalysis show for acute bacterial prostatitis?

A

Pyuria, bacteriuria and +/- hematuria

29
Q

How is uncomplicated acute bacterial prostatitis defined?

A
  • Under 35 and risk of STD

- Over 35 and low risk of STD

30
Q

Treatment of acute bacterial prostatitis under 35 yo at risk for STD?

A
  • Treat as an STD
  • Cover for both chlamydia, gonorrhea
  • Ceftriaxone plus Doxy OR Azithro
31
Q

Treatment of acute bacterial prostatitis over 35 yo low risk for STD?

A

Fluoroquinolone OR Bactrim (some recommend up to 4 wks tx)

32
Q

Treatment of hospitalized acute bacterial prostatitis?

A
  • Parenteral abx (ampicillin and aminoglycosides) until culture results are back
  • Once afebrile for 48 hours, oral abx (quinolones) 4-6 wks
33
Q

What is diagnostic for chronic bacterial prostatitis?

A

Positive culture of prostate secretions or the post prostatic massage urine specimen

34
Q

Treatment of chronic bacterial prostatitis

A

Abx 6-12 weeks

  • Bactrim
  • Cipro
  • Ofloxacin
35
Q

Prognosis of chronic bacterial prostatitis

A
  • Difficult to cure

- Typically results in recurrent UTIs

36
Q

Treatment of nonbacterial prostatitis

A

NSAIDs or Sitz baths for symptomatic relief

37
Q

Incidence of ED is higher in which men?

A

Those with certain illnesses (DM, obesity, BPH, HTN, etc)

38
Q

MC cause of ED

A

Vasculogenic - decreased blood flow to and from penis (e.g. athero)

39
Q

Treatment of ED

A
  • Lifestyle: wt loss, exercise, smoking cessation, decrease ETOH
  • Oral PDE-5 inhibitors
  • Injection therapies
  • Testosterone therapy
  • Penile devices
  • Psych/sex therapy
  • Surgery (prosthesis)
40
Q

Describe a vacuum constriction device

A

Draws venous blood into penis and uses a constriction ring to restrict venous blood return and maintain erection

Clin Med III - GU/Renal (9 decks)

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