Disorders of the prostate

Question 1

Which pathogens cause acute prostatitis?

Answer 1

• E.coli
• Proteus species
• Staphylococcus species
• C. trachomatis
• Neisseria gonorrhoeae

Question 2

How do patients with acute prostatitis present?

Answer 2

• General symptoms: malaise, rigors and fever
• Local symptoms: difficulty in passing urine, dysuria, and perineal tenderness

Question 3

How does a patient with acute prostatitis present on DRE?

Answer 3

• Rectal examination reveals a soft, tender and enlarged prostate
• Inflammation can be focal or diffuse

Question 4

What causes chronic prostatitis?

Answer 4

• Inadequately treated infection
• Can occur because some antibodies cannot penetrate the prostate effectively
• Often will be a history of recurrent prostatic and urinary tract infections
• Causative pathogens are same for acute prostatitis

Question 5

How is chronic prostatitis diagnosed?

Answer 5

• Difficult to diagnose and treat
• Histological examination showing neutrophils, plasma cells and lymphocytes
• A positive culture from a sample of prostatic secretion

Question 6

What is the most common type of prostatitis?

Answer 6

• Chronic non-bacterial prostatitis

Question 7

Outline chronic non-bacterial prostatitis?

Answer 7

• Often no history of recurrent UTIs
• Usual pathogen is C. trachomatis
• Typically affects sexually active men
• Histological examination shows fibrosis as a result of chronic inflammation

Question 8

Who is affected by benign prostatic hypertrophy?

Answer 8

• Detectable in nearly all men over the age of 60
• High level of 5 alpha reductase - converts testosterone to dihydrotestosterone (more powerful than testosterone)

Question 9

What is BPH?

Answer 9

• Non-neoplastic enlargement of prostate gland, can eventually lead to bladder outflow obstruction
• Cause is unknown but may be related to levels of male sex hormones (testosterone)

Question 10

What are the symptoms of BPH?

Answer 10

• Develop as the enlarging prostate gland compresses on prostatic urethra
• Difficulty or hesitancy in starting to urinate
• A poor stream
• Dribbling post micturition
• Frequency and nocturia

Question 11

How does the prostate feel on DRE in BPH?

Answer 11

• Smooth, firm and rubbery

Question 12

How can untreated BPH present?

Answer 12

• Acute urinary retention accompanied by a distended and tender bladder and a desperate urge to pass urine
• Alternatively patient may have progressive bladder distension
• Leads to chronic painless retention and overflow incontinence
• Can lead to bilateral upper tract obstruction and renal impairment
• Pt presents with CKD

Question 13

What is the medical treatment of BPH?

Answer 13

• Alpha blockers - relax smooth muscle at bladder neck and within prostate
• Finasteride (5a-reductase inhibitor) prevents testosterone being converted to dihydrotestosterone (more potent)