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clin med GU > Dz of prostate > Flashcards

Dz of prostate Flashcards

1
Q

what is LUTs

A

lower urinary tract symptoms
effects 15-50% of men >40yo
pt impact increased risk of falls, decreased QOL, depression and Impaired ADL

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2
Q

causes of LUTS

A

dysfuntion of bladder, prostate
neurologic dz
medical condition
medications

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3
Q

normal bladder function

A

stores 300-500ml of urine

empties to completion after urge

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4
Q

abnormal function (failure to store)

A

voiding small amounts frequently
uncontrollable urge
incomplete emptying

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5
Q

function of prostate gland

A

Secretes prostatic fluid that is a thin, milky substance w/ an alkaline pH

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6
Q

overactive bladder syndrome

A

syndrome including urinary urgency w or w/o incontinence and urinary freq and noctura

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7
Q

BPH

A

asymptomatic microscopic detection of prostatic hyperplasia, the benign proliferation of the prostate stoma and epithelium

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8
Q

LUTS storage issues

A 
urgency
frequency
noctuira
urge incontinence
stress incontinence
overflow incontinence
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9
Q

LUTs voiding

A 
hesitancy
poor flow/weak stream
intermittency
straining to void
terminal dribbling
prolonged urination
urinary retention
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10
Q

how to determine cause of symptoms

A

weak flow think prostate
voiding small amounts think bladder
good flow, norm volume thing other medical conditions

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11
Q

take home message about OAB and BPH

A

40-50% of men have coexisting symptoms

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12
Q

OAB tx

A

anticholinergics, antimuscarinic
bladder training, biofeedback, pelvic floor muscle therapy, electrical stimulation
surgical if necessary

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13
Q

OAB tx guidelines by AUA/SUFU

A

1st line: behavioral therapy and +/- pharmacologic therapy
2nd line: anticholingergics antimuscarinics
3rd line: surgery

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14
Q

OAB pharmacologic agents

A

Solifenacin
Oxybutinin
Fesoterodine
Tolterodine

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15
Q

BPH

A

MC benign tumor in men
genetic componenet
incidence increased w/age reaching 90% by 70’s

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16
Q

BPH patho

A

characterized by proliferation of prostate dihydrotestosterone (DHT) is the major hormone responsible for DHT

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17
Q

BPH s/s

A

obstructive/ irritative symptoms
chronic obstruction predisposes to recurrent UTI
Acute urinary bladder obstruction

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18
Q

BPH PE

A

complete GU/GI
prostate exam: comment on the size and consistency of gland thought this does not correlate to severity of symptoms
neuro exam

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19
Q

BPH labs

A

U/A exclude infection and hematuria: normal
PSA- used when screening for prostate CA in combo with DRE
use is controversial

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20
Q

BPH imaging

A

CT or Renal U/S only if there is presence of other urinary tract dz or complications of UTI
Cystoscopy only if considering surgery to help determine what approach to use

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21
Q

BPH tx

A

based on severity of dz
watchful waiting reserved for pts with mild dz and UAS score 0-7
medical therapy
surgery

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22
Q

BPH medical therapy

A

alpha blockers
a-1 blockers
a-2 blockers
5α-reductase inhibitors

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23
Q

alpha blockers MOA

A

relax smooth muscle in the bladder neck and prostate gland reducing bladder outlet obstruction and increasing peak urinary flow rates

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24
Q

alpha 1 blockers

A

requires dose titration
S/E: orthostatic hypoHTN, dizziness, fatigue, ejaculation, rhinitis
Ex: terazosin, Doxazosin, Prazosin

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25
Q

alpha 1a blockers

A

receptors are localized to prostate and bladder neck therefore fewer side effects
Ex: Tamsulosin, Silodosin

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26
Q

5α-reductase inhibitors MOA

A

MOA blocks the conversion of testosterone to dihydrotestosterone
decreases prostate size
reduces baseline PSa 50%

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27
Q

5α-reductase inhibitors

A

Finasteride

Dutasteride

28
Q

PDE-5 inhibitor MOA

A

enhances smooth muscle relaxation in prostate, bladder and urethra
Not used 1st line
Used to tx s/s of BPH in men w/ urinary symptoms and ED

29
Q

PDE-5 inhibitor drugs

A

Tadalafil, Sildanefil, Vardenafil

30
Q

BPH combo therapy

A

α-blocker + 5α-reductase inhibitors have been shown to reduce the risk of progression of dz and reduce the long term risk of acute urinary retention and need for invasive surgery

31
Q

BPH tx for small prostate and low PSA and IPSS <7

A

watchful waiting

32
Q

BPH tx for prostate large, PSA high and IPSS <7

A

5 alpha reductase

33
Q

BPH tx for moderate or severe symptoms with small prostate and low PSA level, IPSS>7

A

alpha blocker

34
Q

BPH tx for moderate to severe symptoms with large prostate and high PSA, IPSS>7

A

5 alpha reductase

or in combo with alpha blocker

35
Q

BPH surgery

A

TURP
transurethral resection of the prostate
endoscopic prostatectomy

36
Q

TUIP

A

used in men w/mod to severe symptoms and small prostate w/ posterior commissure hyperplasia or elevated bladder neck

37
Q

Open simple prostate

A

performed when prostate is too large to remove endoscopically

38
Q

acute bacterial prostatitis

A

caused by E.coli and pseudomonas where bacteria ascents up the urethra and reflux of infected urine into prostate ducts

39
Q

acute bacterial prostatitis symptoms

A

perineal, sacral, surapubic pain
fever
irritative voiding complaints

40
Q

acute bacterial prostatitis PE

A

fever

warm and tender prostate feels boggy

41
Q

acute bacterial prostatitis labs

A

CBC will show leukocytosis w/ left shift
U/A pyuria, bacteriuria and hematuria
GC/Chl probe if risk for STD
Urine culture will be positive

42
Q

acute bacterial prostatitis umcomplicatied age<35 risk of STD tx

A

treat as an STD

Ceft 250mg IM or Cefixime plus doxy

43
Q

acute bacterial prostatitis umcomplicatied age>35 low risk of STD tx

A

Fluoroquinolone (cipro, levo or bactrim)

44
Q

acute bacterial prostatitis hospitalization

A 
paranteral antibiotics (ampicilling and aminoglycosides) till sensitivity 
Urethral catheterization or instrumentation CI
45
Q

chronic bacterial prostatitis

A

may evolve from acute bacterial prostatitis

46
Q

chronic bacterial prostatitis symptoms and PE

A 
symptoms:
irritative voiding
low back pain
perineal and suprapubic discomfort 
dysuria
many pts report hx of recurrent UTI
PE: unremarkable and afebrile
prostate may feel normal or boggy
47
Q

chronic bacterial prostatitis labs

A

U/A normal
Expressed prostate reveals leukocytes
Positive culture of prostate secretions or post prostatic message

48
Q

chronic bacterial prostatitis tx

A

bactrim
Ciprofloxacin
Olfloxacin
NSAID and sitz bath

49
Q

nonbacterial prostatitis

A

dx of exclusion

MC of all the prostatitis’s

50
Q

nonbacterial prostatitis presentation

A

mimics chronic bacterial prostatitis except no hx of UTI

51
Q

nonbacterial prostatitis labs

A

all cultures are negative

Leukocytes expressed in prostatic secretions shows inflammation

52
Q

nonbacterial prostatitis tx

A

NSAID or Sitz bath for symptomatic relief

diet restrictions if certain food make symptoms worse

53
Q

prostatodynia

A

noninflammatory d/o that affects young and middle aged men

54
Q

prostatodynia etiology

A

voiding dysfunction

pelvic floor musculature dysfunction

55
Q

prostatodynia symptoms and PE

A

symptoms: irritative voiding, no UTI Hx
hesitancy, interruption of flow and may describe lifelong hx of voiding trouble
PE: prostate normal
increased sphincter tone

56
Q

prostatodynia labs

A

U/A normal
prostatic secretion normal num of leukocytes
Urodynamic testing may show voiding and pelvic floor dysfunction

57
Q

prostatodynia tx

A 
sitz bath
biofeedback to help with muscle dysfunction
alpha blocking agents 
terazosin
doxazosin
58
Q

ED

A

inability to attain or maintain erection for sex

59
Q

ED is higher is these populations

A

DM, Obesity, BPH, HTN, Low HDL, cardiovascular dz

60
Q

ED RF

A 
smoking
spinal cord injury
Hx of radiation or surgery of prostate
meds
psychosocial
61
Q

Ed patho

A

failure to initiate
failure to fill
failure to store adequate blood volume in lacunar network

62
Q

MC type of ED

A

Vasculogenic-distrubance of blood flow to and from penis

Other is Neurogenic from d/o that affect the spine

63
Q

ED med induced

A

thiazides, B-blockers, CCB, digoxin, SSRI, TCA

64
Q

ED Tx

A 
Lifestyle changes: weight loss, exercise, smoking cessation, deccrease alcohol, refrain from recreation drugs
PDE-5 inhibitors
Testosterone therapy
Penile devices
Psychological therapy
surgery
65
Q

ED PDE-5 inhibitors

A

treats psychogenic, diabetic, vaculogenic
onset 60-120 min
CI w/ men using nitrates, CHF or cardiomyopathies

66
Q

other ED tx

A

testosterone for hypogonadism
Vacuum constrictive devices
Intraurethral alprostadil
Infracavernosal injectiong

clin med GU (6 decks)

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