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Clin Med GI > Prostate Disorder > Flashcards

Prostate Disorder Flashcards

1
Q

Where does the prostate sit and what is it’s job?

A

Liquid portion of semun
Sits at the base of the penis (which is why ED is common with prostatis) inferior to the bladder (which is why UTIs are common)

DRE allows you to feel

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2
Q

Gross vs microscopic hematuria. Also initial, terminal, total

A

Gross = visible to naked eye, more blood (concerning of cancer)

Microscopic = you need a microscope

initial (blood after first voiding)
Terminal (at the end of urinating)
Total (throughout urination)

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3
Q

Irritative voiding symptoms

A

Inflammation in the bladder

Urgency
Dysuria (painful)
Frequency
Nocturia (waking up in the middle of the night)

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4
Q

Obstructive voiding symptoms

A

Hesitancy
Dribbling (still leak after peeing)
Decreased force ((low water pressure in water hose) or caliber of stream (more pinpoint with high pressure)
Interruption of stream (randomly stops)

Means that there is an obstruction

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5
Q

Urinary incontinence

A

Overflow
Urge (involuntary and pee w/out
Stress (laughing, coughing)
Total (no mental switch, just randomly void with no triggers and no control over bladder)

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6
Q

What is acute bacterial prostatitis?

A

ascent up urethra
Can occur in setting of cystitis, urethritis

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7
Q

What are the risk factors for prostatitis?

A

factors predisposing to GU infections
Catheter, prostate biopsy, urethral stricture
Anecdotal risks - no strong evidence to support
Trauma (bike riding, horseback riding)
Dehydration
Sexual abstinence

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8
Q

What is the MC causative agent of acute bacterial prostatitis?

A

G- rods are most common pathogen
E. coli - 58-88%,

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9
Q

What are the s/s of acute bacterial prostatitis?

A

Fever, chills, malaise - common
Pain - perineal, sacral, or suprapubic
Irritative voiding s/s
Occasionally obstructive voiding s/s

DRE - Hot, exquisitely tender prostate
Prostatic massage contraindicated - risk of septicemia!

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10
Q

What are the labs of acute bacterial prostatits?

A

CBC - leukocytosis and left shift
Urinalysis - pyuria, bacteriuria, hematuria
Urine culture - + for causative agent

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11
Q

When do you order imaging for acute bacterial prostatits?

A

If no response to abx in abx

Pelvic CT or transrectal US to assess for prostatic abscess

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12
Q

What is the IV treatment for acute bacterial prostatitis that is not nosocomial?

A

fluoroquinolone +/- aminoglycoside , or ampicillin/gentamicin empirically

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13
Q

What is the IV treatment for acute bacterial prostatitis that is nosocomial?

A

IV carbapenem or IV broad-spectrum PCN/cephalosporin +/- aminoglycoside

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14
Q

What are the two categories used for oral therapy of ABP?

A

Bactrim or fluoroquinolone (cipro)

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15
Q

What is the MC causitive organism of chronic bacterial prostatits?

A

E coli climbing up the urethra

sometimes no hx of acute prostatitis

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16
Q

What are the s/s of prostatitis?

A

Some are asymptomatic
Most - irritative voiding symptoms; may see obstructive voiding s/s
Pain - dull, poorly located, in suprapubic, perineal or low back regions
History of recurrent bacteriuria or UTIs

DRE - often normal (because we only feel a small part of the tissue)
May see boggy (spongy), mild tender, enlarged, and/or indurated prostate

NOT hot, not

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17
Q

What is the texture of a prostate/cervix?

A

Tip of the nose

boggy/spongy feels like a sponge

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18
Q

What are the labs of CBP?

A

UA - normal unless cystitis also present
Prostatic secretions - Increased WBCs (>10 per hpf) with + culture
Lipid-laden macrophages
Urine culture - negative
+ for causative organism after prostatic massage

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19
Q

what is the imaging of CBP?

A

usually not needed
Prostatic calculi may be visible

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20
Q

what is the treatment for CBP?

A

Same as acute

fluroquinolones or bactrim for 6-12 weeks (but prolonged treatment may need to C dif)

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21
Q

Why is CBC normal for chronic prostatitis vs

A

Puss is already in collecting ducts

chronic = walled off puss in microabcesses = not show up in CBC (massage releasese this though)

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22
Q

What is a non-pharm treatment for CBP?

A

sitz bath

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23
Q

What is non-bacterial prostatits?

A

MC cause of prostatitis

similar symptoms to chronic prostatits

often neurologic, but as inflammatory markers

24
Q

what are the s/s of non-bacterial prostatis?

A

Irritative voiding or obstructive voiding
Pain - perineal, lower abdominal, or low back
Often dull and poorly localized as with CBP
May have hx of other pain syndromes (e.g. IBS, fibromyalgia)
Less likely to have hx of UTI than in CBP
DRE - tenderness in 50% of pts

25
Q

What is the UA and prostatic secretion analysis of nonbacterial prostatits?

A

UA - unremarkable
Prostatic Secretions
increased WBC if inflammatory (chronic/nonbacterial prostatitis)
normal if noninflammatory
negative culture
Urine culture - negative
Imaging - mainly to rule out other pathology
e.g., obstruction in pts with obstructive voiding s/s

26
Q

How do you treat nonbacterial prostatits?

A

hard to treat, but actually use antibiotics for 2 weeks (stop if they are not improving)

fluoroquinolones

often treated based on symptoms (pain = NSAIDs)
-alpha blockers -osin
5-𝛼-reductase inhibitors - finasteride, dutasteride
-sitz baths
-acupuncture, cernilton
Pelvic floor physical therapy
Treatment of psych disorders

27
Q

What are the selective alpha blockers?

A

-osin

tamsulosin is MC

28
Q

What is benign prostatic hyperplasia?

A

MC benign tumor in men (increases with age)

-increases glandular and stromal components

over 80% over 80 have it! But often asymptomatic

29
Q

Apart from age, what are risk factors for benign prostatic hyperplasia?

A

Black men - more likely to have severe s/s and to need surgery
Asian men - less likely than black or white men to have BPH

Increased risk - higher free PSA levels, prostatitis, heart disease, beta-blocker use, lack of exercise, obesity
Decreased risk - NSAIDs, excessive ETOH use, smoking, exercise

30
Q

Why does age lead to BPH?

A

Aging prostate seems to become more sensitive to androgens and growth factors
Aging prostate may also stop normal cell death
Testosterone, dihydrotestosterone, and estrogen may be involved in development

31
Q

What are the two ways that BPH leads to obstruction?

A

Mechanical (stopping urine flow)
Muscles are constricted due to excessive stimulation of alpha-receptor

32
Q

How does BPH typically come on?

A

Comes on slowly

33
Q

What are the s/s of obstructive voiding of BPH?

A

Obstructive voiding - mechanical blockage
Urine hesitancy
Decreased force and caliber of stream
Sensation of incomplete bladder emptying
Double voiding (urinating within 2 hours)
Straining to urinate
Postvoid dribbling

34
Q

What are the s/s of irritative voiding in BPH?

A

urgency, frequency, nocturia
Due to secondary response of bladder to increased outlet resistance
Detrusor muscle hypertrophy and hyperplasia, collagen deposition

35
Q

How can you determine how bad the BPH of a patient is?

A

AUA symptom score

based on symptoms - and asks if it effects them

36
Q

What is the DRE for BPH?

A
  • smooth, firm, symmetric, elastic enlargement of prostate
    Induration or asymmetric enlargement β†’ possible cancer
37
Q

What are the s/s of a neuro exam for BPH?

A

normal, but r/o neurogenic bladder

38
Q

What are the s/s of lower abdominal exam for BPH?

A

might have a distended bladder

39
Q

What are the labs for BPH?

A

UA - often normal
May see hematuria
PSA - may help screen for prostate cancer
Can be elevated in BPH even when no cancer is present
Prostate Bx - usually only done if concern for cancer
Transrectal or transperineal

40
Q

When is BPH imaged?

A

often not needed
US - may be indicated if high serum Cr or UTI
Upper GU tract imaging - only if complications arise or comorbid GU disease present

41
Q

When do you do watchful waiting for BPH?

A

mild symptoms (score 0-7) or pts who do not want tx
Not all pts will experience s/s progression!
Up to 50% have spontaneous regression
Limited data on natural course of disease

42
Q

When are you not a candidate for BPH?

A

basically if no major s/s

Refractory urinary retention
Large bladder diverticula
Recurrent UTI or gross hematuria
Bladder stones
CKD

43
Q

What are the 3 types of alpha blockers?

A

πžͺ1a - 70% of adrenoreceptors in prostate, bladder neck
πžͺ1b - smooth muscle of vasculature
πžͺ1d - prostate, bladder neck, detrusor, sacral spinal cord

44
Q

What are the a1-blockade agents?

A

Prazosin
Doxazosin
Terazosin

45
Q

What are the selective a1a

A

silodosin
tamsulosin
alfuzosin

46
Q

What are the SE of a1 blockers?

A

orthostatic hypotension, dizziness, tiredness, retrograde ejaculation, rhinitis, and headache
Floppy Iris Syndrome - cataract surgery complication in pts taking πžͺ1-blockers

47
Q

What are the DDI of a1 blockers?

A

antihypertensives, PDE-5 inhibitors can cause significant drops in BP when taken with alpha blockers

48
Q

What is the MOA of 5-πžͺ-reductase inhibitors?

A

5-πžͺ-reductase - converts testosterone to dihydrotestosterone

Inhibiting this enzyme reduces size of prostate gland
Takes ~6 months of treatment to see full benefit
Reduces prostate size by ~20% - may reduce need for surgery

49
Q

when are 5-πžͺ-reductase inhibitors used?

A

More effective in men with larger prostates
All 5-πžͺ-reductase inhibitors reduce PSA by 50%
Should double PSA value when comparing to pre-treatment PSA
May reduce risk of prostate cancer (reduces testosterone level)

50
Q

What are the two 5-πžͺ-reductase inhibitors?

A

Finasteride
Dutasteride

51
Q

What are the SE of Finasteride and Dutasteride

A

similar to low T

Decreased libido, erectile or ejaculatory dysfunction

52
Q

What is first-line therapy of BPH?

A

alpha blocker + 5-alpha-reductase inhibitor is considered first-line and superior to either treatment alone

53
Q

What is the PDE 5 inhibitor and what is it used for?

A

Tadalafil
Approved for use in men with BPH + ED symptoms
Not superior to alpha-blockers, no extra benefit as adjunct

it’s expensive though :(

54
Q

What surgery is used for BPH?

A

Transurethral Resection of the Prostate (TURP)

leads to retrogade ejaculation sometimes

55
Q
A

Clin Med GI (10 decks)

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