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Urology > Prostate Disorders > Flashcards

Prostate Disorders Flashcards

1
Q

Disorder of the Prostate

A 
Benign prostatic hyperplasia (BPH)
Acute bacterial prostatitis
Chronic bacterial prostatitis
Non-bacterial prostatitis
Prostadynia
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2
Q

Define Benign Prostatic Hyperplasia

A

Most common benign tumor

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3
Q

Risk Factors for BPH

A

Poorly understood
Maybe some genetic predisposition
maybe some racial factors

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4
Q

Pathophysiology of Benign Prostatic Hyperplasia

A

Growth begins in periurethral glandular tissue
Surgical capsule forms around adenomatous hyperplasia
Increased resistance to urine flow
Bladder hypertrophy
Increased risk of infection
Highly vascular & predisposed to bleeding
Painless hematuria

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5
Q

Clinical Presentation of Benign Prostatic Hyperplasia

A 
Hesitancy
Weak stream
Decrease caliber of stream
Incomplete bladder emptying
Straining
Post void dribble
Frequency
Nocturia
Urgency
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6
Q

Diagnosis of BPH

A

Almost entirely on history

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7
Q

Physical Exam of BPH

A

Good physical exam
DRE
Neurological exam
Labs

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8
Q

DRE For BPH

A

Size & consistency should be noted
Consistency: smooth, firm, elastic enlargement
Induration: possibility of cancer

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9
Q

Neurological Exam for BPH

A

Sphincter tone

Reflexes

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10
Q

Labs for BPH

A

UA
Creatinine
PSA (+/-)

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11
Q

Imaging of BPH

A

PVR
Renal ultrasound
TRUS

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12
Q

Indications for Imaging in BPH

A

UTIs
Hematuria
Renal insufficiency
Hx of stones

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13
Q

Goals of BPH Therapy

A

Relieve symptoms

Delay further prostate enlargement

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14
Q

Symptoms to Relieve in BPH

A 
Incomplete bladder emptying
Feelings of urgency to urinate
Weak urinary stream
Having to push or strain to start urinating
Nocturia
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15
Q

Medications for BPH Management

A 
Alpha-1 adrenergic antagonists
5-alpha-reuctase inhibitors
Anticholinergic agents
Phosphodiesterase-5 (PDE5) inhibitors
Herbal
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16
Q

Benefits of Alpha-blockers

A

Primarily for symptomatic relief

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17
Q

Benefits of 5-alpha-reductase Inhibitors

A

Reduces prostate size

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18
Q

Benefits of Anticholinergics

A

Reduces irritative voiding symptoms

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19
Q

Benefits of PDE-5 Inhibitors

A

Symptomatic relief and Erectile Dysfunction

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20
Q

Herbal Therapy

A

Saw palmetto

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21
Q

1st Line Treatment for BPH

A

Limit fluid before bed
Avoid decongestants
Double void
Void frequently

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22
Q

2nd Line Treatment for BPH

A

Alpha blocker

5-alpha-reductase inhibitor

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23
Q

3rd Line Treatment for BPH

A

Combination therapy of alpha blocker & 5-alpha-reductase inhibitor

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24
Q

Surgical Options for BPH

A

TURP
Transurethral Incision of the Prostate (TUIP)
Transurethral laser surgery (PVP)
Simple Prostatectomy

25
Q

Indications for a Prostatectomy

A 
Refractory acute retention
Hydronephrosis
Repeated UTIs due to obstruciton
Recurrent or refractory gross hematuria
Elevated Cr level that responds to a period of bladder decompression with catheter drainage
26
Q

Transurethral Resection of the Prostatectomy (TURP)

A

Most common surgical procedure

Associated with incontinence, erectile dysfunction, & retrograde ejaculation

27
Q

Transurethral Incision of the Prostate (TUIP)

A

Better choice for young men with smaller prostates

Reduces risk for retrograde ejaculation & subsequent infertility

28
Q

Transurethral Laser Surgery (PVP)

A

Less bleeding

29
Q

Simple Prostatectomy

A

Large prostates too big for TURP
Patients with BPH & bladder stones
Longer stay in hospital & higher chance of blood loss

30
Q

Urinary Retention in BPH

A

Progress over time with symptoms

Can be acute & painful

31
Q

Diagnosis of Urinary Retention

A

PVR
Renal ultrasound
Cr level

32
Q

Treatment of Urinary Retention

A

Medication: alpha-blocker/5-alpha-reductase inhibitor
Foley catheterization
Self cath
Suprapubic tube

33
Q

Define Acute Bacterial Prostatitis

A

Swelling & irritation of the prostate gland that develops rapidly

34
Q

Bacteria Culprits of of Acute Bacterial Prostatitis

A 
E. coli
Enterococci
Klebsiella
Protus mirabilis
Pseudomonas
Staph
35
Q

STIs that may Cause Acute Bacterial Prostatitis

A

Chlamydia
Gonorrhea
Trichomonas
Ureaplasma urealyticum

36
Q

Acute Bacterial Prostatitis may Develop from What Issues

A 
Epididymitis
Urethritis
UTIs
Bladder outlet obstruction
Catheterization or cystoscopy
Prostate biopsy
Trauma
Phimosis
Anal intercourse
Transurethral surgeries
37
Q

Acute Bacterial Prostatitis & Age Groups

A

20-35: multiple sex partners, anal intercourse

50+: enlarged prostate, UTIs

38
Q

Symptoms of Acute Bacterial Prostatitis

A 
Sudden onset
Abdominal pain
Pain & burning with urination
Fever, chills, flush
Urinary retention
Low back pain
Pain with BM
Painful ejaculation
Perineal pain
39
Q

Diagnosis of Acute Bacterial Prostatitis

A

Good PE
UA & culture
CBC

40
Q

Treatment of Acute Bacterial Prostatitis

A 
Bactrim or Septra
Ofloxacin or Cipro
Tetracyline
Shot of cefriaxone + doxycycline (7 days)
Hospital stay & IV antibiotics
Stool softeners
41
Q

Most Common Cause of Chronic Bacterial Prostatitis

A

Gram-negative rods

Enterococcus

42
Q

Symptoms of Chronic Prostatitis

A 
Frequency
Dribbling
Loss of stream volume & force
Double voiding
hesitancy
Urgency
\+/- pelvic or perineal pain
Intermittent discomfort in low back and/or testicles
\+/- hematuria, hematospermia, or painful ejaculations
43
Q

Examination for Chronic Prostatitis

A

Enlarged prostate
Variable amount of asymmetry
Bogginess
Tenderness

44
Q

Work-up of Chronic Prostatitis

A

UA: normal
Analysis of expressed prostatic secretions (EPS)
Pre- and post-prostate massage urines
Lab analysis: gram stain, leukocyte count, culture & sensitivity

45
Q

Management of Chronic Bacterial Prostatitis

A

Trimethoprim-Sulfamethoxazole (Bactrim): 2-3 months
Cipro: 4 weeks
Doxycycline
PES or post-prostatic massage should be evaluated

46
Q

Management of Chronic Non-bacterial Prostatitis

A

Doxycycline may be tried

47
Q

What medications can help with manage chronic prostatitis symptoms?

A

Alpha blockers
Anti-inflammatories
Sitz baths

48
Q

Surgical Treatment of Chronic Prostatitis if Antibiotics & Other Measures Fail

49
Q

Nonbacterial Prostatitis Common Etiologies

A 
Chlamydiae
Mycoplasmas
Ureaplasmas
Viruses
Inflammatory
Autoimmune
50
Q

Define Male Chronic Pelvic Pain syndrome

A

Recurrent symptomatic exacerbations of nonbacterial prostatitis

51
Q

Presentation of Nonbacterial Prostatitis

A 
No history of previous infection
Frequency
Dribbling
Loss of stream volume & force
Double voiding
hesitancy
Urgency
\+/- pelvic or perineal pain
Intermittent discomfort in low back and/or testicles
\+/- hematuria, hematospermia, or painful ejaculations
52
Q

Labs for Nonbacterial Prostatitis

A

UA: normal

Expressed prostatic secretions

53
Q

Treatment of Nonbacterial Prostatitis

A

Treat against mycoplasma, chlamyida
Erythromycin: ureplasma
Symptomatic relief

54
Q

Define Prostatodynia

A

Noninflammatory disorder of the prostate

Voiding dysfunction & pelvic floor muscle dysfunction

55
Q

Presentation of Prostatodynia

A

Symptoms similar to chronic prostatitis
No history of UTI
Hesitancy & start/stop of urinary flow

56
Q

PE Findings in Prostatodynia

A

Unremarkable
Increased sphincter tone
Periprostatic tenderness

57
Q

Labs for Prostatodynia

A

UA: normal
Espressed prostatic secretions
Urodynamic studies

58
Q

Treatment of PRostatodynia

A

Alpha-blockers
Diazepam for pelvic floor muscle dysfunction
biofeedback/Physical

Urology (12 decks)

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