Prostate Disorders Flashcards
Disorder of the Prostate
Benign prostatic hyperplasia (BPH) Acute bacterial prostatitis Chronic bacterial prostatitis Non-bacterial prostatitis Prostadynia
Define Benign Prostatic Hyperplasia
Most common benign tumor
Risk Factors for BPH
Poorly understood
Maybe some genetic predisposition
maybe some racial factors
Pathophysiology of Benign Prostatic Hyperplasia
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
Clinical Presentation of Benign Prostatic Hyperplasia
Hesitancy Weak stream Decrease caliber of stream Incomplete bladder emptying Straining Post void dribble Frequency Nocturia Urgency
Diagnosis of BPH
Almost entirely on history
Physical Exam of BPH
Good physical exam
DRE
Neurological exam
Labs
DRE For BPH
Size & consistency should be noted
Consistency: smooth, firm, elastic enlargement
Induration: possibility of cancer
Neurological Exam for BPH
Sphincter tone
Reflexes
Labs for BPH
UA
Creatinine
PSA (+/-)
Imaging of BPH
PVR
Renal ultrasound
TRUS
Indications for Imaging in BPH
UTIs
Hematuria
Renal insufficiency
Hx of stones
Goals of BPH Therapy
Relieve symptoms
Delay further prostate enlargement
Symptoms to Relieve in BPH
Incomplete bladder emptying Feelings of urgency to urinate Weak urinary stream Having to push or strain to start urinating Nocturia
Medications for BPH Management
Alpha-1 adrenergic antagonists 5-alpha-reuctase inhibitors Anticholinergic agents Phosphodiesterase-5 (PDE5) inhibitors Herbal
Benefits of Alpha-blockers
Primarily for symptomatic relief
Benefits of 5-alpha-reductase Inhibitors
Reduces prostate size
Benefits of Anticholinergics
Reduces irritative voiding symptoms
Benefits of PDE-5 Inhibitors
Symptomatic relief and Erectile Dysfunction
Herbal Therapy
Saw palmetto
1st Line Treatment for BPH
Limit fluid before bed
Avoid decongestants
Double void
Void frequently
2nd Line Treatment for BPH
Alpha blocker
5-alpha-reductase inhibitor
3rd Line Treatment for BPH
Combination therapy of alpha blocker & 5-alpha-reductase inhibitor
Surgical Options for BPH
TURP
Transurethral Incision of the Prostate (TUIP)
Transurethral laser surgery (PVP)
Simple Prostatectomy
Indications for a Prostatectomy
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
Transurethral Resection of the Prostatectomy (TURP)
Most common surgical procedure
Associated with incontinence, erectile dysfunction, & retrograde ejaculation
Transurethral Incision of the Prostate (TUIP)
Better choice for young men with smaller prostates
Reduces risk for retrograde ejaculation & subsequent infertility
Transurethral Laser Surgery (PVP)
Less bleeding
Simple Prostatectomy
Large prostates too big for TURP
Patients with BPH & bladder stones
Longer stay in hospital & higher chance of blood loss
Urinary Retention in BPH
Progress over time with symptoms
Can be acute & painful
Diagnosis of Urinary Retention
PVR
Renal ultrasound
Cr level
Treatment of Urinary Retention
Medication: alpha-blocker/5-alpha-reductase inhibitor
Foley catheterization
Self cath
Suprapubic tube
Define Acute Bacterial Prostatitis
Swelling & irritation of the prostate gland that develops rapidly
Bacteria Culprits of of Acute Bacterial Prostatitis
E. coli Enterococci Klebsiella Protus mirabilis Pseudomonas Staph
STIs that may Cause Acute Bacterial Prostatitis
Chlamydia
Gonorrhea
Trichomonas
Ureaplasma urealyticum
Acute Bacterial Prostatitis may Develop from What Issues
Epididymitis Urethritis UTIs Bladder outlet obstruction Catheterization or cystoscopy Prostate biopsy Trauma Phimosis Anal intercourse Transurethral surgeries
Acute Bacterial Prostatitis & Age Groups
20-35: multiple sex partners, anal intercourse
50+: enlarged prostate, UTIs
Symptoms of Acute Bacterial Prostatitis
Sudden onset Abdominal pain Pain & burning with urination Fever, chills, flush Urinary retention Low back pain Pain with BM Painful ejaculation Perineal pain
Diagnosis of Acute Bacterial Prostatitis
Good PE
UA & culture
CBC
Treatment of Acute Bacterial Prostatitis
Bactrim or Septra Ofloxacin or Cipro Tetracyline Shot of cefriaxone + doxycycline (7 days) Hospital stay & IV antibiotics Stool softeners
Most Common Cause of Chronic Bacterial Prostatitis
Gram-negative rods
Enterococcus
Symptoms of Chronic Prostatitis
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
Examination for Chronic Prostatitis
Enlarged prostate
Variable amount of asymmetry
Bogginess
Tenderness
Work-up of Chronic Prostatitis
UA: normal
Analysis of expressed prostatic secretions (EPS)
Pre- and post-prostate massage urines
Lab analysis: gram stain, leukocyte count, culture & sensitivity
Management of Chronic Bacterial Prostatitis
Trimethoprim-Sulfamethoxazole (Bactrim): 2-3 months
Cipro: 4 weeks
Doxycycline
PES or post-prostatic massage should be evaluated
Management of Chronic Non-bacterial Prostatitis
Doxycycline may be tried
What medications can help with manage chronic prostatitis symptoms?
Alpha blockers
Anti-inflammatories
Sitz baths
Surgical Treatment of Chronic Prostatitis if Antibiotics & Other Measures Fail
TURP
Nonbacterial Prostatitis Common Etiologies
Chlamydiae Mycoplasmas Ureaplasmas Viruses Inflammatory Autoimmune
Define Male Chronic Pelvic Pain syndrome
Recurrent symptomatic exacerbations of nonbacterial prostatitis
Presentation of Nonbacterial Prostatitis
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
Labs for Nonbacterial Prostatitis
UA: normal
Expressed prostatic secretions
Treatment of Nonbacterial Prostatitis
Treat against mycoplasma, chlamyida
Erythromycin: ureplasma
Symptomatic relief
Define Prostatodynia
Noninflammatory disorder of the prostate
Voiding dysfunction & pelvic floor muscle dysfunction
Presentation of Prostatodynia
Symptoms similar to chronic prostatitis
No history of UTI
Hesitancy & start/stop of urinary flow
PE Findings in Prostatodynia
Unremarkable
Increased sphincter tone
Periprostatic tenderness
Labs for Prostatodynia
UA: normal
Espressed prostatic secretions
Urodynamic studies
Treatment of PRostatodynia
Alpha-blockers
Diazepam for pelvic floor muscle dysfunction
biofeedback/Physical