Prostate Disorders Flashcards
Benign Prostatic Hyperplasia:
- MC in who?
- pathophysiology
MC in older men, 90% of men older than 80YO have BPH
Pathophys:
-growth begins in the periurethral glandular* tissue, over time surgical capsule forms around the adenomatous hyperplasia. as glad enlarges there is increased resistance* to urine flow with subsequent bladder muscle hypertrophy..eventually bladder will not empty completely and there will be residual urine predisposing men to infection. Hyperplastic prostate is highly vascular and predisposed to bleeding which can result in painless hematuria*.
BPH:
- clinical presentation
- dx
Presentation:
- obstructive sx:
- -hesitancy
- -weak stream
- -decrease caliber of stream
- -incomplete emptying of the bladder
- straining
- postvoid dribble
Irritative sx:
- frequency
- nocturia
- urgency
Dx:
- AUA sx scoring:
- -Mild 0-7
- -Moderate 8-19
- -severe: 20-35
- Dx is based almost entirely on hx!
- DRE: size and consistency (Size of degree doesnt necessarily correlate with the degree of mechanical obstruction)
- Neurologic exam: sphincter tone, reflexes
- Labs:
- -UA
- -Creatinien
- -PSA (+/-)
- Imaging:
- -PVR
- -Renal US
- -TRUS
- **Imaging not standard; only done in presence of concomitant urinary tract disease or complications from BPH.
BPH:
- goals of therapy
- tx Medications
Goals:
-relieve sx of incomplete emptying, feelings of urgency, weak urinary stream, nocturia, delay furtehr prostate enlargement
Tx:
Meds
-alpha-1 adrenergic antagonists (alpha blockers) = sx relief
- 5-alpha reductase inhibitors = reduce prostate size.
- anticholinergic agents = reduce irritative voiding
- PDE-5 inhibitors = sx relief and ED
- Herbal = saw palmeto
BPH:
-guidelines for treatment.. 1st line, 2nd line, and 3rd line therapy.
1st line:
- if sx are mild (AUA less than 7), no medical tx is recommended…watchful waiting.
- -limit fluid before bedtime
- -avoid decongestants
- -double void
- -void frequently
2nd line:
- pharm therapy if AUA is greater than 7
- -use alpha blockers in pt who is also hypertensive*
- -5-alpha reductase if prostate is enlarged to 40g or more
3rd line:
-combo therapy
BPH:
- indications for prostatectomy
- surgical options & their complications
- tx for urinary retention
indications for prostatectomy:
- refractory acute retention
- hydronephrosis
- repeated UTIs d/t obstruction
- recurrent or refractory gross hematuria
- elevated Cr level that responds to a period of bladder decompression with catheter drainage
Surgical option:
- Transurethral resection of the prostatectomy (TURP) (MC procedure for BPH***)
- -retrograde ejaculation resulting in infertility is a common complication
- Transurethral incision of the prostate (TUIP)
- -better choice in young men, reduces retrogradde ejaculation and subsequent infertility
- Transurethral laseer surgery (PVP)
- -less bleeding
-simple prostatectomy (for large prostates too big for TURP)
Tx for urinary retention:
- alpha-blocker/5-alpha-reductase inhibitors
- foley catheterization
- self cath
- SP tube
Acute Bacterial Prostatitis:
- cause
- what is this?
- MC age
- e.coli prostatitis may occur spontaneously or after what?
Cause:
-Typical bugs causing UTI: e.coli(MC), enterococci, Klebsiella, protus mirabilis, pseudomonas, staph
-STI infections: chlamydia, gonorrhea, tichomonas, ureaplasma urealyticum
What: swelling and irritation (inflamm or infection) of the prostate gland that develops rapidly
MC age in men is greater than 35YO
May occur after epididymitis, urethritis, UTI
Who is most at risk of acute bacterial prostatitis?
men age 50 or older who have an elarged prostate are at increased risk for prostatitis d/t their risk of UTI.
Acute Bacterial prostatitis:
- sx
- dx
- tx
sx:
- abdd pain (above pubic bonee)
- pain and buring with urination
- fever, chills, flush
- inability to completely empty bladder
- low back pain
- pain with bowel movement
- painful ejaculation
- pain in perineal area.
Dx:
- goodd PE –refrain from prostate massage or even DRE this may cause sepsis
- UA/UC
- CBC
Tx:
- abx; most often Bactrim/septra, Cipro/Floxin, tetracycline/doxy for 4wks
- shot of rocephin followed by 7d course of doxy
- for severe cases Hospitalization and IV abx
Chronic Bacterial prostatitis:
- cause
- sx
- PE findings
cause: may evolve from acute bacterial prostatitis but many men have NO hx of acute infection.
- -gram - rods are MC cause
Sx:
- frequency, dribbling, loss of stream, volume, and force.
- double voiding, hesitancy, and urgency
- may or may not have pelvic or perineal pain
- low back &/or testicle pain
- may have hematuria, hematospermia, or painful ejections.
PE:
-enlarged prostate with variable amount of asymmetry, bogginess, and tenderness(not typically exquisitely tender like acute)
Chronic bacterial prostatitis:
- work up
- management
Work up:
- UA is usually normal
- analysis of expressed prostatic secretions
- -if no prostatic secretions can be obtained; pre-and post prostate massage urines
- lab analysis includes gram stain, leuk count, culture, and sensitivity
Management:
- Bactrim for 2-3months
- Cipro for 4wks
- Doxy (esp if concerned about chlamydia)
- expressed prostatic secretions should be evaluataed at the end of the tx period to demonstrate cure..if not cured then longer course of Abx.
- Flomax may be useful for sx management
- Transurethral resectionof prostate (TURP) is an option when repeated course of abx and other measures fail
Tx of chornic nonbacterial prostatitis
doxycycline*, azithro, or erythro
flomax may be useful for sx management
non-bacterial postatitis:
- cause
- presentation
- what is this termed if a man has recurrent sx exacerbations of this?
- dx
cause: unknown, may be inflammatory or autoimmune
presentation:
- identical to that of chronic without UTI present.
Termed male chronic pelvic pain syndrome if recurrent symptomatic exacerbations
Dx:
- ua normal
- expressed prostatic secretions = increased number of leukocytes
Prostatodynia:
- what is this?
- presentation
- PE
- Labs
- Tx
What: noninflamm disorder of prostate, includes voiding dysfuunction and pelvic flood muscle dysfunction
Presentation:
- sx similar to chronic prostatitis
- no hx of UTI
- hesitancy and Stop/start of urinary flow
PE:
- unremarkable
- increased sphincter tone and periprostatic tenderness
labs:
- UA normal
- expressed prsotatic secretions = normal # of leukocytes
- urodynamic studies normal
Tx:
- alpha blockers
- diazepam for pelvic floor muscle dysfunction
- Biofeedback/PT
if patient had surgery for BPH are they at decreased risk for CA?
no!
