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GU-male > prostate disorders > Flashcards

prostate disorders Flashcards

1
Q

what is prostatitis?

A

inflammation of the prostate

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2
Q

symptoms of prostatitis mimic …

A

UTIs and other prostate disorders

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3
Q

prostatitis includes 25% of all visits regarding GU concerns in what age group of men?

A

young/middle aged

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4
Q

symptoms of acute prostatitis?

A

very symptomatic, sudden onset of fever, chills, LBP, body aches, perineal pain

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5
Q

causes of acute prostatitis

A

overgrowth of bacteria normally found in prostatic fluid (ie E. coli)

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6
Q

physical exam findings in acute prostatitis

A

tender, swollen indurated prostate, purulent secretions, bacteriuria

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7
Q

lab findings for acute prostatitis

A

WBCs and bacteria in urine/prostate fluid w/ acute onset and systemic Sx

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8
Q

treatment for acute prostatitis

A

*ER referral; antibiotics 7-10 days

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9
Q

symtpoms of chronic prostatitis

A

asymptomatic to suprapubic pain or LBP, intermittent as it waxes and wanes

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10
Q

causes of chronic prostatitis are..

A

bacterial (: from acute prostatitis, Chlamydia, ureaplasma urealyticum, underlying
anatomical variant harboring bacteria) or non-bacterial (unknown-dx by exculsion)

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11
Q

lab findings with chronic prostatitis

A

bacterial: WBCs and bacteria in urine/prostate fluid w/insidious onset
non-bacterial: may see WBCs in urine or prostate fluid, but no evidence of infection

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12
Q

treatment for chronic prostatitis

A

bacterial: antibiotics 4-12 wks, NSAIDS, Sitz baths

non-bacterial: NSAIDS, natural anti-inflamm., relax tissue

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13
Q

symptoms with both chronic and acute prostatitis

A

tender swollen prostate, dysuria, nocturia, urgency, hesitancy, frequency,
hematuria, pelvic/ab pain, LBP, joint/muscle pain, painful ejaculation

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14
Q

risk factors with both chronic and acute prostatitis

A

catheterization, unprotected sex, abnormal urinary tract,

recent cystitis, BPH, DM, immunocompromised

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15
Q

dx with both chronic and acute prostatitis

A

prostatic stripping and culture discharge, WBCs in discharge is not
diagnostic, pH of fluid rises w/ infection, pre/post massage collection of urine for
culture, PSA levels elevated
• DRE looking at size, symmetry, consistency, lumps/nodules,
discomfort/pain

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16
Q

what is prostadynia

A

chronic pelvic pain syndrome (CPPS)

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17
Q

symptoms/signs of prostadynia

A

similar to prostatitis but without inflammation or bacterial infection, pain in pelvis/perineum and extends to penis/testes/rectum, may cause voiding or sexual dysfunction

18
Q

causes of prostadynia

A

unknown (msl spasm? nerve entrapment?)

19
Q

tx of prostadynia

A

Finesteride used w/ BPH may reduce Sx

20
Q

pudendal nerve entrapment (PNE) causes include

A

impact trauma, surgery, congenital malformations

21
Q

Pudendal nerve is predisposed to entrapment at

A

the level of ischial spine and within the pudendal canal

22
Q

signs and symptoms of pudendal nerve entrapment

A

pain in penis/scrotum/perineum/anorectal, prostatitis-like pain and voiding/sexual dysfunction are hallmark of PNE, aggravated by sitting, relieved by standing/lying down

23
Q

how is pudendal nerve entrapement diagnosed

A

a clinical diagnosis, imaging is not necessarily helpful, r/o causes of
prostatitis

24
Q

treatment for pudendal nerve entrapment

A

DC evaluation for MSK issues, acupuncture, PT, meds/supplements,
decompression surgery.

25
Q

is BPH precancerous?

A

no

26
Q

who most commonly gets BPH

A

african americans; condition of aging

27
Q

causes of BHP

A

unknown, hormonal influence?

28
Q

where does hyperplasia occur with BPH

A

in transitional zone starting around prostatic urethra

29
Q

symptoms of BPH only occur in ___% of patient

A

20

30
Q

what are some symptoms with BPH that can occur?

A

Partial obstruction of lower urinary tract: difficulty initiating urine stream (hesitancy), interruption of stream, frequency, urgency, nocturia

31
Q

what are common PE findings with BPH, cancer, and prostatitis?

A

BPH → non-tender, soft, boggy.
CA → rock-hard.
Prostatitis → painful.

32
Q

dx for BPH done by

A

DRE, AUA symptom index questionnaire

33
Q

labs for BPH? (what to be wary of..)

A

PSA. But PSA is elevated with: BPH, prostate CA, recent ejaculation or DRE
(~2 days) and prostatitis.

34
Q

with PSA lab test, what is normal and what is more important to look for

A

: increases w/ age so normal values vary (0-4.0 ng/mL is normal). More important is the “velocity” that PSA increases.

35
Q

what are complications of BPH

A

decreased quality of life and ADLs, residual urine can cause UTIs and acute urinary retention → ER referral, complete obstruction which would require surgery

36
Q

do BPH complications increase risk of developing prostate cancer?

A

no

37
Q

when should you refer a patient with BPH

A

when patients need transrectal US guided biopsy

38
Q

what are medications for BPH

A

5-alpha-Reductase Inhibitors (Finasteride/Proscar) → inhibits testosterone
conversion to DHT. Alpha-blockers → relax smooth muscle

39
Q

when should a patient with BPH get surgery

A

for those with more serious complications. TURPs to make a pathway so they can pee again

40
Q

what are some alternative natural options for patients with BPH

A

Saw Palmetto (160 mg 2x/day) to improve urine flow and decrease
Prevents estrogen from binding r/cs. Inhibits conversion of testosterone to DHT.
• Amino acids, beta-sitosterol, zinc picolinate, pygeum bark, nettles

41
Q

how is Saw Palmetto different than medications (what does it not affect?)

A

Sx; does not affect PSA like meds and does not seem to interfere w/ PSA measurements.

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