prostate disorders Flashcards
what is prostatitis?
inflammation of the prostate
symptoms of prostatitis mimic …
UTIs and other prostate disorders
prostatitis includes 25% of all visits regarding GU concerns in what age group of men?
young/middle aged
symptoms of acute prostatitis?
very symptomatic, sudden onset of fever, chills, LBP, body aches, perineal pain
causes of acute prostatitis
overgrowth of bacteria normally found in prostatic fluid (ie E. coli)
physical exam findings in acute prostatitis
tender, swollen indurated prostate, purulent secretions, bacteriuria
lab findings for acute prostatitis
WBCs and bacteria in urine/prostate fluid w/ acute onset and systemic Sx
treatment for acute prostatitis
*ER referral; antibiotics 7-10 days
symtpoms of chronic prostatitis
asymptomatic to suprapubic pain or LBP, intermittent as it waxes and wanes
causes of chronic prostatitis are..
bacterial (: from acute prostatitis, Chlamydia, ureaplasma urealyticum, underlying
anatomical variant harboring bacteria) or non-bacterial (unknown-dx by exculsion)
lab findings with chronic prostatitis
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
treatment for chronic prostatitis
bacterial: antibiotics 4-12 wks, NSAIDS, Sitz baths
non-bacterial: NSAIDS, natural anti-inflamm., relax tissue
symptoms with both chronic and acute prostatitis
tender swollen prostate, dysuria, nocturia, urgency, hesitancy, frequency,
hematuria, pelvic/ab pain, LBP, joint/muscle pain, painful ejaculation
risk factors with both chronic and acute prostatitis
catheterization, unprotected sex, abnormal urinary tract,
recent cystitis, BPH, DM, immunocompromised
dx with both chronic and acute prostatitis
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
what is prostadynia
chronic pelvic pain syndrome (CPPS)
symptoms/signs of prostadynia
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
causes of prostadynia
unknown (msl spasm? nerve entrapment?)
tx of prostadynia
Finesteride used w/ BPH may reduce Sx
pudendal nerve entrapment (PNE) causes include
impact trauma, surgery, congenital malformations
Pudendal nerve is predisposed to entrapment at
the level of ischial spine and within the pudendal canal
signs and symptoms of pudendal nerve entrapment
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
how is pudendal nerve entrapement diagnosed
a clinical diagnosis, imaging is not necessarily helpful, r/o causes of
prostatitis
treatment for pudendal nerve entrapment
DC evaluation for MSK issues, acupuncture, PT, meds/supplements,
decompression surgery.
is BPH precancerous?
no
who most commonly gets BPH
african americans; condition of aging
causes of BHP
unknown, hormonal influence?
where does hyperplasia occur with BPH
in transitional zone starting around prostatic urethra
symptoms of BPH only occur in ___% of patient
20
what are some symptoms with BPH that can occur?
Partial obstruction of lower urinary tract: difficulty initiating urine stream (hesitancy), interruption of stream, frequency, urgency, nocturia
what are common PE findings with BPH, cancer, and prostatitis?
BPH → non-tender, soft, boggy.
CA → rock-hard.
Prostatitis → painful.
dx for BPH done by
DRE, AUA symptom index questionnaire
labs for BPH? (what to be wary of..)
PSA. But PSA is elevated with: BPH, prostate CA, recent ejaculation or DRE
(~2 days) and prostatitis.
with PSA lab test, what is normal and what is more important to look for
: increases w/ age so normal values vary (0-4.0 ng/mL is normal). More important is the “velocity” that PSA increases.
what are complications of BPH
decreased quality of life and ADLs, residual urine can cause UTIs and acute urinary retention → ER referral, complete obstruction which would require surgery
do BPH complications increase risk of developing prostate cancer?
no
when should you refer a patient with BPH
when patients need transrectal US guided biopsy
what are medications for BPH
5-alpha-Reductase Inhibitors (Finasteride/Proscar) → inhibits testosterone
conversion to DHT. Alpha-blockers → relax smooth muscle
when should a patient with BPH get surgery
for those with more serious complications. TURPs to make a pathway so they can pee again
what are some alternative natural options for patients with BPH
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
how is Saw Palmetto different than medications (what does it not affect?)
Sx; does not affect PSA like meds and does not seem to interfere w/ PSA measurements.
