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UROLOGY > PROSTATE DISORDERS > Flashcards

PROSTATE DISORDERS Flashcards

1
Q

most common benign tumor

A

BPH (benign prostatic hyperplasia)

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2
Q

incidence of BPH increases with ______

A

AGE

8% - age 31-40
50% - age 51-60
90% - men over 80 years old

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3
Q

risk factors for BPH

A

the risk factors for BPH are not well understand

  • may be some genetic predisposition
  • may be some racial factors
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4
Q

SYMPTOMS OF BPH

A
  • hesitancy
  • weak stream
  • decreased caliber of stream
  • incomplete emptying of bladder
  • straining
  • post-void dribbling
  • frequency
  • nocturia
  • urgency
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5
Q

OBSTRUCTIVE SYMPTOMS OF BPH

A
  • hesitancy
  • weak stream
  • decreased caliber of stream
  • incomplete emptying of bladder
  • straining
  • post-void dribbling
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6
Q

IRRITATIVE SYMPTOMS OF BPH

A
  • frequency
  • nocturia
  • urgency
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7
Q

screening for severity of BPH

A

AUA

0-7 = mild
8-19 = moderate
20-35 = severity
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8
Q

prostatic hyperplasia is a part of normal aging and is hormonally dependent on an increase in ________________________ production

A

dihydrotestosterone

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9
Q

physical exam for BPH

A

DRE

Size and consistency of prostate should be noted

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10
Q

LABS for BPH

A
  • UA (may do urine culture if UA is abnormal/WBCs)
  • Creatinine
  • PSA = +/-
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11
Q

what are we looking for in the UA for BPH

A
  • blood
  • WBCs (infection)
  • protein (renal dysfunction)
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12
Q

IMAGING FOR BPH

A

***Imaging is not standard for BPH - only recommended to order imaging in the presence of concomitant urinary tract disease, or complications of BPH (hematuria, hx of stones, hx of UTIs/UTI, renal dysfunction, increased creatinine, etc)

  • PVR
  • renal US
  • TRUS (trans-rectal ultrasound)

PVR = post-void residual test = measures the amount of urine remaining in bladder after urinating

  • 2 ways = cathether & US
  • with Cath = urinate, then stick cath up to see how much urine is remaining in the bladder
  • with US = before urinating and after - see how much volume of urine is remaining in bladder
  • renal US = to check for hydronephrosis
  • TRUS = to check bladder & prostate size (both would be enlarged)
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13
Q

goals of BPH therapy

A
  • relieve symptoms

- delay further prostate enlargement

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14
Q

BPH MEDICATION CLASSES

A

Alpha-1 adrenergic antagonists (alpha-blockers)

5-alpha-reductase inhibitors

Anticholinergic agents

Phosphodiesterase-5 (PDE-5) inhibitors

Herbal

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15
Q

alpha-1 adrenergic antagonists (alpha blockers) MOA

A

smooth muscle relaxation

  • so causes smooth muscle relaxation of prostate & bladder neck –> decreased urethral resistance and decreased obstruction –> increased urinary outflow
  • Indications = provides rapid symptom relief but no effect on clinical course of BPH

this med would be effective in smaller prostates where the size is so enlarged that you would want a medication that shrinks prostate size

Rapid function

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16
Q

SE OF ALPHA BLOCKERS

A
  • ***HYPOTENSION
  • orthostatic hypotension
  • dizziness
  • retrograde ejaculation
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17
Q

guidelines for BPH treatment

A 
FIRST LINE
If symptoms are mild (AUA score <7), no medical treatment is recommended.  Watchful waiting!!    
- Limit fluid before bedtime
- Avoid decongestants
- Double void
- Void frequently

SECOND LINE (First line medical)
Pharm therapy if AUA is >7
- Use alpha blocker in patient who is also hypertensive
- 5-alpha-reductase inhibitor if prostate is enlarged to 40g or more.

THIRD LINE
Combination therapy

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18
Q

BPH treatment if pt also hypertensive

A

alpha blocker

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19
Q

BPH treatment if prostate is enlarged to 40g or more

A

5 alpha reductase inhibitor

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20
Q

alpha blocker meds

A
  • Tamsulosin (Flomax) = most uroselective
  • Alfuzosin
  • Doxazosin
  • Terazosin
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21
Q

5-alpha reductase inhibitor drugs

A

Finasteride (Proscar)

Dutasteride (Avodart)

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22
Q

5-alpha reductase inhibitor drugs MOA

A

Androgen inhibitor

Inhibits the conversion of testosterone into dihydrotestosterone –> suppresses prostate growth & reduces bladder obstruction

not as rapid functioning as alpha blockers

has a positive effect on the course of BPH (both size reduction and decreases need for surgery, unlike alpha blockers)

SE = ED, decreased libido, breast tenderness / enlargement

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23
Q

herbal treatment for BPH

A

saw palmetto

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24
Q

treatment for BPH & ED

A

PDE-5 inhibitors

Cialis / Viagra

25
Q

how do anticholinergics help with BPH when a SE of anticholinergics is urinary retention?

A
  • helps with irritative symptoms by causing the bladder to relax (no pee)

doesn’t help with obstructive symptoms, because not relaxing the prostate or bladder neck, but so that don’t have to urinate all the time even when there is residual urine in the bladder

26
Q

**Operations for BPH leave a small amount of residual prostate tissue, risk for future ___________is the same

A

malignancy

27
Q

surgical operation for BPH that is perhaps better choice for younger men with smaller prostates;

reduces risk for retrograde ejaculation and subsequent infertility

A

Transurethral Incision of the Prostate (TUIP)

28
Q

Most common surgical procedure for BPH

A

TURP = Transurethral Resection of the Prostate

29
Q

Retrograde ejaculation resulting in infertility is a common complication of which BPH surgery

A

TURP = Transurethral Resection of the Prostate

30
Q

Has classically been said to be associated with ______________ & __________; however, recent research comparing TURP patients with watchful waiting showed same incidences

A

incontinence and erectile dysfunction

31
Q

INDICATIONS FOR A PROSTATECTOMY FOR BPH

A 
Refractory acute retention 
Hydronephrosis
Repeated UTIs due to obstruction 
Recurrent or refractory gross hematuria 
Elevated Cr level that responds to a period of bladder decompression with catheter drainage
32
Q

BPH surgical procedure that has:

For large prostates to big for TURP
Patients with BPH and bladder stones
Longer stay in hospital and higher chance of blood loss

A

simple prostatectomy

33
Q

what is acute bacterial prostatitis

A

Swelling and irritation (inflammation or infection) of the prostate gland that develops rapidly.

34
Q

acute bacterial prostatitis can be due to which bacterial agents

A 
E-coli********
Enterococci
Klebsiella
Protus mirabilis
Psuedomonas
Staph
35
Q

most common bug causing acute bacterial prostatitis

A

E. COLI

36
Q

acute bacterial prostatitis can be caused by which STDs

A

Chlamydia
Gonorrhea
Trichomonas
Ureaplasma urealyticum

37
Q

most common STDs to cause acute bacterial prostatitis

A

Chlamydia

Gonorrhea

38
Q

E. coli prostatitis may occur spontaneously or after:

A

Epididymitis
Urethritis
Urinary tract infections

39
Q

Acute prostatitis may also develop from problems involving the urethra or prostate, such as:

A 
Bladder outlet obstruction
Catheterization or cystoscopy 
Prostate biopsy 
Trauma 
Phimosis 
Anal intercourse 
Transurethral surgeries
40
Q

Prostatitis is rare in young boys.

viral prostatitis may be seen in children, however, from a viral cause: ___________ = most common

A

MUMPS

41
Q

who is at increased risk of developing acute bacterial prostatitis

A

Men ages 20 - 35 who have multiple sexual partners are at an increased risk. Also at high risk are those who engage in anal intercourse, especially without using condoms.

Men age 50 or older who have an enlarged prostate are at increased risk for prostatitis due to their risk of urinary tract infection.

42
Q

ACUTE BACTERIAL PROSTATITIS SYMPTOMS

A

Abdominal pain (usually right above the pubic bone)
Pain and burning with urination
Fever, chills, flush
Inability to completely empty the bladder (urinary retention)
Low back pain
Pain with bowel movement
Painful ejaculation
Pain in the area between the genitals and anus (perineal pain)

43
Q

Diagnostics for acute bacterial prostatitis

A
  • UA & urine culture
  • CBC
  • PSA +/-
44
Q

Treatment for acute bacterial prostatitis

A
  • Bactrim or fluoroquinolones (cipro or ofloxacin) x at least 4 weeks
  • Ceftriaxone IM + Doxy for prostatitis caused by STD
  • A hospital stay and IV antibiotics for severe cases
  • Stool softeners may reduce the discomfort that occurs with bowel movements.
45
Q

most common type of prostatitis

A

nonbacterial prostatitis

46
Q

termed male chronic pelvic pain syndrome

A

nonbacterial prostatitis

47
Q

nonbacterial prostatitis presents the same as ______________________________, just without the __________

A

chronic bacterial infection, just without a bacterial infxn

**have recurrent symptomatic exacerbations (which is why its termed male chronic pelvic pain syndrome)

48
Q

treatment for nonbacterial prostatitis

A

erythromycin

don’t know what’s causing it, so covering for mycoplasma, chlamydia, and ureaplasma

(also mentioned = doxy & azithro)

49
Q

lab findings for nonbacterial prostatitis

A

UA = normal

prostate secretions = increased leukocytes, but no growth shown on culture!

50
Q

chronic bacterial prostatitis = may evolve from _________________________ but many times men have NO hx of an acute infxn

A

acute bacterial prostatitis

51
Q

CAUSE of chronic bacterial prostatitis (bugs)

A

GRAM NEGATIVE RODS (1 gram positive)

  • E. coli*****
  • enterococci
  • treponema
  • trichomonas
  • Gardnerella
52
Q

SYMPTOMS OF CHRONIC BACTERIAL PROSTITIS

A

Can present much differently than acute prostatitis

Frequency, dribbling, loss of stream volume and force, double voiding, hesitancy, and urgency

May or may not have pelvic or perineal pain

May have intermittent discomfort in low back and/or testicles

May have hematuria, hematospermia, or painful ejaculations

53
Q

chronic prostatitis exam

A

enlarged prostate with a variable amount of

o asymmetry
o bogginess
o tenderness (not typically exquisitely tender like acute prostatitis)
54
Q

Diagnostics for chronic bacterial prostatitis

A
  • UA = usually normal
  • EPS = expressed prostatic secretions
  • if can’t get EPS = do pre & post prostatic massage urines
  • obtain gram stains, leukocyte count, and culture from these
55
Q

treatment of chronic bacterial prostatitis

A
  • Bactrim x 2-3 months
  • Fluoroquinolone (cipro) x 4 weeks
  • Can use Doxycycline as well (especially if concerned about Chlamydia)

**EPS or Post-prostatic massage should be evaluated at the end of the treatment period to demonstrate cure (if evidence of infection still present, longer course of antibiotics may be indicated)

TURP = for refractory chronic prostatitis

For both situations (acute & chronic) α-blockers - e.g. Tamsulosin (Flomax) can help with symptoms, also anti-inflammatories and sitz baths

56
Q

PROSTATODYNIA =

A

non-inflammatory disorder of the prostate

with voiding dysfunction & pelvic floor muscle dysfunction

57
Q

SYMPTOMS OF PROSTATODYNIA

A

same as chronic prostatitis, but no hx of UTI

  • have hesitancy & stop/start of urine flow
58
Q

LABS OF PROSTATODYNIA

A 
UA = normal
EPS = normal # of leukocytes
59
Q

TREATMENT FOR PROSTATODYNIA

A

alpha blockers
diazepam for pelvic floor muscle dysfunction
biofeedback / PT

UROLOGY (12 decks)

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