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Genitourinary > Prostate Disorders (Test 3) > Flashcards

Prostate Disorders (Test 3) Flashcards

1
Q

Define Prosatitis

A

Defined as microscopic inflammation of the tissue of the prostate gland

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2
Q

True or False- A history of Sexually transmitted diseases is NOT associated with an increased risk of prostatitis

A

False- iS

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3
Q

What percentage of male pts presenting with GU complaints are diagnosed with Prostatitis

A

25%

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4
Q

MC prostatitis

A

Chronic nonbacterial prostatitis / Chronic pelvic pain syndrome accounts for 90-95% of the cases

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5
Q

MC bacterial Prostatitis

A

80% caused by gram-negative rods, especially Escherichia coli

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6
Q

In males under 35 y.o. with acute bacterial prostatitis we should consider what two STI’s

A

Neisseria gonorrheae, and Chlamiydia

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7
Q

Signs/Symptoms of Acute bacterial prostatitis

A

Perineal, sacral, or suprapubic pain

Fever

Irritative voiding

Varying degrees of obstructive symptoms may occur as the acutely inflamed prostate swells, which may lead to urinary retention

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8
Q

PE findings of Acute Baterial Prostatitis

A
  • High fever - over 100 F
  • Warm and often tender prostate on rectal exam
  • *gental rectal examination, vigorous manipulations may result in septicemia
  • Prostatic Massage is contraindicated**
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9
Q

Laboratory Findings of Prostatitis

A

CBC- leukocytosis and left shift

  • Urinalysis shows pyuria, bacteriuria, and varying degrees of hematuria
  • urine cultures will demonstrate offending pathogen
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10
Q

DDX for pts with Bacterial prostatitis will include?

A

Acute pyelonephritis
acute epididymitis
acute diverticulitis
Urinary retention from benign or malignant prostatic enlargement

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11
Q

Tx of Acute Bacterial Prostatits

A

Hospitalization
IV antibx with ampicillin / aminoglycoside
once afebrile switch to Oral ABx
-Ciprofloxacin, Oflaxacin, or Bactrim for 4-6 wks.

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12
Q

What catheter should be used if urinary retention develops

A

Suprapubic catherization to reduce chance of septiciemia

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13
Q

Prognosis of Acute Bacterial Prostatits

A

W/ effective tx, chronic bacterial prostatis is rare

Refer when:

  • Evidence of urinary retention
  • Evidence of chronic prostatitis
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14
Q

What is Chronc Bacterial Prostatits called

A

Type II Bacterial Prostatits

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15
Q

What will you find in a UA in a pt that has Chronic bacterial prostatitis (type II)

A

Typically UA is normal unless there is a secondary cystitis

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16
Q

what is required for absolute diagnosis of Chronic Bacterial Prostatitis

A

Culture of the secretions or the post prostatic massage urine specimen

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17
Q

Technique for Prostatic massage when testing for Chronic Bacterial Prostitis

A

Instruction for cleaning glans

Collect midstream pre massage

Stop urination and massage prostate to gain 3-4 drops of milked prostate fluid

Have pt urinate remaining out after collection to urinal

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18
Q

Tx of Chronic Bacterial Prostatitis

A

Trimethoprim-sulfamethaxazole is associated with best cure rates, however, increasing resistance to this antibiotic up to 20% has been noted

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19
Q

Other effective agents of Chronic Bacterial Prostatitis

A

Quinolones, cephalexin, erythromycin and carbenicillin

The optimal duration of therapy is form 6-12 wks

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20
Q

Prognosis of chronic bacterial prostatitis

A

Difficult to cure but symptoms and tendency to recurrent urinary tract infections can be controlled by suppressive antibiotic therapy.

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21
Q

Most common of the prostatitis syndromes from

A

Nonbacterial prostatitis

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22
Q

Cause of Nonbacterial prostatitis

A

unknown cause

-specuation implicates chlamydiae, mycoplasmas, ureaplasmas, and viruses, but no substantial proof exists. Cultures always negative

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23
Q

New classification of the Nonbacterial Prostatitis

A

Type IIIa Inflammatory chronic pelvic pain syndrome

24
Q

Type IIIb is or is not inflammatory

A

is non-inflammatory

25
Q

As the prostate enlarges with increasing age, pts will develop ________ symptoms and urine ______ into the prostatic ducts.

A

Obstructive

Refluxes

26
Q

even with sterile non bacterial urine there is an increase in chemical irritation and inflammation thus the non bacterial prostatitis

A

no question here…

27
Q

Major distinction of nonbacterial prostatitis

A

Absence of a history of UTI and lack of positive cultures for bacteria

28
Q

In older men with irritative voiding what needs to be excluded out

A

Bladder cancer

29
Q

Tx of nonbacterial prostatitis

A

Examine of expressed prostate secretions

if inflammatory cells . >10 WBC seen per high power field then we will tx for 14 days with antibx.

30
Q

Antibiotics are successful for what percentage of cases over a course of 4 weeks

A

50%

31
Q

Tx if inflammatory do what

A

Start Erythromycin (250 mg orally four times daily) for 14 days. Yet should be continued for 3-6 weeks if favorable clinical response ensues

32
Q

Prognosis of Nonbacterial Prostatits

A

Annoying, recurrent symptoms are common, but serious sequelae have not been identified

33
Q

What is the new classification of Prostadodynia

A

Type IIIb

34
Q

What is prostatodynia

A

Noninflammatory disorder that affects young and middle-aged men and has variable causes, including voiding dysfunction and pelvic floor musculature dysfunction

35
Q

Signs / Symptoms fo prostodynia

A

Same as those seen with chronic prostatitis, yet there is no history of UTI

Additional symptoms may include hesitancy and interruption of flow.

Pt’s may relate a lifelong history of voiding difficulty

36
Q

what are a few PE signs of prostatodynia

A

unremarkable but increased anal sphincter tone and periprostatic tenderness may be observed

37
Q

Laboratory findings for Prostadynia

A

normal numbers of leukocytes <10 so we know it not a inflammatory problem

38
Q

Tx of Prostadodynia

A

Bladder neck and urethral spasms can be treated by alpha-blocking agents, Terazosisn or doxazosin

PT for pelvic floor muscle dysfunction therapy

39
Q

BPH is the abbreviation of

A

Benign Prostatic hyperplasia

40
Q

Most common benign tumor in men

A

Benign prostatic hyperplasia

41
Q

incidence of BPH

A

20% in men 41-50
50% in men age 51-60
over 90% in men over 80

42
Q

Pathophysiology of BPH

A

mechanical obstruction of the urethra or bladder neck. Causes a higher bladder outlet resistance

43
Q

Symptoms of BPH

A

Hesitancy, decreased force, sensation of incomplete bladder emptying, double voiding (urination for second time within 2 hours) ,
And post void dribbling

44
Q

Degree of obstruction does not always correlate to what

A

Size and consistency of prostate.

45
Q

If ________ is detected on prostate examination he clinician must be alert to possibility of cancer and further evaluation is needed.

A

Induration

46
Q

AUA score of what should be managed by watchful waiting for BPH

A

0-7

47
Q

BPH progression is not inevitable and that some men undergo Spontaneous improment or resolution of their symptoms..

A

dont use a sledgehammer to kill a gnat

48
Q

Tx of BPH

A

Transurethral resection of prostate (TURP)

Transurethral Incision of the prostate (TUIP)

Open simple prostatectomy

49
Q

Instrument utilized for TURP

A

Resectoscope- combined visual and surgical instrument.

50
Q

Ninety-five percent of simple prostatectomies can be performed __________

A

endoscopically (TURP)

51
Q

when should TUIP be utilized

A

men with moderate to severe symptoms and small prostates (30 gms or less) often have posterior commissure hyperplasia or an elevated bladder neck)

These pts will often benefit from incision of the prostate

The procedure is more rapid and les morbid than TURP. Ret. Ejaculation rates , lower than 25%

52
Q

When the prostate is too large to be removed endoscopically the BPH treatment of choice becomes

A

Open Simple Prostatectomy

53
Q

complications of Open Simple Prostatectomy

A

increased morbidity (ie hemorrhage and longer hospital stay vs TURP)

54
Q

What is the gold standard of surgical repair for enlarged prostates from BPH

A

TURP ( transurethral resection of the prostate )

55
Q

When to refer for BPH Treatment

A

Progression of Urinary Retention

Pt dissatisfaction with medical therapy

Need for surgical intervention or further evaluation

Genitourinary (11 decks)

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