Prostate Disorders (Test 3) Flashcards
Define Prosatitis
Defined as microscopic inflammation of the tissue of the prostate gland
True or False- A history of Sexually transmitted diseases is NOT associated with an increased risk of prostatitis
False- iS
What percentage of male pts presenting with GU complaints are diagnosed with Prostatitis
25%
MC prostatitis
Chronic nonbacterial prostatitis / Chronic pelvic pain syndrome accounts for 90-95% of the cases
MC bacterial Prostatitis
80% caused by gram-negative rods, especially Escherichia coli
In males under 35 y.o. with acute bacterial prostatitis we should consider what two STI’s
Neisseria gonorrheae, and Chlamiydia
Signs/Symptoms of Acute bacterial prostatitis
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
PE findings of Acute Baterial Prostatitis
- 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**
Laboratory Findings of Prostatitis
CBC- leukocytosis and left shift
- Urinalysis shows pyuria, bacteriuria, and varying degrees of hematuria
- urine cultures will demonstrate offending pathogen
DDX for pts with Bacterial prostatitis will include?
Acute pyelonephritis
acute epididymitis
acute diverticulitis
Urinary retention from benign or malignant prostatic enlargement
Tx of Acute Bacterial Prostatits
Hospitalization
IV antibx with ampicillin / aminoglycoside
once afebrile switch to Oral ABx
-Ciprofloxacin, Oflaxacin, or Bactrim for 4-6 wks.
What catheter should be used if urinary retention develops
Suprapubic catherization to reduce chance of septiciemia
Prognosis of Acute Bacterial Prostatits
W/ effective tx, chronic bacterial prostatis is rare
Refer when:
- Evidence of urinary retention
- Evidence of chronic prostatitis
What is Chronc Bacterial Prostatits called
Type II Bacterial Prostatits
What will you find in a UA in a pt that has Chronic bacterial prostatitis (type II)
Typically UA is normal unless there is a secondary cystitis
what is required for absolute diagnosis of Chronic Bacterial Prostatitis
Culture of the secretions or the post prostatic massage urine specimen
Technique for Prostatic massage when testing for Chronic Bacterial Prostitis
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
Tx of Chronic Bacterial Prostatitis
Trimethoprim-sulfamethaxazole is associated with best cure rates, however, increasing resistance to this antibiotic up to 20% has been noted
Other effective agents of Chronic Bacterial Prostatitis
Quinolones, cephalexin, erythromycin and carbenicillin
The optimal duration of therapy is form 6-12 wks
Prognosis of chronic bacterial prostatitis
Difficult to cure but symptoms and tendency to recurrent urinary tract infections can be controlled by suppressive antibiotic therapy.
Most common of the prostatitis syndromes from
Nonbacterial prostatitis
Cause of Nonbacterial prostatitis
unknown cause
-specuation implicates chlamydiae, mycoplasmas, ureaplasmas, and viruses, but no substantial proof exists. Cultures always negative
New classification of the Nonbacterial Prostatitis
Type IIIa Inflammatory chronic pelvic pain syndrome
Type IIIb is or is not inflammatory
is non-inflammatory
As the prostate enlarges with increasing age, pts will develop ________ symptoms and urine ______ into the prostatic ducts.
Obstructive
Refluxes
even with sterile non bacterial urine there is an increase in chemical irritation and inflammation thus the non bacterial prostatitis
no question here…
Major distinction of nonbacterial prostatitis
Absence of a history of UTI and lack of positive cultures for bacteria
In older men with irritative voiding what needs to be excluded out
Bladder cancer
Tx of nonbacterial prostatitis
Examine of expressed prostate secretions
if inflammatory cells . >10 WBC seen per high power field then we will tx for 14 days with antibx.
Antibiotics are successful for what percentage of cases over a course of 4 weeks
50%
Tx if inflammatory do what
Start Erythromycin (250 mg orally four times daily) for 14 days. Yet should be continued for 3-6 weeks if favorable clinical response ensues
Prognosis of Nonbacterial Prostatits
Annoying, recurrent symptoms are common, but serious sequelae have not been identified
What is the new classification of Prostadodynia
Type IIIb
What is prostatodynia
Noninflammatory disorder that affects young and middle-aged men and has variable causes, including voiding dysfunction and pelvic floor musculature dysfunction
Signs / Symptoms fo prostodynia
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
what are a few PE signs of prostatodynia
unremarkable but increased anal sphincter tone and periprostatic tenderness may be observed
Laboratory findings for Prostadynia
normal numbers of leukocytes <10 so we know it not a inflammatory problem
Tx of Prostadodynia
Bladder neck and urethral spasms can be treated by alpha-blocking agents, Terazosisn or doxazosin
PT for pelvic floor muscle dysfunction therapy
BPH is the abbreviation of
Benign Prostatic hyperplasia
Most common benign tumor in men
Benign prostatic hyperplasia
incidence of BPH
20% in men 41-50
50% in men age 51-60
over 90% in men over 80
Pathophysiology of BPH
mechanical obstruction of the urethra or bladder neck. Causes a higher bladder outlet resistance
Symptoms of BPH
Hesitancy, decreased force, sensation of incomplete bladder emptying, double voiding (urination for second time within 2 hours) ,
And post void dribbling
Degree of obstruction does not always correlate to what
Size and consistency of prostate.
If ________ is detected on prostate examination he clinician must be alert to possibility of cancer and further evaluation is needed.
Induration
AUA score of what should be managed by watchful waiting for BPH
0-7
BPH progression is not inevitable and that some men undergo Spontaneous improment or resolution of their symptoms..
dont use a sledgehammer to kill a gnat
Tx of BPH
Transurethral resection of prostate (TURP)
Transurethral Incision of the prostate (TUIP)
Open simple prostatectomy
Instrument utilized for TURP
Resectoscope- combined visual and surgical instrument.
Ninety-five percent of simple prostatectomies can be performed __________
endoscopically (TURP)
when should TUIP be utilized
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%
When the prostate is too large to be removed endoscopically the BPH treatment of choice becomes
Open Simple Prostatectomy
complications of Open Simple Prostatectomy
increased morbidity (ie hemorrhage and longer hospital stay vs TURP)
What is the gold standard of surgical repair for enlarged prostates from BPH
TURP ( transurethral resection of the prostate )
When to refer for BPH Treatment
Progression of Urinary Retention
Pt dissatisfaction with medical therapy
Need for surgical intervention or further evaluation
