prostate gland diseases Flashcards
where is the prostate gland
at the base of the bladder and surround the urethra
prostate histology
fibromuscular tissue and glandular epithelial cells
prostatitis
inflammation of the prostate gland that can be infectious or noninfectious
most common bacteria associated with acute prostatitis for men >35
E. coli
most common bacteria causing acute prostatitis in men <35
chlamydia and gonorrhea
most common bacterial cause of chronic prostatitis
E. coli
general prostatitis irritative voiding symptoms
frequency
urgency
dysuria
general prostatitis obstructive symptoms
hesitancy poor or interrupted stream straining to void incomplete emptying malaise arthralgias
acute prostatitis symptoms
fever
chills
perineal pain
lower back/abdominal pain
chronic prostatitis symptoms
recurrent UTIs or intermittent dysfunction
acute prostatitis PE
very tender boggy prostate
warm and swollen
chronic prostatitis PE
contender boggy prostate
acute prostatitis diagnostic tests
urinalysis
blood tests
acute prostatitis urinalysis and lab findings
pyuria and bacteruria (E. coli!)
increased PSA
increased inflammatory markers
when to use prostatic massage
chronic prostatitis to increase bacterial yield on UA and culture
chronic pelvic pain syndrome sx
ED
painful ejaculation
bloody same
moderate an diffuse pain
bacterial prostatitis treatment
fluoroquinolone or TMPSMX
refractory chronic prostatitis tx
Transurethral resection of the prostate (TURP)
BPH definition
benign glandular and stromal hyperplasia in the periurethral or transitional zone of the prostate leading to bladder outlet obstruction
BPH is most common in ___ because…
older men because prostate hyperplasia is part of normal aging
hormones involved in BPH
DHT
estrogens
both are prostatic growth factors
testosterone is converted to ____ by _____
DHT by 5alpha reductase enzyme
estrogen is ______ in BPH
elevated
testosterone levels are ______ in BPH because
decreased because it is converted to DHT which leads to hyperplasia of prostate
_______ causes irritative symptoms of BPH
detrusor overactivity
static component of BPH
enlargement of the prostate gland
dynamic component of BOH
increase in smooth muscle tone of prostate and bladder neck that is mediated through alpha 1 adrenergic receptors
what happens to the detrusor muscle in BPH?
bladder muscle thickens due to increased pressure while voiding
FUNWISE sx of BPH
frequency urgency nocturia weak stream intermittent stream straining emptying not complete
DRE BPH findings
symmetrically enlarged smooth firm prostate with rubbery texture
IPSS
international prostate symptom score that categorizes symptoms “bother” in the past 30 days
AUASI
American Urological Association Symptom Index determine prostate disease severity and response to tx
mild IPSS score tx
reassurance and watchful waiting for 1 year
TURP
removes excess prostate tissue relieving obstruction in BPH
TURP AEs
sexual dysfunction
urinary incontinence
rapid symptom relief of BPH
alpha 1 blockers like tamsulosin
suppresses prostate growth and can decrease prostate size
5 alpha reductase blockers like finasteride
BPH complications
recurrent UTI bladder calculi hydronephrosis CKD hematuria
hydronephrosis is
dilation of renal pelvis, calyces or proximal ureter due to a distal obstruction leading to oliguria
detrusor muscle hypertrophy can lead to
bladder trabeculation and pseudodiverticula formation
irritative symptoms are due to
urinary storage
obstructive urinary symptoms are due to
voiding issues from obstruction
first line pharmacotherapy for symptomatic BPH
alpha blockers (-zosin)
decrease bladder neck and retrial sphincter tone results in
decreased resistance to urinary outflow (more pee)
improves LUTS
