Trigger - prostate disorders Flashcards
risk factors for this condition includes catheters, prostate biopsy, urethral stricture
acute bacterial prostatitis
DRE showing red hot tender prostate
acute bacterial prostatitis
leukocytosis showing left shift. UA showing pyuria, bacteriuria, hematuria. UC - + causative agent.
acute bacterial prostatitis
remember you have to get a culture in these patients so you can use the right abx
in acute bacterial prostatitis, if there is no response to abx in 24-48 hrs what should be done
pelvic CT or transurethral US to assess for abscess
treatment is amp/gent or fluoroquinolones +/- aminoglycoside
acute bacterial prostatitis that is NOT nosocomial
quinolones - cipro/levo/moxi
aminoglycosides ex- gentamicin, tobramycin, streptomycin
treatment includes carbapenem, broad spectrum PCN +/- aminoglycoside, broad spectrum ceph +/- aminoglycoside
nosocomial acute bacterial prostatitis
ceph - cefdinir, cefipime
pcn - ampicillin
treatment includes bactrim, levo, cipro.
oral abx tx for acute bacterial prostatitis
pain that is dull, poorly located, in suprapubic, perineal or low back regions.
chronic bacterial prostatitis
this could also be in nonbacterial prostatitis, CPPS
DRE showing boggy/spongy, tender, enlarged and/or indurated prostate
chronic bacterial prostatitis
positive urine culture AFTER prostatic massage
chronic bacterial prostatitis
lipid laden macrophages and WBCs in prostate secretions
chronic bacterial prostatitis
flouroquinolones or bactrim is used in treatment of what
chronic bacterial prostatitis
all negative tests except perhaps WBCs on the prostatic secretions MAYBE
nonbacterial prostatitis or CPPS
treated with 5-a reductase inhibitors
nonbacterial prostatitis or CPPS
which alpha blockers are used for urinary symptoms that have less SE?
tamsulosin
sildosin
alfuzosin
this medication causes relaxation in bladder neck and smooth muscle in the prostate
alpha blockers (tamsulosin, sildosin, alfuzosin)
not recommended in young men d/t decreased semen volume
5-a-reductase inhibitors
finasteride
dutasteride
what parts of the prostate are increased in BPH
glandular and stromal components
presents with mainly obstructive voiding that is slow onset and gradually progresses
BPH
hypertrophy, hyperplasia and collagen deposition are the causes of what
BPH irritative voiding s/s
DRE showing smooth, firm, symmetric, elastic enlargement of prostate
BPH
induration or assymetric enlargement of prostate
cancer
normal UA, may see slight elevation in PSA
BPH
when is US indicated in BPH
high serum Cr or UTI
watchful waiting indicated when
mild BPH = AUA score of 0-7
SE for orthostatic hypotension, dizziness, and floppy iris syndrome
alpha 1 blockers
DDI with antihypertensives and PDE-5 inhibitors
alpha blockers
converts testosterone to dihydrotestosterone
5-4-redutase inhibitor
takes 6 months to see the full benefits of this drug
5-a-reductase inhibitors
reduces prostate side by 20%
5-a-reductase inhibitors
SE decreased libido and erectile/ejaculatory dysfunction
SE of 5-a-rductase inhibitors
what is the affect of NSAIDS, smoking and ETOH on risk of BPH
decreases risk of developement
if a patient has gross hematuria or recurrent UTIs how would it affect their treatment plan for BPH
they would NOT be a candidate for watchful waiting
also not a candidiate:
- refractory urinary retention
- large bladder diverticula
- bladder stones
- CKD
MC used surgical tx for BPH
TURP
pt after surgery has complaints of HTN, confusion, NV, and seiuzres
transurethral resection syndrome
also see:
bradycardia
coma
visual disturbances
spasms
what sugircal intervention is used if the prostate is over 100 grams
open/robotic simple prostatectomy
which minimally invasive prostate treatments use heat to treat BPH
- TULIP (i guess cuz technically its a laser)
- TU - electrovaporization
- TUNA (radiofrequency waves)
- hyperthermia
- rezume (vapor thermal treatment)
a patient presents with obstructive voiding s/s and hx of multiple vertebral fractures
probs prostate cancer
elevated alk phos/hypercalcemia
bony metastases in prostate cancer
a patient has prostate cancer that is confined to the prostate and is palpable on exam. what stage is it?
stage T2
reminder:
T1 - Clinically inapparent (not seen on imaging or palpated
on exam) - elevated PSA only
T2 - Tumor confined within prostate, visible or palpable
T3 - Tumor extends through prostate capsule, may invade seminal vesicles
T4 - Tumor is fixed or invades adjacent structures
removal of seminal vesicles, ampulla of vas deferens and the prostate is known as what
radical prostatectomy
glycoprotein produced only by cells of the prostate gland
PSA
when should you discontinue DRE and PSA screening
- PSA <1.0 at age 65
- PSA <3.0 at age 75
- Life expectancy < 10 years
thiazides, statins, NSAIDS and 5-a reductase inhibitors all have this in common
they all reduce PSA!!!!!!
