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nephrology > prostate disorders > Flashcards

prostate disorders Flashcards

1
Q
  • result of direct inoculation, transrectal prostate bx, or transurethral manipulation (Pseudomonas); mostly d/t E coli
  • acutely ill w/ fevers, malaise, myalgia, etc, voiding sxs, pelvic/perineal ache, cloudy urine
  • h.o trauma (fall on perineum, bikes, horses)
  • DRE shows firm edematous tender prostate
  • labs show leukocytosis, pyuria, bacteriuria, high ESR/CRP, high PSA
A

Prostatitis - enlarged prostate that compresses urethra
dx based on symptoms; blood cultures not needed, UA cultures/stain can guide tx
emprically treated

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2
Q

what two things should you r/o in HIV positive pts w/ acute prostatitis?

A

salmonella typhi
GC

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3
Q

likely bacterial etiology for prostatitis in person who traveled to SE asia or northern australia

A

burkholderia pseudomallei

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4
Q

palpable urinary bladder indicates what?

A

urinary retention

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5
Q

if staph aureaus is cultured from UA, what should you do?

A

do blood cultures

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6
Q

5 possible complications of acute prostatitis?

A

bacteremia
epididymitis
chronic prostatitis
prostatic abscess
metastatic infection– endocarditis, spinal/sacroiliac infection

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7
Q

3 main treatments of acute prostatitis? in case of post-prostatic surgery?

A
  • Cipro 500mg BID PO x 6 wks
  • Levo 500 mg PO x 6 wks
  • TMP-SMX one PO BID x 6 wks
  • post-prostatic surgery: IV carbapenem or broad PCN or ceph. if they got prophylactic fluoroquinolones
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8
Q

when treating acute prostatitis, if fever persists and doesn’t tred downward, what should you do?

A

r/o prostate abscess

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9
Q

what is the condition? how is it treated?

  • recurrent UTI in male
  • normal DRE or boggy or firm
  • E.coli with higher virulence factor & greater biofilm formation than acute
A

chronic prostatitis
- same as acute but for 12 wks instead

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10
Q
  • proliferation of glandular tissue, smooth muscle & connective tissue starting at age 40-45
  • LUTS sx: storage/irritative (frequency, urgency, nocturia, incontinence) & voiding sx (weak stream, straining, hesitancy/intermittency)
  • nontender, enlarged prostate on DRE
  • complications include acute urinary retention, UTI, bladder stone, diverticula, renal or ureter damage
A

BPH
NOT a risk factor for prostate cancer

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11
Q

what labs & studies should you get for BPH? (4)

A
  • Labs: UA
  • sx questionnaire @ each visit (8-19 is moderate BPH)
  • post void residual volume (cath or US)- concern if over 250ml
  • Uroflometry– documents amount of obstruction
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12
Q

who should get urology referral? (8)

A
  • severe sx
  • under 45 yo
  • DRE abnormality
  • hematuria
  • elevated PSA
  • dysuria
  • incontinence
  • retention
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13
Q

1st line tx of BPH

A
  • lifestyle modifications–includes kegels, timed voiding, double voiding
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14
Q
  • initial medical tx for BPH w/ improvement seen in days
  • causes bladder neck and prostatic urethra smooth muscle relaxation
  • SE: hypotension, dizziness (bedtime dosing)
A

alpha adrenergic blockers–terazosin, tamsulosin, doxazosin
- extended duration 2nd gen single daily dose
- monitor BP when starting; lower incidence if increased titrated dosing
- hypotension worsened w/ PDE5 (except tamsulosin)

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15
Q

what is this condition? how do you prevent it?

  • associated w/ cataract operations
  • triad: intraoperative miosis (despite preop dilation), iris prolapse & billowing flaccid iris
A
  • intraoperative floppy iris syndrome
  • avoid starting alpha blockers (esp tamsulosin) if planned cataract surgery
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16
Q
  • this class is great for BPH + ED
  • relaxes bladder & prostate smooth muscle fibers by NO/cGMPc signaling or by improving RhoA/Rho-kinase (ROCK) and reducing ANS hyperactivity
  • no change in urine flow rates; slight improvement with increased ADRs
  • SE: HA, flushing, dyspepsia, congestion, back pain, myalgias, sinusitis
A

PDE5 inhibitors
not better than alpha blockers

17
Q
  • best for prostates over 35g or over 1.5 on PSA
  • prevents progression of BPH but takes months (6-12mo. for max effect) for reduction
  • blocks conversion of testosterone to dihydrotestosterone
  • efficacious in tx LUTS d/t prostate enlargement
  • must take indefinitely to prevent relapse
  • SE: PSA suppression, reduced risk of prostate cance by higher level of high grade prostate cancer, sexual dysfunction, teratogenicity if TOUCHED/ingested by female
A

5-alpha reductase inhibitors– finasteride & dustasteride

18
Q

with which class must you get baseline PSA before starting the meds? PSA can also tell if tx is working bc levels should decrease

A

5-ARI
- multiply PSA by 2 if treated more than 3 mo

19
Q

combo of what two meds is associated w/ higher sx reduction, reduction in progression, retention, renal insufficiency, recurrent UTIs esp for those w/ larger prostates?

A

finastride + doxazosin

20
Q

combo of what two drugs showed improved BPH sx and progression esp for those w/ prostate volumes over 30 ml

A

dutastride + tamsulosin

21
Q

natural remedy that is a 5-alpha reductase inhibitor and has antiinflammatory effect

A

saw palmetto (serenoa repens)

22
Q

natural remedy that contains a beta-sitosterol which helps urine flowrates and sx scores

A

hypoxis rooperi (south african star grass)

23
Q

natural remedy with anti-inflammatory effects

A

pygenum africanum (african plum)

24
Q

6 indications for transurethral prostate resection

A
  • LUTS
  • refractory urinary retention (2+ failed tx)
  • recurrent UTI d/t BPH
  • recurrent gross hematuria (r/o other etiologies first)
  • recurrent bladder stones or calculi– sign of end stage bladder decompensation
  • bilateral hydronephrosis w/ renal impairment
25
Q

4 most common metastasis site for prostate cancer (in order)

A
  • bone
  • nodes
  • liver
  • thorax
26
Q

what is it? what 3 conditions is it ELEVATED?

  • secreted by epithelial cells for ejaculate to liquify semen & allow sperm to swim freely
  • dissolves cervical mucus for sperm entery into uterus
  • screening increases detection of prostate cancer in men
A

PSA
elevated in BPH, prostatitis and prostate cancer

27
Q

6 risk factors for prostate cancer

A
  • age
  • fam hx
  • ethnicity (Black men)
  • high fat diet
  • high serum B12 and folate
  • cigarette smoking
28
Q

what is used to confirm prostate cancer

A

prostate biopsy

29
Q

if PSA screening is planned for patient with prostatitis, what do you do?

A

defer PSA for one month till prostatitis is treated

30
Q

4 reasons to defer PSA screening anf for how long?

A
  • prostatis sx
  • retention or urethral instrumentation– wait 2 wks
  • recent biopsy or TURP– wait 6 wks
  • abstain from sex for 48hrs before test for most accurate result

it is OK to get PSA after DRE

nephrology (13 decks)

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