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clin med GU > Dz of prostate > Flashcards

Dz of prostate Flashcards

(66 cards)

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1
Q

what is LUTs

A

lower urinary tract symptoms
effects 15-50% of men >40yo
pt impact increased risk of falls, decreased QOL, depression and Impaired ADL

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2
Q

causes of LUTS

A

dysfuntion of bladder, prostate
neurologic dz
medical condition
medications

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3
Q

normal bladder function

A

stores 300-500ml of urine

empties to completion after urge

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4
Q

abnormal function (failure to store)

A

voiding small amounts frequently
uncontrollable urge
incomplete emptying

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5
Q

function of prostate gland

A

Secretes prostatic fluid that is a thin, milky substance w/ an alkaline pH

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6
Q

overactive bladder syndrome

A

syndrome including urinary urgency w or w/o incontinence and urinary freq and noctura

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7
Q

BPH

A

asymptomatic microscopic detection of prostatic hyperplasia, the benign proliferation of the prostate stoma and epithelium

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8
Q

LUTS storage issues

A 
urgency
frequency
noctuira
urge incontinence
stress incontinence
overflow incontinence
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9
Q

LUTs voiding

A 
hesitancy
poor flow/weak stream
intermittency
straining to void
terminal dribbling
prolonged urination
urinary retention
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10
Q

how to determine cause of symptoms

A

weak flow think prostate
voiding small amounts think bladder
good flow, norm volume thing other medical conditions

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11
Q

take home message about OAB and BPH

A

40-50% of men have coexisting symptoms

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12
Q

OAB tx

A

anticholinergics, antimuscarinic
bladder training, biofeedback, pelvic floor muscle therapy, electrical stimulation
surgical if necessary

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13
Q

OAB tx guidelines by AUA/SUFU

A

1st line: behavioral therapy and +/- pharmacologic therapy
2nd line: anticholingergics antimuscarinics
3rd line: surgery

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14
Q

OAB pharmacologic agents

A

Solifenacin
Oxybutinin
Fesoterodine
Tolterodine

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15
Q

BPH

A

MC benign tumor in men
genetic componenet
incidence increased w/age reaching 90% by 70’s

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16
Q

BPH patho

A

characterized by proliferation of prostate dihydrotestosterone (DHT) is the major hormone responsible for DHT

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17
Q

BPH s/s

A

obstructive/ irritative symptoms
chronic obstruction predisposes to recurrent UTI
Acute urinary bladder obstruction

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18
Q

BPH PE

A

complete GU/GI
prostate exam: comment on the size and consistency of gland thought this does not correlate to severity of symptoms
neuro exam

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19
Q

BPH labs

A

U/A exclude infection and hematuria: normal
PSA- used when screening for prostate CA in combo with DRE
use is controversial

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20
Q

BPH imaging

A

CT or Renal U/S only if there is presence of other urinary tract dz or complications of UTI
Cystoscopy only if considering surgery to help determine what approach to use

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21
Q

BPH tx

A

based on severity of dz
watchful waiting reserved for pts with mild dz and UAS score 0-7
medical therapy
surgery

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22
Q

BPH medical therapy

A

alpha blockers
a-1 blockers
a-2 blockers
5α-reductase inhibitors

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23
Q

alpha blockers MOA

A

relax smooth muscle in the bladder neck and prostate gland reducing bladder outlet obstruction and increasing peak urinary flow rates

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24
Q

alpha 1 blockers

A

requires dose titration
S/E: orthostatic hypoHTN, dizziness, fatigue, ejaculation, rhinitis
Ex: terazosin, Doxazosin, Prazosin

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25
alpha 1a blockers
receptors are localized to prostate and bladder neck therefore fewer side effects Ex: Tamsulosin, Silodosin
26
5α-reductase inhibitors MOA
MOA blocks the conversion of testosterone to dihydrotestosterone decreases prostate size reduces baseline PSa 50%
27
5α-reductase inhibitors | drugs
Finasteride | Dutasteride
28
PDE-5 inhibitor MOA
enhances smooth muscle relaxation in prostate, bladder and urethra Not used 1st line Used to tx s/s of BPH in men w/ urinary symptoms and ED
29
PDE-5 inhibitor drugs
Tadalafil, Sildanefil, Vardenafil
30
BPH combo therapy
α-blocker + 5α-reductase inhibitors have been shown to reduce the risk of progression of dz and reduce the long term risk of acute urinary retention and need for invasive surgery
31
BPH tx for small prostate and low PSA and IPSS <7
watchful waiting
32
BPH tx for prostate large, PSA high and IPSS <7
5 alpha reductase
33
BPH tx for moderate or severe symptoms with small prostate and low PSA level, IPSS>7
alpha blocker
34
BPH tx for moderate to severe symptoms with large prostate and high PSA, IPSS>7
5 alpha reductase | or in combo with alpha blocker
35
BPH surgery
TURP transurethral resection of the prostate endoscopic prostatectomy
36
TUIP
used in men w/mod to severe symptoms and small prostate w/ posterior commissure hyperplasia or elevated bladder neck
37
Open simple prostate
performed when prostate is too large to remove endoscopically
38
acute bacterial prostatitis
caused by E.coli and pseudomonas where bacteria ascents up the urethra and reflux of infected urine into prostate ducts
39
acute bacterial prostatitis symptoms
perineal, sacral, surapubic pain fever irritative voiding complaints
40
acute bacterial prostatitis PE
fever | warm and tender prostate feels boggy
41
acute bacterial prostatitis labs
CBC will show leukocytosis w/ left shift U/A pyuria, bacteriuria and hematuria GC/Chl probe if risk for STD Urine culture will be positive
42
acute bacterial prostatitis umcomplicatied age<35 risk of STD tx
treat as an STD | Ceft 250mg IM or Cefixime plus doxy
43
acute bacterial prostatitis umcomplicatied age>35 low risk of STD tx
Fluoroquinolone (cipro, levo or bactrim)
44
acute bacterial prostatitis hospitalization
``` paranteral antibiotics (ampicilling and aminoglycosides) till sensitivity Urethral catheterization or instrumentation CI ```
45
chronic bacterial prostatitis
may evolve from acute bacterial prostatitis
46
chronic bacterial prostatitis symptoms and PE
``` symptoms: irritative voiding low back pain perineal and suprapubic discomfort dysuria many pts report hx of recurrent UTI PE: unremarkable and afebrile prostate may feel normal or boggy ```
47
chronic bacterial prostatitis labs
U/A normal Expressed prostate reveals leukocytes Positive culture of prostate secretions or post prostatic message
48
chronic bacterial prostatitis tx
bactrim Ciprofloxacin Olfloxacin NSAID and sitz bath
49
nonbacterial prostatitis
dx of exclusion | MC of all the prostatitis's
50
nonbacterial prostatitis presentation
mimics chronic bacterial prostatitis except no hx of UTI
51
nonbacterial prostatitis labs
all cultures are negative | Leukocytes expressed in prostatic secretions shows inflammation
52
nonbacterial prostatitis tx
NSAID or Sitz bath for symptomatic relief | diet restrictions if certain food make symptoms worse
53
prostatodynia
noninflammatory d/o that affects young and middle aged men
54
prostatodynia etiology
voiding dysfunction | pelvic floor musculature dysfunction
55
prostatodynia symptoms and PE
symptoms: irritative voiding, no UTI Hx hesitancy, interruption of flow and may describe lifelong hx of voiding trouble PE: prostate normal increased sphincter tone
56
prostatodynia labs
U/A normal prostatic secretion normal num of leukocytes Urodynamic testing may show voiding and pelvic floor dysfunction
57
prostatodynia tx
``` sitz bath biofeedback to help with muscle dysfunction alpha blocking agents terazosin doxazosin ```
58
ED
inability to attain or maintain erection for sex
59
ED is higher is these populations
DM, Obesity, BPH, HTN, Low HDL, cardiovascular dz
60
ED RF
``` smoking spinal cord injury Hx of radiation or surgery of prostate meds psychosocial ```
61
Ed patho
failure to initiate failure to fill failure to store adequate blood volume in lacunar network
62
MC type of ED
Vasculogenic-distrubance of blood flow to and from penis | Other is Neurogenic from d/o that affect the spine
63
ED med induced
thiazides, B-blockers, CCB, digoxin, SSRI, TCA
64
ED Tx
``` Lifestyle changes: weight loss, exercise, smoking cessation, deccrease alcohol, refrain from recreation drugs PDE-5 inhibitors Testosterone therapy Penile devices Psychological therapy surgery ```
65
ED PDE-5 inhibitors
treats psychogenic, diabetic, vaculogenic onset 60-120 min CI w/ men using nitrates, CHF or cardiomyopathies
66
other ED tx
testosterone for hypogonadism Vacuum constrictive devices Intraurethral alprostadil Infracavernosal injectiong

clin med GU (6 decks)

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