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1

NIH Classification of prostatis (4)

I. Acute bacterial prostatitis II. Chronic bacterial prostatitis IIIA. Chronic prostatitis/pelvic pain syndrome, inflammatory IIIB. Chronic prostatitis/pelvic pain syndrome, noninflammatory IV. Asymptomatic inflammatory prostatitis

2

Granulomatous prostatitis is diagnosed by the histologic finding of ____ with or without other inflammatory cells. It is commonly found on specimens from ___ and ____

Granulomatous prostatitis is diagnosed by the histologic finding of epithelioid granulomas with or without other inflammatory cells (Uzoh et al., 2007). It is commonly found on specimens from transurethral resections and prostate biopsies

3

IgG4-related disease is a fibroinflammatory condition characterized by several features: tendency to form __ at multiple sites, __ and ___, ___, and often, but not always, elevated levels of serum IgG4

IgG4-related disease is a fibroinflammatory condition characterized by several features: tendency to form tumorlike lesions at multiple sites, dense infiltrate of lymphocytes and IgG4 +plasma cells, characteristic pattern of fibrosis, and often, but not always, elevated levels of serum IgG4

4

Category I Prostatitis: Acute Bacterial Prostatitis

Risk factors for the development of acute prostatitis include: (7)

Risk factors for the development of acute prostatitis include
unprotected sexual intercourse, specifically insertive anal intercourse, phimosis, condom catheter use, indwelling urethral catheters, and urinary tract instrumentation, including endoscopic procedures and prostate biopsy

5

The presentation of category I prostatitis is acute symptoms of a urinary tract infection (UTI), characteristically including __ and ___. Some patients have symptoms suggestive of systemic infection, such as malaise, fever, and myalgias

The presentation of category I prostatitis is acute symptoms of a urinary tract infection (UTI), characteristically including urinary frequency and dysuria. Some patients have symptoms suggestive of systemic infection, such as malaise, fever, and myalgias

6

. Acute prostatitis should be considered in any man who presents with a febrile UTI. Febrile UTI in men can be from pyelonephritis, acute cystitis, or prostatitis

bacteria also have significantly higher rates of septicemia (Kim et al., 2015). Acute prostatitis should be considered in any man who presents with a febrile UTI. Febrile UTI in men can be from pyelonephritis, acute cystitis, or prostatitis

7

Acute prostatitis is the one situation in which one may palpate a truly ___  from __ and __. The prostate is tender and swollen in__of cases

Acute prostatitis is the one situation in which one may palpate a truly “boggy” prostate from edema from inflammation. The prostate is tender and swollen in 60% to 90% of cases

8

in acute bacterial prostatitis: Caution should be used to avoid __  that could lead to bacterial dissemination and sepsis.

Caution should be used to avoid aggressive palpation that could lead to bacterial dissemination and sepsis.

9

Antibiotics are the mainstay of therapy for acute bacterial prostatitis. The most recent European Association of Urology (EAU) guidelines on treating UTIs recommend the parenteral administration of high-dose bactericidal antibiotics such as a broad-spectrum ___, ___ cephalosporin, or a ____. In initial therapy, any of these can be combined with an aminoglycoside

Antibiotics are the mainstay of therapy for acute bacterial prostatitis. The most recent European Association of Urology (EAU) guidelines on treating UTIs recommend the parenteral administration of high-dose bactericidal antibiotics such as a broad-spectrum penicillin, third-generation cephalosporin, or a fluoroquinolone. In initial therapy, any of these can be combined with an aminoglycoside

10

___ should be suspected in men with high fever or a history of immunosuppression such as diabetes or HIV or who do not respond to initial therapy after 48 hours

Prostatic abscess should be suspected in men with high fever or a history of immunosuppression such as diabetes or HIV or who do not respond to initial therapy after 48 hours

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__ should   be   used   if   long-term   drainage   is   needed.

A   suprapubic   tube   should   be   used   if   long-term   drainage   is   needed.

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Chlamydia spp. can cause prostatic infection by an a___ after urethral inoculation in animal models (Pal et al., 2004). The main argument is the difficulty of attributing the findings of Chlamydia spp. in the __ or ___ to prostate infection alone given the possibility of urethral contamination, as Chlamydia spp. are a common cause of urethritis

Chlamydia spp. can cause prostatic infection by an ascending route after urethral inoculation in animal models (Pal et al., 2004). The main argument is the difficulty of attributing the findings of Chlamydia spp. in the expressed prostatic secretions or semen to prostate infection alone given the possibility of urethral contamination, as Chlamydia spp. are a common cause of urethritis

13

prostatitis dx: The diagnosis is currently made by the ___ and ___ test also called the ____. The VB3 specimen gives information as to a persistent prostatic source of bacteria. The patient provides a midstream pre-massage urine specimen and a urine specimen (____) after prostatic massage to obtain ___

The diagnosis is currently made by the pre-massage and post-massage test (or two-glass test). The VB3 specimen gives information as to a persistent prostatic source of bacteria. The patient provides a midstream pre-massage urine specimen and a urine specimen (initial 10 mL) after prostatic massage to obtain expressed prostatic secretions (EPS)

14

prostatis : In men with human immunodeficiency virus (HIV), cultures should be sent not only for the usual bacteria but also for:

more atypical organisms, including anaerobes, anaerobes, fungi, and TB

15

chronic prostatis dx: Urine should be assessed for ___. If present in the setting of infection, it should be rechecked ___ after resolution of infection to look for resolution of the hematuria. Persistent hematuria should prompt an evaluation. Physical examination should evaluate for ___. Abdominal examination is necessary to rule out other causes of abdominal/suprapubic pain. Scrotal examination is needed to evaluate for any associated areas of inflammation and possible infection such as the___ and ___. A digital rectal examination is indicated to look for prostate size and any abnormalities to suggest prostate cancer. It is important to assess for bladder outlet obstruction and urinary retention. Retention of urine may predispose to recurrent urinary tract infection. A postvoid residual urine of more than ___ has been correlated with increased risk of infection

Urine should be assessed for hematuria. If present in the setting of infection, it should be rechecked 4 to 6 weeks after resolution of infection to look for resolution of the hematuria. Persistent hematuria should prompt an evaluation. Physical examination should evaluate for fever. Abdominal examination is necessary to rule out other causes of abdominal/suprapubic pain. Scrotal examination is needed to evaluate for any associated areas of inflammation and possible infection such as the epididymis and testis. A digital rectal examination is indicated to look for prostate size and any abnormalities to suggest prostate cancer. It is important to assess for bladder outlet obstruction and urinary retention. Retention of urine may predispose to recurrent urinary tract infection. A postvoid residual urine of more than 180 mL has been correlated with increased risk of infection

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chronic prostatis: Imaging is not recommended/ recommended for men with a UTI and history of diabetes, chronic kidney disease, stones, voiding difficulties, neurologic disease, poor response to antibiotics, infection with urea-splitting bacteria, or hematuria more than 1 month after the infection

Imaging is recommended for men with a UTI and history of diabetes, chronic kidney disease, stones, voiding difficulties, neurologic disease, poor response to antibiotics, infection with urea-splitting bacteria, or hematuria more than 1 month after the infection

17

PRostatitis tx: Penetration into the prostate, therefore, is dependent on ___, and the factors that influence this transport are :(5)

preferred meds used: ___

The prostate capillary bed lacks active transport mechanisms for antibiotics. Penetration into the prostate, therefore, is dependent on passive transport (no capillary bed), and the factors that influence this transport are drug concentration, lipid solubility, degree of ionization or charge, degree of protein binding, and size and shape of the molecule

18

chronic prostatis tx: __ and ___ are the antibiotics of choice not only because of their tissue penetration but also because of their spectrum of coverage, which includes gram-negatives, including Pseudomonas, gram-positives, and atypical pathogens such as Chlamydia spp. and genital Mycoplasma spp. Duration of treatment is based on expert opinion; the recommendation is ___

Fluoroquinolones such as ciprofloxacin and levofloxacin are the antibiotics of choice not only because of their tissue penetration but also because of their spectrum of coverage, which includes gram-negatives, including Pseudomonas, gram-positives, and atypical pathogens such as Chlamydia spp. and genital Mycoplasma spp. Duration of treatment is based on expert opinion; the recommendation is 4 to 6 weeks.

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chronic prostatis tx : Beyond Quinolones

give examples

cefoxitin

Piperacillintazobactam achieves prostatic levels that would be adequate to treat infections from E. coli, Klebsiella, and Proteus but not adequate levels to treat Pseudomonas

fosfomycin has in vitro activity against E. coli with antimicrobial resistance, includingChapter 56 Inflammatory and Pain Conditions of the Male Genitourinary Tract
ESBL strains

For patients whose symptoms are refractory to medical therapy, TURP has been used with results of 52% to 67% of patients responding to TURP down to the surgical capsule

20

Not all patients with chronic bacterial prostatitis need imaging.
In men younger than 45 years old with a first event of acute UTI, imaging showed no abnormalities. It is recommended, however, in this group to rule out ___. Men with a flow rate of more than ___ should be further evaluated

Not all patients with chronic bacterial prostatitis need imaging.
In men younger than 45 years old with a first event of acute UTI, imaging showed no abnormalities. It is recommended, however, in this group to rule out urethral stricture. Men with a flow rate of more than 15 mL/min should be further evaluated

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The term prostatitis implies inflammation of the prostate gland. However only about __ of men with clinical CPPS have been found to have prostatic inflammation on biopsy

The term prostatitis implies inflammation of the prostate gland. However only about one-third of men with clinical CPPS have been found to have prostatic inflammation on biopsy

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CPPS: On awakening, serum cortisol levels rise; there is a significantly ____ in men with CPPS compared with controls. Men with CPPS also have a lower/higher  ___ level and blunted ACTH rise in response to stress than men without symptoms

On awakening, serum cortisol levels rise; there is a significantly greater cortisol rise in men with CPPS compared with controls. Men with CPPS also have a lower baseline adrenocorticotropic hormone (ACTH) level and blunted ACTH rise in response to stress than men without symptoms

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There have been few biomarkers that correlate with symptoms in CP/CPPS. One of these markers is ___), a neuropeptide that plays a role in nociception

There have been few biomarkers that correlate with symptoms in CP/CPPS. One of these markers is nerve growth factor (NGF), a neuropeptide that plays a role in nociception

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CPPS symptoms: severe symptom was ___, followed by urinary frequency and obstructive voiding symptoms. The most frequent site of pain was the __

severe symptom was pain in the pelvic region, followed by urinary frequency and obstructive voiding symptoms. The most frequent site of pain was the perineum

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The prevalence of ED in men with CP/CPPS is reported at ___

The prevalence of ED in men with CP/CPPS is reported at 15% to 40%

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men with CP/CPPS were ___ more likely to self-report a history of cardiovascular disease, most commonly hypertension. A follow-up study by Shoskes et al. found ___ in men with CPPS compared with controls

men with CP/CPPS were six times more likely to self-report a history of cardiovascular disease, most commonly hypertension. A follow-up study by Shoskes et al. found greater arterial stiffness in men with CPPS compared with controls

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Men with CP/CPPS were__ more likely to self-report a history of nervous system disease compared with asymptomatic age-matched controls

Men with CP/CPPS were 5 more likely to self-report a history of nervous system disease compared with asymptomatic age-matched controls

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UPOINT: THE “SNOWFLAKE HYPOTHESIS”: the largest domain has been __ and ___, and the smallest domain has been the __ category. Men with CP/CPPS generally are characterized by multiple domains. In an early description, only one in five men were positive for only one domain, one-third of men were characterized by two domains, and the rest by three or more domains

UPONT snowflake theory: the largest domain has been organ-specific and urinary, and the smallest domain infectious category. Men with CP/CPPS generally are characterized by multiple domains. In an early description, only one in five men were positive for only one domain, one-third of men were characterized by two domains, and the rest by three or more domains

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Evaluation for Men With Chronic Pain and Chronic Pelvic Pain Syndrome: enumerate

Mandatory

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Evaluation for Men With Chronic Pain and Chronic Pelvic Pain Syndrome:

recommended

Optional