Prostate + UTI

Question 1

RF for prostate cancer

Answer 1

Urban african americans
Family history
High dietary fat
Smoking

Question 2

Sx of prostate cancer

Answer 2

Asymptomatic
LUTS - storage, voiding, incontinence
LBP (mets)

Question 3

Rx of prostate cancer (low, intermediate + high risk)

Answer 3

Low risk = active surveillance (PSA q6mo, DRE annually)
Intermediate risk = radical prostatectomy, brachytherapy, RT, PSA q6mo for 5 yrs
High risk = RT, androgen deprivation therapy, radical prostatectomy, radical RT, PSA q6mo

Question 4

Complications of radical prostatectomy, radiation + mets

Answer 4

Radical prostatectomy: urinary incontinence
Radiation: bowel dysfunction, erectile dysfunction
Mets: adrenal gland, bone, liver, lung

Question 5

Ix for prostate cancer

Answer 5

Order PSA if abnormal DRE, LUTS, FU of man w/ prostate cancer
Free PSA <10% suggestive of cancer
Don’t order if life expectancy <10 yrs

Question 6

RF for BPH

Answer 6

Age
Obesity
Fam hx

Question 7

Sx of BPH

Answer 7

LUTS - storage, frequency, incontinence, nocturia, hesitancy, weak stream, intermittance, straining, dribbling, incomplete void, retention
Erectile dysfunction

Question 8

Ix for BPH

Answer 8

UA
PSA if life expectancy >10 yrs

Question 9

Lifestyle management of BPH

Answer 9

Fluid restrict at bedtime
Avoid alcohol, caffeine, spicy food
Avoid irritating meds (TCAs, diuretics, antihistamines)
Bladder training
Pelvic floor exercises
Urethral milking

Question 10

Medications for BPH

Answer 10

Alpha blocker (Tamsulosin)
5-alpha reductase inhibitors (Finasteride)
Combo best if symptomatic LUTS + enlarged prostate
DC alpha blocker after 6mo
Desmopressin

Question 11

Alpha blocker (Tamsulosin) monitoring, effectiveness + SE

Answer 11

Monitor BP
Reduces LUTS but not dz progression
SE: HA, dizziness, somnolence, postural hypotension

Question 12

5-alpha reductase inhibitors (Finasteride) uses, SE

Answer 12

Only if enlarged prostate on DRE
Shrinks prostate, reduces retention
Used best in conjunction with alpha blocker
SE: ED, reduced libido

Question 13

Use of desmopressin

Answer 13

Good for nocturnal polyuria

Question 14

Surgical options for BPH

Answer 14

Mono or bipolar transurethral resection of prostate
Bipolar plasma kinetic vaporization
Prostatectomy

Question 15

Irritative vs obstructive sx of BPH

Answer 15

Irritative: frequency, urgency
Obstructive: weak stream, hesitancy, incomplete voiding

Question 16

Pathogens causing prostatitis

Answer 16

E coli, pseudomonas, proteus, enterobacter, enterococcus

Question 17

RF prostatitis

Answer 17

indwelling catheter, DM, immunosuppression, perineal trauma

Question 18

Sx prostatitis

Answer 18

UTI sx, irritative + obstructive voiding sx, fever, pain in lower back, exquisitely tender prostate

Question 19

Acute + chronic rx of prostatitis

Answer 19

Acute = Septra 2 tabs BID
Chronic = levofloxacin 500mg

Question 20

RF for UTI

Answer 20

Sexually active
Diaphragm use
Not voiding after sex
New sexual partner
Vesicoureteral reflux
Posterior urethral valves

Question 21

Causes of UTI

Answer 21

Causes:
Klebsiella
E coli
Enterobacter
Proteus
Staph

Question 22

What makes a UTI complicated?

Answer 22

Complicated UTI:
Male
Pregnancy
Catheterisation
Anatomical abnormalities
Chronic renal dz
T2DM
Immunosuppressed

Question 23

Ix for UTI (adults + kids under 2)

Answer 23

UA: nitrites, leuks, blood
UC if complicated, peds, recurrent or pyelo
RBUS for <2y/o
Voiding Cystourethrogram if abnormal RBUS or <2y/o + 2nd UTI

Question 24

Rx for UTI

Answer 24

Management:
Nitrofurantoin 100mg BID 5/5
1-2w if nursing home
Trimethoprim for kids 1-2w
Ciprofloxacin 500mg BID x1-2w for pyelonephritis or complicated UTI

Question 25

Other causes of dysuria

Answer 25

STI
Vaginitis
Stones
Interstitial cystitis
Prostatitis