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DU PA BPH, ED, Prost

Duke PA BPH, ED, Prostatitis

Define erectile dysfunction Consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse
Most cases of male erectile disorders have __ cause Organic rather than psychogenic
The neurotransmitters that initiate and contribute to male erection include__ Nitric oxide, vasoactive intestinal peptide, acetylcholine, and prostaglandins
A loss of libido may indicate __ androgen deficiency on the basis of either hypothalamic, pituitary, or testicular disease.
Loss of erections may result from __ Arterial, venous, neurogenic, or psychogenic causes
Many medications, especially __ are associated with erectile disorders Antihypertensives
__ medications rarely alter erections Vasodilators, alpha blockers, and diuretic
Centrally acting sympatholytics (methyldopa, clonidine, reserpine) can result in __ Loss of erection
Beta blockers, and spironolactone may result in __ Loss of libido
The gradual loss of erectile function over a period of time is more indicative of __ Organic causes of erectile dysfunction
__ prior to intercourse has been effective in delaying ejaculation Clomipramine 25 mg
A complete recording of drug use should be made, since about __% of all cases of sexual dysfunction may be drug related 25
What laboratory values should be assessed with erectile/sexual dysfunction CBC, U/A, lipids, serum testosterone, glucose, prolactin
What further labs are needed if a patient has abnormal levels of testosterone or prolactin LH, and FSH to help localize the site of the disease to the hypothalamus, pituitary, or testes
What is the initial point in the pathway leading to penile erection Sexual stimulation (psychogenic or tactile)
Sexual stimulation causes the release of __ by the cavernous nerves into the neuromuscular junctions Nitric oxide
To achieve an erection decreased smooth muscle Ca+ concentration leads to __ Muscular relaxation, cavernosal artery dilation, and increased blood flow
Psychogenic causes of ED are now thought to represent <__% of patients seen by ED specialists 15
What is the anatomic site now believed to be the most common cause of ED Neuromuscular junction where the cavernosal nerves meet the smooth muscle and endothelium of the deep cavernous penile arteries
Testosterone plays a __ role in erectile dysfunction Permissive
What is the most common endocrine disorder affecting erectile ability Diabetes mellitus
What is the most important effect that diabetes has on erectile ability Loss of function of long autonomic nerves
Because of the uncommon occurrence of __ conditions in persons seeking treatment of ED, testing of theses axes is not part of the routine workup of ED thyroid and adrenal
90% of patients with ED respond to injected vasodilatory agents indicating that __ is not the cause of most cases of ED Atherosclerotic arterial narrowing
Afferent somatic sensory signals are carried from the penis via the __ pudendal nerve to S2-S4
The paired cavernosal nerves penetrate the corpus cavernosa and innervate the __ Cavernous artery and veins
Sympathetic innervation originates in the intermediolateral gray matter at what levels Thoracolumbar levels T10-L2
What is the most effective long term option for impotence treatment Penile prosthesis
>__% of all men will develop histological evidence of BPH during the course of their lifetime 90
__% of men with BPH will develop symptoms that will lead them to seek treatment 50
Lower urinary tract symptoms can be divided into what two categories Obstructive voiding symptoms and irritative voiding symptoms
What hormone is believed to be responsible for the development and maintenance of the hyperplastic cell growth characteristics of BPH Dihydrotestosterone
The development of BPH occurs predominantly in the __ Periurethral prostatic tissue referred to as the transition zone
Tissue growth in the transition zone of the prostate leads to what phenomenon Bladder outlet obstruction
What is the American Urological Association (AUA) symptom index for BPH A self administered validated questionnaire consisting of seven questions related to the symptoms of BPH and BOO
An AUA score of __ is considered mild 0-7
An AUA score of __ is considered moderate 8-19
An AUA score of __ is considered severe 20-35
What is the preferred first line treatment option for patients diagnosed with LUTS from BPH Medical management
Medical management is initiated for patients with __ AUA scores Moderate to severe
What are the indications for surgery in a patient with LUTS from BPH Refractory urinary retention, hydronephrosis with/ without renal impairment, recurrent UTI, recurrent gross hematuria, or bladder calculi; renal insufficiency; large postvoid residual volume
What is the driving factor for treatment of LUTS due to BPH The amount to which the patients symptoms are bothersome to him
What are the most common prescribed medication for the treatment of LUTS associated with BPH Alpha-adrenergic antagonists (doxazosin, terazosin, tamsulosin, and extended release alfuzosin)
This regimen is most effective in reducing symptoms and preventing disease progression in patients with large prostate glands (>40g) 5a reductase inhibition (finasteride and dutasteride)
What are the most widely used and studied phytotherapeutic extracts used for the treatment of LUTS associated with BPH Saw palmetto berry
What is considered the gold standard for surgical treatment of BPH Transurethral Resection of the Prostate (TURP)
What does TUMT stand for Transurethral microwave thermotherapy, one of the most widely studied minimally invasive methods of treating symptomatic BPH
What does TUNA stand for Transurethral Needle Ablation
What are the major benefits of the minimally invasive therapies for BPH (TUMT, Tuna) over the more invasive TURP The reduction in bleeding, fluid absorption, the risks associated with general or spinal anesthesia, decreased rates of incontinence, ED, bladder neck contractures, and urethral strictures, reduce hospital stay
What is the success rate for the heat based minimally invasive therapies for BPH 65-75% of patients with symptomatic reduction and flow rate improvement
What procedure produces the greatest improvement in both urinary flow rates and symptom score for BPH TURP
What complications are all higher with TURP than the less invasive therapies for BPH Urinary incontinence, retrograde ejaculation, and urethral stricture
__ is reserved for patients with severely large prostate glands Open surgical enucleation (prostatectomy)
Prostatitis is an extremely common clinical condition resulting in __% of office visits to a urologist 25
What is the most common urologic diagnosis in men younger than 50 years and is the third most common diagnosis in men older than 50 years Prostatitis
What is the most common symptomatic type of prostatitis and may be the most prevalent of all the prostate disorders Chronic nonbacterial prostatitis CPPS
Patients with acute bacterial prostatitis usually present with what symptoms Fever, chills, dysuria, perineal and low back pain
__ are recommended for the treatment of acute bacterial prostatitis because they reach excellent tissue levels within the prostate Fluoroquinolones
Although bacterial resistance and conversion to CBP is low it is beneficial to obtain __ Follow up urine culture to document clearance of the infection
__ is associated with inflammation of the prostate gland and recurrent urinary tract infections with bacteria localized to the prostate via standardized localization testing CBP
Symptoms of Chronic Bacterial Prostatitis Nonspecific but include LUTS, pelvic pain and or sexual dysfunction
__ are indicated for the treatment of CBP and must be tailored to the specific organism Trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone
__ is rarely indicated for patients with CBP Surgery
The NIH category __ makes up the largest percentage of patients with clinical prostatitis III chronic nonbacterial prostatitis
Patients with chronic nonbacterial prostatitis usually exhibit what symptoms Pain (perineal, low back, suprapubic, groin, scrotal), voiding dysfunction (dysuria, week stream, frequency, urgency, or nocturia), and/or sexual dysfunction (painful ejaculation or low libido)
The presence of __ is mandatory for the diagnosis of category III prostatitis Pelvic pain
Noninflammatory CPPS, aka prostadynia is typically seen in __ Younger males age 20-50 years
Patients with prostadynia usually exhibit pelvic pain and voiding symptoms but have __ Negative urine cultures, normal EPS,, and normal prostate on DRE
What is the most common benign tumor in men Benign prostatic hyperplasia
The usual etiologic agents of acute bacterial prostatitis Gram negative rods such as E. coli and Pseudomonas species
How long should antibiotic therapy for acute bacterial prostatitis last 4-6 weeks
Chronic bacterial prostatitis is associated with __ Recurrent UTI’s
DRE findings with chronic bacterial prostatitis Normal prostate exam
What are the symptomatic treatments for chronic bacterial prostatitis NSAIDS and Sitz baths
Acute bacterial prostatitis commonly presents with __ High fever, severely tender prostate on rectal exam
TCA’s can be used to treat pain associated with Prostatodynia
__% of all men suffer from some form of ED 50
What are the requirements for achieving an erection Intact penile nervous system, normal musculature, sufficient arterial blood flow (pudendal arteries), adequate resistance to penile venous outflow
Considered, by most urologists, as the single most useful tool for diagnosing BPH AUA symptom index
What is the normal size of the adult prostate 20g
The normal prostate is about the size of __ A walnut
Cell proliferation within the __ is the primary cause of prostate gland enlargement Transition zone
The prostate is about __ on the DRE 2 finger breadths
Meares-Stamey 4 glass test is for: Chronic bacterial prostatitis
Created by: bwyche