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DU PA BPH, ED, Prost
Duke PA BPH, ED, Prostatitis
| Question | Answer |
|---|---|
| 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
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