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Men CM BPH, Prostati
Men's Health
| Question | Answer |
|---|---|
| Acute Bacterial Prostatitis | Rarely occurs, commonly caused by gram negative, infection enters through the prostatic ducts. May lead to abscess in immunocompromised, or sepsis. May may look sick |
| Sx of ABP | Fever, Chills, Dsyuria, Perineal Pain, Low back pain, irritative voiding sx, urinary retention |
| labs for ABP | CBC - leukocytosis, UA - pyuria, bacteriuria, possibly hematuria |
| PE of ABP | Distended bladder, DRE (be gentle if you do it): warm, boggy, tender. |
| TX of ABP | Abx tx 4-6 weeks, urinary retention requires suprapubic catheterization. Intraurethral is CI in ABP |
| ___ Prostatitis is assciated with recurrent UTIs | Chronic Bacterial Prostatitis |
| Sx of CBP | non-specific, lower UTI sx, pelvic pain, sexual dysfunction. Labs: UA is normal. Prostatic secretion show elevated leukocyte count. Patients afebrile (unlike ABP) |
| PE of CBP | Abdominal tenderness, testicular tenderness may be present. DRE IS NORMAL/prostate nontender (unlike ABP) |
| Tx of CBP | difficult to tx b/c no inflammation/minimal vascularity. Symptomatic tx is best option: NSAIDs and sitz baths. Duration of tx is controversial 6-12 weeks. Long term abx tx may help in controlling recurrent UTIs |
| Similar presenting feature of ABP and CBP | Irritative voiding |
| Non-Bacterial Prostatitis | Most common type of Prostatitis, uknown etiology, pathophysiology poorly understood. |
| Notes on Non-bacterial Prostatitis | Absent hx of UTI (unlike CBP), Culture of Prostatic secretions is usually negative, Diagnosis of exclusion, very difficult to dx and tx |
| Clinical Manifestations of Non-Bacterial Prostatitis | Weak urine stream, urinary frequency, nocturia, decreased libido, ejaculatory pain, perineal pain, low back discomfort, groin pain, dysuria |
| Non-Bacterial Prostatitis has overlapping sx with _______ and may be difficult to differentiate | CBP. Can use NIH-CPSI to help differentiate. 4-6 weeks is acceptable with abx. Sitz baths and NSAIDs may be best. Educated on chronic nature of dz |
| Prostatodynia | Non-inflammatory, commonly seen in younger men 20-50 yo, quality of life significantly impacted, pathophysiology is poorly understood. (possibly pelvic floor and voiding dysfunction) |
| Prostatodynia Sx | same as CBP (no hx of UTIs), chronic pelvic pain, voiding sx, NORMAL DRE, Comorbidities include: depression and anxiety |
| Tx of Prostatodynia | Supportive measures, good patient communications, Alpha-Blockers, NSAIDs, TCAs (anticholinergic AEs improve urinary frequency and urgency sx) |
| ED epidemiology | Age and general health are common predictors. 10 million men/year affected. 50% of men have varying degrees of ED. 25% of men over age 65 experience ED |
| ED notes | Most cases have an organic cause, obtaining an erection is a neurovascular phenomenon, |
| Requirements in achieving an erection | Intact penile nervous system (NO, Acetocholine, Prostaglandin, VAP); Normal musculature (smooth muscle); Sufficient arterial flow (pudendal arteries); Adequate resistance to penile venous outflow |
| Questions to ask with ED | Libido level? (testosterone level is important, consider hypothalamus, pituitary adn testicular dys); Medical conditions? (DM/Vascular dz); Depression? (risk factor); Ask about am/pm tumenescence/rigidity (if present consider psychogenic causes) |
| If tumenescence is present in the am/pm, ED may be | psychogenic |
| Possible causes | hyperlipidemia, htn, depression, neurological dz, DM, renal failure, adrenal disorders, thyroid dz, pelvic trauma, drug use, peyronie's dz, psychogenic (15%) |
| Sequence of events in an erection | 1)psychogenic and tactile stimulation initiates erection; 2)sym and parasymp signals are transmitted to pelvic nerve plexus; 3)nerve signals activate vasoactive neurotransmitters (chiefly NO, others also) |
| Sequence of events in an erection continued | 4) stimulation cause of release of vasoactive neurotransmitters from cavernosal nerves; 5) Neurotransmitters cause dilateion and constriction of the penile blood vessels; 6) Penile blood flow increases; 7) erection achieved! |
| Tx of ED | stepwise starting with oral. Drug tx: Phosphodiesterase Inhibitors, Intra-urethral suppository therapy (PGE), cavernous injection, vascular reconstruction, Testosterone tx (onl in men with documented androgen deficiency, increases PSA monitor annually) |
| Other Tx of ED | Vacuum - constrictive devices, Penile Prosthesis implants (implanted in corporal body: rigid, malleable, hinged and inflatable types; 90% satisfaction rate) |
| Priapism | Prolonged erections; may cause cavernosal tissue fibrosis |
| Most common benign tumor in men | BPH. 90% of men by age of 80 or older. 50% of men age 51-60 affected |
| Sx of BPH | Obstructive Sx: hesitancy, incomplete emptying, post-voiding dribbling, decreased force, straining. Irritative sx: urgency, frequency, nocturia |
| Prostate on DRE in BPH | Smooth and non-indurated, firm, elastic (rubbery-feel), enlarged. Also be sure to examine the bladder for distention. Size of prostate does not correlate with sx presentation |
| Tx options for BPH | Watchful waiting (some men spontaneously improve), UA and culture (exclude infxn), Medication (alpha blockers and 5alpha reductase inhibitors), Surgery (conventional, minimally invasive) |
| Invasive surgeries for BPH | TURP, TUIP, Open prostatectomy |
| Minimally invasive surgeries for BPH | TULIP, TUNA, Electro-vaporization (laser), Hyperthermia |
| Gold standard invasive tx for BPH | TURP. Better flow rates compared to any minimally invasive procedure. Risks: 75% of retrograde ejactulation, 5-10% impotence, <1% incontinence |
| Most commonly used in cases involving smaller-sized prostate | TUIP |
| _____ is commonly used in patients with large prostate glands (>100g). It is indicated for patients with bladder diverticulum or stone. | Open prostatectomy |
| TULIP Procedure | guided by transrectal US, laser causes coagulation necrosis of the prostate, prostate tissue "sloughs"" away over several weeks. Two subtypes: Photo-vaporization:higher power laser used, Interstitial laser: fiberoptic instrument used |
| TUNA procedure | Radiofrequency needle used to heat tissue causing necrosis & microwaves used to heat prostate tissue causing necrosis |
| Normal prostate size | 20grams, approximately 2 fingerbreadths on DRE. |
| Primary cause of prostate gland enlargement | Cell proliferation within the "transition zone" |
Created by:
ltm12