Men's Health
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| 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
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| Sx of ABP | Fever, Chills, Dsyuria, Perineal Pain, Low back pain, irritative voiding sx, urinary retention
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| labs for ABP | CBC - leukocytosis, UA - pyuria, bacteriuria, possibly hematuria
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| PE of ABP | Distended bladder, DRE (be gentle if you do it): warm, boggy, tender.
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| TX of ABP | Abx tx 4-6 weeks, urinary retention requires suprapubic catheterization. Intraurethral is CI in ABP
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| ___ Prostatitis is assciated with recurrent UTIs | Chronic Bacterial Prostatitis
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| 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)
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| PE of CBP | Abdominal tenderness, testicular tenderness may be present. DRE IS NORMAL/prostate nontender (unlike ABP)
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| 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
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| Similar presenting feature of ABP and CBP | Irritative voiding
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| Non-Bacterial Prostatitis | Most common type of Prostatitis, uknown etiology, pathophysiology poorly understood.
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| 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
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| Clinical Manifestations of Non-Bacterial Prostatitis | Weak urine stream, urinary frequency, nocturia, decreased libido, ejaculatory pain, perineal pain, low back discomfort, groin pain, dysuria
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| 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
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| 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)
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| Prostatodynia Sx | same as CBP (no hx of UTIs), chronic pelvic pain, voiding sx, NORMAL DRE, Comorbidities include: depression and anxiety
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| Tx of Prostatodynia | Supportive measures, good patient communications, Alpha-Blockers, NSAIDs, TCAs (anticholinergic AEs improve urinary frequency and urgency sx)
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| 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
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| ED notes | Most cases have an organic cause, obtaining an erection is a neurovascular phenomenon,
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| 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
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| 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)
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| If tumenescence is present in the am/pm, ED may be | psychogenic
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| Possible causes | hyperlipidemia, htn, depression, neurological dz, DM, renal failure, adrenal disorders, thyroid dz, pelvic trauma, drug use, peyronie's dz, psychogenic (15%)
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| 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)
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| 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!
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| 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)
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| Other Tx of ED | Vacuum - constrictive devices, Penile Prosthesis implants (implanted in corporal body: rigid, malleable, hinged and inflatable types; 90% satisfaction rate)
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| Priapism | Prolonged erections; may cause cavernosal tissue fibrosis
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| Most common benign tumor in men | BPH. 90% of men by age of 80 or older. 50% of men age 51-60 affected
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| Sx of BPH | Obstructive Sx: hesitancy, incomplete emptying, post-voiding dribbling, decreased force, straining. Irritative sx: urgency, frequency, nocturia
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| 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
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| 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)
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| Invasive surgeries for BPH | TURP, TUIP, Open prostatectomy
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| Minimally invasive surgeries for BPH | TULIP, TUNA, Electro-vaporization (laser), Hyperthermia
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| 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
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| Most commonly used in cases involving smaller-sized prostate | TUIP
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| _____ is commonly used in patients with large prostate glands (>100g). It is indicated for patients with bladder diverticulum or stone. | Open prostatectomy
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| 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
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| TUNA procedure | Radiofrequency needle used to heat tissue causing necrosis & microwaves used to heat prostate tissue causing necrosis
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| Normal prostate size | 20grams, approximately 2 fingerbreadths on DRE.
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| Primary cause of prostate gland enlargement | Cell proliferation within the "transition zone"
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