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