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30 Cards in this Set
- Front
- Back
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what percentage of prostatitis is casued by acute bacterial prostatitis? what are some of the presenting features of acute bacterial prostatitis? |
acute bacterial prostatitis accounts for 5% of prostatitis. symptoms include: fever, chills, perineal or lower abdominal pain, dysuria, urinary frequency, urinary urgency, painful ejaculation, hematospermia. (AFP april 2013) |
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what are the examination and investigation findings in acute bacterial prostatitis? |
examination - tender boggy prostate, may have fever, may have sepsis investigation - urine dipstick and MCS (bacturia and pyruia), raised inflammatory markers. Blood culture if septic |
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what are the causative organisms for acute bacterial prostatitis? what is the initial outpatient treatment? |
Usually Escherichia coli, Proteus species, Klebsiella species). Rarely, sexually transmitted (eg Chlamydia trachomatis) or systemic pathogens (eg Burkholderia pseudomallei) cause infection. treat same as cystitis in men - triprim 300mg x 7days; or cephalexin 500mg BD x7 days; or augmentin duo BD x7days (eTG) |
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what are some complications of acute bacterial prostatitis and how would you manage these? |
1. not improving on oral therapy, sepsis - suspect prostate abscess. arrange CT or transrectal USS. Needs IVAB's and urological assessment, may need drainage. 2. Urine retention - relieve with suprapubic catheter. Urethral catheter is contraindicated and will make matters worse! 3. chronic bacterial prostatitis - cipro or norflox or trimethoprim for 4 weeks (eTG) 4. fistula formation - urosurgical opinion 5. spread of infection to the spine or sacroiliac joints - urosurgical and ortho opinion |
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what are some presenting symptoms of chronic bacterial prostatitis? |
genitourinary pain or discomfort, recurrent urinary tract infections with no history of bladder instrumentation, dysuria and frequency with no other signs of ABP or new onset sexual dysfunction without other aetiology (AFP april 2013) |
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how should you investigate for suspected chronic bacterial prostatitis? |
pre and post prostate massage urine MCS (AFP April 2013). >20 leuks in the post massage urine MCS is diagnostic for chronic bacterial prostatitis. consider testing for chlamydia |
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How to treat chronic bacterial prostatitis? |
ciprofloxacin 500mg BD or norfloxacin 400mg BD or trimethoprim 300mg OD for 4 weeks (eTG) NSAIDS, sitz baths, frequent ejactulation, perianal massage |
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What are symptoms of Chronic prostatitis/Chronic pelvic pain syndrome? |
CP/CPPS can vary widely and include dysuria; urinary frequency; urinary urgency; weak urinary stream; pain in the perineum, lower abdomen, testicles or penis; hematospermia or difficulty achieving erection. |
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What are diagnostic criteria for Chronic prostatitis/Chronic pelvic pain syndrome? |
Diagnosis requires the patient to have had pelvic pain or urinary symptoms for more than three of the previous 6 months with no evidence of ABP or urinary tract infection in that time. It is a diagnosis of exclusion and laboratory or imaging studies are indicated to rule out other potential causes of symptoms. |
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how do you treat Chronic prostatitis/Chronic pelvic pain syndrome? |
alpha blockers, ab's and nsaids. not much research available to guide treatment. |
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8 general causes of haematospermia |
trauma, malignancy (rare, but prostate ca must be excluded. Testicular, bladder and urethral cancer very rarely cause haematospermia, and only if advanced), infection, prolonged abstinence, obstruction, systemic disorder, iatrogenic, idiopathic. (AFP dec 2015) |
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what are some red flags for haematospermia? |
1. patient’s age (>40 years) 2. recurrent or persistent haematospermia 3. prostate cancer risk factors (eg positive family history or African heritage) 4. constitutional symptoms (eg weight loss, anorexia, bone pain). |
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what are some specific questions you may ask to help find cause of haematospermia |
history of TB or schistosomiasis, on blood thinners, presence of a bleeding disorder, prolonged abstinance, prolonged sexual intercourse/mastibation, perineal pain, fever, recent urological procedure |
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what investigations do you order for haematospermia (everyone/those with red flags) |
everyone - urine MCS and cytology , FBE, coags, STI screen risk factors - PSA if >40 yrs or prostate ca RF's, urine and semen acid fast bacilli and parasites ** note - if haematuria AND haematospermia present, follow the haematuria route of investigation (CT, pyelogram, cystoscopy) |
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Premature ejactulation - how long is normal?! (time from penetrating vagina to ejaculation) |
in primary PE (as in present since first sexual encounter) <1min in acquired PE (as in has been able to go longer but now is ejaculating prematurely) <3mins. these both have low incidence. what has higher incidence is men who have perceived PE and those who have variation in their ejaculation time (which is normal) (AFP Oct 2015) |
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Treatment for different types of PE. |
Primary - pharmacotherapy, psychotherapy Acquired - pharmacotherapy, psychotherapy perceived or variable PE - psychotherapy, reassurance, education |
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medications for premature ejactulation |
1. dapoxetine (Priligy) - TGA approved but not on PBS. Take 30-60mg 1-3hrs before intercourse. half life 1.5hrs - short acting 2. paroxetine, sertraline, -need daily dose AND PRN before intercourse. erectile dysfunction can be a side effect 3. fluoxetine - daily dose, can cause erectile dysfunction |
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what should you ask about/assess in history when a man comes in with erectile dysfunction? |
assess cardiovascular risk - diabetes, cholesterol, smoking, alcohol, family history, hypertension. ED can be a symptoms of underlying cardiovascular disease. (AFP May 2013) |
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what's a contraindication to prescribing phophodiesterase inhibitors for erectile dysfunction? |
concurrent use of nitrates, untreated IHD. use with nitrates can cause profound hypotension which can be fatal |
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80% of erectile dysfunction has an organic cause. What are the 3 main causes of erectile dysfunction? |
medications, diabetes, neurovascular disease (eTG) |
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what are 3 medications used for erectile dysfunction? |
1. sildenafil (viagra) 50mg 1hr before sexual activity. dose range 25-100mg 2. tadalafil (cialis) 10mg, sometime before sexual activity. if taking it more than twice a week, can use 2.5mg every day instead. dose fange 10-20mg 3. vardenafil (levitra) 10mg, 30-60 mins before sexual activity/ dose range 5-20mg (eTG) ** all are one dose per 24hrs except tadalafil daily** |
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if phosphodiesterase inhibitors are contraidicated or dont work, what are the other options for erectile dysfunction |
1. intracavernosal injection - alprostadil (Caverject) - must warn about risk of priapism and know how to manage it! 2. implants - inflatable or semi rigid 3. vaccum (penis pump i think) (eTG) |
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how do you manage priapism (erection lasting >2hrs) |
1. pseudoephidrine 120mg immediate release and a hot show. 2. erection not subsided in 4 hrs - repeat the pseudoephidrine and hot shower 3. erection not subsided after 6 hrs - needs aspiration of cavernosum (eTG) |
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5 symptoms of prostate cancer |
1. bladder outlet obstruction (70%) 2. acute retention (25%) 3. back pain (15%) 4. haematuria (5%) 5. uraemia (5%) also tiredness, perineal pain and weight loss (Murtaghs) |
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4 abnormal signs on DRE |
1. harp lump/nodule (50% are not cancer) 2. asymmetry 3. induration 4. loss of median sulcus |
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diagnostic triad: dysruia + fever + perineal pain = ? |
prostatitis |
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diagnostic triad: poor urine flow + straining to void + frequency = ? |
bladder outlet obstruction |
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a note on prostate cancer screening in asymptomatic men from RACGP guideline ... |
The risk of developing prostate cancer increases with age and positive family history. However, because prostate cancer is normally slow growing, men aged >75 years or with a life expectancy of <10 years are at reduced threat of dying from a diagnosis of prostate cancer. Men with uncomplicated lower urinary tract symptoms (LUTS) do not appear to have an increased risk of prostate cancer. The most common cause of LUTS is benign prostate enlargement. Early prostate cancer often does not have symptoms |
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when should you do a PSA in asymptomatic high risk men ie. Men with one or more first-degree relatives diagnosed <65 years of age, Men with a first-degree relative with familial breast cancer (BRCA1 or BRCA2) |
on demand after they've read the RACGP information sheet. The current recommendation is on demand PSA screening in asymptomatic men. If they have symptoms, then PSA testing is indicated clinically. |
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there is a patient information sheet on PSA for prostate cancer screening on the RACGP website in the guidelines section |
FYI! |
