What is the urological assessment scale used to assess severity of prostate symptoms
american urologic assessment symptom score
Name the 7
... [Show More] questions used to assess prostate symptoms
frequency
nocturia
weak stream
hesitancy
intermittence incomplete emptying
urgency
0= not present 5= almost always present
total score
mild-0-7
moderate- 8-19
severe 20-35
what should the prostate feel like
firm, smooth, symmetrically enlarged gland
what are the major causes of an elevated psa
bph, prostate cancer, prostate infection
how long does it take for psa to reduce after ejaculation
24 hours
what does an alpha blocker do?
cause blood vessels to dilate; lowering blood pressure--also treats BPH
what is an example of an alpha blocker
flomax (tamusulosin)
alpha blocker action
Stimulates central alpha receptors which decrease sympathetic outflow from the CNS, causing a decrease in peripheral vascular resistance and a slight decrease in cardiac output. Used for mild-to-moderate HTN
where are alpha receptors prevalent
prostate
base of bladder
prostate capsule
prostatic uretha
alpha adrenergic antagonists ______ bladder outlet obstruction
decrease
Name the alpa adrenergic antagonists
terazosin (hytrin)
tamsulosin (flomax)
doxazosin (cardura)
How do 5-alpha reductase inhibitors work?
Blocks testosterone and reduces the size of the prostate by up to 50%
how long does it take for 5-alpha reductase inhibitors to work
6-12 months
Name the 5 alpha reductase inhibitors
Finasteride (Proscar)
Dutasteride (Avodart)
How do PDE5 inhibitors work?
Selective inhibition of PDE5
Maintains cGMP levels in the penis
Maintains elevated pressure and impaired venous outflow in corpus cavernosum
Erection is harder and lasts longer
Name the PDE-5 inhibitors
Sildenafil (viagra)
Varenafil
Tadalafil (Cialis)
use caution with flomax for those with a ______ allergy
sulfa
which alpha blockers require renal/hepatic adjustment
silodosin (rapaflo) needs renal and hepatic adjustment
flomax does not require adjustment
acute prostatitis
Acute inflammation of the prostate usually due to bacteria
what usually causes prostatitis
sti
gram neg organisms such as e coli,
chlamydia
gonorrhea
assessment findings of prostatitis
fever
chills
pelvic, perineal pain
enlarged, boggy, tender prostate
cloudy urine
frequency
urgency
pain with defacation
hematuria
elevated psa
why should gently prostate exam be performed with suspected prostatitis
risk of bacteremia
uncomfortable
what abx to use in protatitis
TMPS
cipro
levo
X 6 weeks!
if STI, treat for STI
Treatment of prostatitis
ABX
antipyretics
NSAIDS
stool softeners
Adequate fluid intake
should see improvement in 2-6 days, if not refer to urologist
when should PSA rescreening be done after acute prostatitis
1 month after treatment
how common is prostate cancer
1 in 6 will be diagnosed with it, 1 in 36 will die from it, second most common form of cancer in men (after skin cancer), second most common cause of cancer death (after lung cancer)
name the risk factors for prostate cancer
black race
65 yoa or older
family history
brca mutations
prostate cancer screening reduces mortality but absolute risk reduction is-
small
begin prostate cancer screening at age- (based on mutual decision)
50
high risk for prostate cancer screen at age-
40-45
only screen if life expectancy is > ____
10 years
what will flomax do to the psa
falsely lower
check baseline psa prior to med initiation!
normal PSA
less than 4 ng/mL
PSA > ____ requires biopsy
10
scrotal tenderness with bowel sounds in the scrotum-
inguinal hernia
how are inguinal hernias most commonly diagnosed
physical exam
How is an inguinal hernia treated?
surgery
direct hernia
inguinal hernia protruding through hesselbach triangle medial to inferior epigastric vessels
testicular torsion
twisting of the spermatic cord causing decreased blood flow to the testis
presentation of testicular torsion
Severe, sudden onset pain
*No fever or pyuria*
Testis is swollen and tender
absent ipsilateral (same side) cremaster reflex!!
tender, high riding testical
how quick must testicular torsion be corrected
4-6 hours
irreversible damage after 12 hours
cremaster reflex
Stroke inner thigh will cause the scrotum to move the testes closer to the body
what ages are impacted mostly by testicular cancer
15-35 YO [Show Less]