University of Nigeria Virtual Library Serial No. AGUGUA, N.E.N - - PDF document

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Serial No. Author 1 AGUGUA, N.E.N Author 2 Author 3 Title

Presentation of Proastatic Disorders

Keywords Description

Presentation of Prostatic Disorders

Category Publisher Publication Date Signature

Ojionuka Arinze B.

Digitally signed by Ojionuka Arinze B. DN: CN = Ojionuka Arinze B., C = US, O = University of Nigeria, Nsukka, OU = Innovation Centre Reason: I have reviewed this document Date: 2007.02.18 20:15:19 -08'00'

'v

CHAPTER 38 PRESENTATTON OF PROSTATIC DISORDERS Ilnl~kc most gland~~lar disordcrs the "data baze" of hizlor~r. cx:~rnin:ltion and preliminary invcstigation, is i ~ w d l y suffic.ie11t to Icarl the student to a working diagnosis in pro~tatic disordi~r~.

'I he history yiclds the pml:dcm of pain. clisordcred nrict\~ritioti,

hacniaturia and associatcd gcncral symptoms. PAIN in p r o d a t ~ c disordcrs can bc classified as r~rctlml,

~c.ct,ll,

pwnc.al, prlvic and bone p a n . Urethral pain in asso~iation w ~ l h lrequtwt micluntion may supwst acute of cllronic urethritis. Pelvic pail1 tl~ic to a congc\tt~d pro\tatr may he tcll over the sacr11111 ; ~ n d may occur in a~mc~iltion w ~ t h chron~c licart lailut'e or after urt.tll~,~l

• r rectal ~nstruinentat~on.

Rectal pain with tencmus occurs in chronic prostatit~s. Perinral pain which is commonly an inlcnsc burning pain In the yerincwm i5 wpgcstive of prostatic inflamn~atory

• disciw. Bone pain with an eniarpcd prostate suggests ;

I metajtatic

pro4tatic carcinoma. Disordered micturition in association willr trcquency presrnts as difficulty to start (hesitancy) atid d ~ f l ~ * u l t y to stop (ternimal drlhbling). Therc may br a sensation of incomplctc. bladdcr emptying. Such a history alerts the student to thc diagnosis

• f hcnign prostatic hypertrophy. Carcinoma of the prostate has a

similar prewntation but of a shorter durutlon. II:leni:rturia on its own is rarely indicative of prostatic disordcrs but iltl acutely infected and conpcstcd prostate may be the source

• f haTmaturia.

h p o t e n c ~ , weakness, Sevrr and lethargy are associated symptoms

• stntitjs is tense. swollen and tcndrr and in chronic cases there is in

addition sot'! :Irc:ls of Iluctuation or thickened areas of fibrosis. U ~ t i l'orni rnl:~rpcment

01' llic prost:] tc may he felt in benign prostatic

Iiypc~r-lropliy

: thc ~iicdian

sulcus is n~;~intaincd. The carcinoma of pro.~t;ifc

is Il;~rd

and Il~c,r-c niay bc ohlitcration o f ~ I I C median srllcus. ('c.rt;~inly. thc natrlrc and site of tlic. prmtatc gland is better ;~rpr~c.i;rlcd

• n hirn;lnu;il palpation.

X-RAYS Cvsto-urcfhrowopy cu:lnlIncs thc \!r?thra : ~ n d

• bladder. Thc land-

n ~ , r ~ l .

01

llic pro\t:it~c urctl1r:r 1s the \crunmntariirrn. This area,

• n 11ir po\tcr~or

urct1ir;il w;dl, recc.ivcs t l ~ c

• stia of thc prostalic

dr~c.t\ thc common ci;~culatory ducts ,rnd the prostatic utrlcle. Iht* pro\t,it~c urethr,~ I., redtl(,ned and congested In prostatitis.

1 tic rnc.rl~,~n

lolw ol I I C p r o ~ l ~ ~ t c . gland may bc seen on cystoscopy to c m w ohstrnctrvt. uropnthy whcrvaj ttie prodate gland may feel

1101 m,~l

• r1 I ~nclal

c x ; ~ r n ~ n ; ~ t ron. Pmsfatic Biopsy Hl\tolog~c spcomrn of the prostate gland may be

• h t ~ ~ n e d

hv :

J 1r;tnsurc thral. transrcct;il or transpenneal approach.

F l ~ ~ ( o I o ~ v

d~;~pnosi\ could hc prostatlt~j. htvirgn prostate hypertrophy

• ~ ~ I ( J \ ~ , I ~ I L

c,irclnorn:l

Prrsenta tion of Prostatic Disorders 23

7 ACID PHOSPHATASE

e

The prostatic acid phosphatase is an isocnzyn~e which is behi assayrd by a radioimmune technique.

1n summary, the working diagnostic conccpt in profttrlic rli~~:ar~X~,r is as far any other surgical lesion, "Sir (Mad;~ni),

I h ~ h

jxi(lt-pt I!:\$

d

benign prostatic enlargement (anatomico - pathologrc;~l dia8no:iis)

as shown by Bone Scan".