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

University of Nigeria Virtual Library Serial No. AGUGUA, N.E.N Author 1 Author 2 Author 3 Title Presentation of Proastatic Disorders Keywords Description Presentation of Prostatic Disorders Category Publisher Publication Date Digitally signed by Ojionuka Arinze B. Ojionuka DN: CN = Ojionuka Arinze B., C = US, O = University of Nigeria, Nsukka, OU = Innovation Centre Signature Reason: I have reviewed this Arinze B. document Date: 2007.02.18 20:15:19 -08'00'

CHAPTER 38 'v 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 or 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 ; metajtatic I 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 of 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 of haTmaturia. h p o t e n c ~ , weakness, Sevrr and lethargy are associated symptoms (.of' j'llnstatilis.

- 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 o n hirn;lnu;il palpation. ;~rpr~c.i;rlcd X-RAYS Cvsto-urcfhrowopy cu:lnlIncs thc \!r?thra : ~ n d bladder. Thc land- n ~ , r ~ l . llic pro\t:it~c urctl1r:r 1s the \crunmntariirrn. This area, 01 on 11ir po\tcr~or urct1ir;il w;dl, recc.ivcs t l ~ c ostia 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. lolw ol I I C p r o ~ l ~ ~ t c . 1 tic rnc.rl~,~n gland may bc seen on cystoscopy to c m w ohstrnctrvt. uropnthy whcrvaj ttie prodate gland may feel 1101 m,~l or1 I ~nclal c x ; ~ r n ~ n ; ~ t ron. Pmsfatic Biopsy Hl\tolog~c spcomrn of the prostate gland may be o h t ~ ~ n e d hv : 1r;tnsurc thral. transrcct;il or transpenneal approach. J F l ~ ~ ( o I o ~ v d~;~pnosi\ could hc prostatlt~j. htvirgn prostate hypertrophy o~ ~ 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), jxi(lt-pt I!:\$ I h ~ h d benign prostatic enlargement (anatomico - pathologrc;~l dia8no:iis) as shown by Bone Scan".