Cyndi - Week 8 - Exam 4 Flashcards
what is benign prostatic hypertrophy?
enlargement of prostate gland d/t overgrowth of tissue; hormonal changes during aging process
what are the 6 characteristics of BPH?
- ↑ % estrogen/↓ testosterone
- ↑ accumulation of DHT? (prostatic androgen made from testes)
- result = hyperplasia - more cells
- enlargement compresses urethra
- compression not r/t size but location
- lack of cellular apoptosis
what are the 4 complications of BPH?
- urinary retention
- UTI
- bladder or kidney damage
- hydronephrosis (fluid backup in kidney)
what are the 8 risk factors for BPH?
- obesity
- sedentary lifestyle
- alcohol use
- age (> 50 years = 50%; >80years = 90%)
- erectile dysfunction
- smoking
- diabetes
- family hx
T/F: BPH does predispose to prostate cancer
FALSE; it does NOT predispose to cancer
how is BPH diagnosed? (8)
History + Physical DRE – digital rectal exam done by 50 y/o to r/o cancer Urinalysis (UA) with culture PSA – Prostate‐specific antigen Serum creatinine TRUS: Trans Rectal UltraSound Uroflowmetry/Post Void Residual Cystoscopy (risk for infection; 5-10 min; anesth; bleeding normal for 24hrs; clot; irrigation)
what are the two main clinical manifestations of BPH?
- obstruction (d/t obstruction or retention)
- irritation (d/t inflammation or infection)
what are the sxs of obstruction for BPH?
- Decreased force (weaker stream)
- Difficulty initiating
- Intermittency (stopping and starting)
- Dribbling - bladder full → still have some → go a little
what are the sxs of irritation for BPH?
- Frequency, urgency
- Pain
- Nocturia
- Incontinence
what are the 3 different tx for BPH?
- watchful waiting
- medications
- invasive
what does watchful waiting consist of for BPH tx?
- Dietary (no artificial sweetners, no coffee)
- Timed voiding schedule (q2hr to try to urinate)
- Pt education
what meds are used for BPH tx?
- 5 alpha reductase inhibitors - Proscar
- Alpha adrenergic receptor blocker - Hytrin
- Erectogenic drugs - Cialis,Viagra
- Herbal therapy - Saw Palmetto
what invasive tx is used for BPH?
- Coude catheter – special catheter
- Prostate stent
- Surgery – TURP
what is the post op care for transurethral resection of the prostate (TURP)?
- Ambulate
- Monitor for hemorrhage
- Bladder spasms
•Treat with Belladonna (B&O suppository) - Urinary incontinence
- Monitor for S/S infection:
•Assess urine character and amounts; enc hydration - Continuous bladder irrigation (CBI)
•To manage blood clots and prevent obstruction
what is continuous bladder irrigation used for in BPH?
NS irrigation used to remove blood clots
what are the NI for bladder irrigation?
- Clots may occur for 24‐36 h
- Removed 24‐48 H post‐op
- Irrigation may be used intermittently
- Pt may experience bladder spasms
- Strict I&O
what is important to remember about the catheter used for continuous bladder irrigation?
has a large balloon (30 mL)
what is prostate cancer? and three characteristics of prostate cancer?
Malignant tumor of the prostate gland
• One in 6 men
• Generally good long‐term survival – but depends
• Androgen‐dependent tumor
what are the risk factors for prostate cancer?
- Ethnicity (African American) *test
- Age
- Familial history
- Other
what are the diagnostics used for prostate cancer?
- Labs
- Digital Rectal Exam ‐ hard, nodular, asymmetrical area felt for
- Ultrasound used to locate tumor sites
- TRUS
- Biopsy
- CT, MRI, bone scan to look for metastases
what labs are used to help diagnose prostate cancer?
- PSA – initial and monitoring
- PAP‐prostatic iso‐enzyme of acid phosphates
- Alkaline phosphatase - met. into bone - elevated
what grading system is used for biopsies for prostate cancer?
TNM system for grading tissue pathology (1‐4)
what are the initial symptoms of prostate cancer?
same as BPH • Frequency, urgency • Pain • Nocturia • Incontinence • Decreased force (weaker stream) • Difficulty initiating • Intermittency (stopping and starting) • Dribbling - bladder full → still have some → go a little
what are the later symptoms of prostate cancer?
- Pain, back pain
- Urinary retention
- Bilateral lower extremities weakness, bowel or bladder dysfunction
- Weight loss and fatigue
T/F: prostate cancer may be asymptomatic
TRUE
what is the tx of prostate cancer?
- Watchful waiting/active surveillance
- Surgical approach
- Radiation ‐ implanted seeds, external beam
- Medications ‐ hormone therapies
- Orchiectomy- removal of testes
what are the surgical tx for prostate cancer?
- Radical prostatectomy
- Retropubic
- Perineal
- Nerve sparing to maintain sexual function - Cryotherapy-
TEST: what are the considerations for perineal radical prostatectomy?
concerned about infection, clean frequently, constipation, care with wound
what is post op care for prostatectomy for prostate cancer?
- Retropubic versus perineal
- Treat pain
- Accurate I&O
- Encourage po as tolerated
- Ambulate
- Encourage to verbalize feelings
- Assess the urinary catheter for patency ‐ blood clots may impede drainage – monitor urine output!!
- Minimize catheter manipulation - sticker the way they go1
- Care of drain, dressing changes
what are the complications of prostate cancer?
Metastases Surgery complications: - Infection - Incontinence - Erectile dysfunction - Hemorrhage - Urinary retention - DVT - PE
what is testicular cancer and what are the characteristics?
Rare cancer of young men developed from embryonic germ cells
• Seminoma (not as aggressive/common)
• Nonseminoma (rare/aggressive)
• Others 10%
whata are the risk factors for testicular cancer?
- History of cryptorchidism
- A family history of testicular cancer
- Others: orchitis, HIV, maternal exposure to exogenous estrogen, testicular cancer in other testes
what are the diagnostic tests for testicular cancer?
• Self exam *test** - Perform in warm area • Physical exam - Firm non‐tender lump - Testicular swelling - Although testicles may not be same size normally • Flashlight exam • Ultrasound of testes • Labs – tumor markers • CT‐Abdominal and pelvis
T/F testicular cancer may be asymptomatic
TRUE
what are the possible early sxs of testicular cancer?
- Painless lump
- Scrotal swelling
- Feeling of scrotal heaviness
- Non‐tender, firm mass
- Pain or ache
what are the possible late sxs of testicular cancer?
back or chest pain
cough
dyspnea
what are the different tx for testicular cancer?
Surgery – radical orchiectomy
Radiation
Chemotherapy
T/F: 95% have complete remission if detected and treated in early stages
TRUE
why aren’t meds routinely used for testicular cancer and what might a man want to consider?
- Medications used can cause infertility, as well as other serious complications.
- Patients may save sperm before treatment
what is erectile dysfunction?
Inability to obtain or maintain an erection
how is ED diagnosed?
- self‐report of problem – age can affect causes
- Sexual and psychosocial history questionnaire
- Physical exam
- Labs
what are the possible reasons for ED for a younger man?
Stress, depression, substance abuse
what are the possible reasons for ED for an older man?
Atherosclerosis, medications, diabetes
what are the clinical manifestations of ED?
- Gradual vs sudden
- Intermittent vs continuous
- Psychological or life changes
- Distress
what types of drugs are known to cause ED?
- ARBs, ACE, CCB
what is the treatment for ED?
- Diet and lifestyle changes
- Erectogenic drugs
- Penile implants
- Sexual counseling
- Emotional support
what is the primary goal for someone with ED?
restore satisfactory sexual function
what is incontinence?
The involuntary leaking of urine
• 80% of incontinence can be improved
how can incontinence be managed?
Causative factors Kegel exercises to strengthen pelvic muscles Timed voiding schedule Medications Surgery
