genitourinary Flashcards
loss of urine associated with activities that increase intraabdominal pressure
stress incontinence
Involuntary loss of urine usually preceded by a strong, unexpected urge to void
Urge incontinence
Urge and stress incontinence together
mixed incontinence
an involuntary loss of urine associated with incomplete emptying
overflow incontinence
function of bladder volume
Overactive bladder
effects urine flow in men
prostate, or BPH
hypermobility of the bladder neck bladder is competent at rest, increase in abdominal pressure leads to increased closure pressure
anatomic stress urinary incontinence-
Open bladder neck at rest, mild increase in intra abdominal pressure can result in leakage
Intrinsic sphincter deficiency
instability of the detrusor muscle during bladder filling due to idiopathic or neurogenic causes. Causes the bladder neck to open and incontinence to occur
detrusor overactivity
incontinence related to spinal cord injuries below t11 or l1, may be caused by MS, SM or spina bifida
neurogenic bladder
Resnick’s DIAPPERS mnemonic
Delirium or confused state Infection- urinary Atrophic urethritis, vaginitis Pharmaceuticals Psychological, especially severe depression Excess urinary output (CHF, hyperglycemia) Restricted mobility Stool impaction
systems involved in physical examination for incontinence
Abdominal, genitourinary, pelvic, and rectal components
Management of stress incontinence
Behavioral therapies include…
Behavioral therapies: timed or double voiding, smoking cessation, weight loss, pelvic muscle exercises pessary, bowel management
Management of stress incontinence
Medical therapies include…
Alpha-adrenergic agonists: methoxamine, phenylephrine, oxymetazoline, tetrahydrozoline, xylometazoline
Tricyclic antidepressants: Remeron (mirtazipine),
estrogen
what do alpha-adrenergic agonists do
bind a alpha receptors on vascular smooth muscle and induce smooth contraction and vasoconstriction. Mimics sympathetic adrenergic nerve activation
how do tetracyclic antidepressants work
act by inhibiting reuptake of neurotransmitters serotonin and or noradrenaline in the brain thus elevating mood. Used less due to side effects
managing stress incontinence
Surgical therapies include:
Bladder neck suspensions, slings, artificial sphincters
Urge incontinence
behavioral therapie…
bladder training, schedule voiding, minimize bladder irritants, suppression of urge
Urge incontinence
Medical management:
anticholinergic- antimuscarinics, vaginal estrogen
how do anticholinergics work
blocking acetylcholine prevents impulses from the parasympathetic nervous system from reaching smooth muscle and causing contractions, cramps or spasms
anticholinergic medications
dicyclomine, chlordiazepoxide, atropine, scopolamine, glycopyrrolate
how do antimuscarinic medications work
inhibiti the functions of parasympathetic nervous system : atropine scopolamine
urge incontinence management
surgical therapies
neurosacral modulation, bladder augmentation, botox injections
Health promotion to reduce incontinence
Weight management, tobacco cessation, exercise. food and fluid adjustments
second most common malignant neoplasm in men
Prostate Cancer
Most common type of prostate cancer
Adenocarcinoma located in the posterior peripheral zone of the prostate
important predictor of prognosis
Histologic grading
most common sites of prostate cancer metastasis
lymph node and bone
presenting sx of prostate Cancer
urinary hesitancy, urgency, nocturia, frequency and hematuria, asymptomatic in early stages of disease. Sx increase in intensity during a 1-2 month period as opposed to slow increase in BPH
abnormal digital rectal exam, but negative PSA
refer to urology for evaluation
most sensitive and specific screening method for prostate cancer
DRE combined with PSA
what is a PSA
enzyme secreted by the prostate gland
medication that can increase PSA
finasteride, dutasteride
PSA value in early prostate cancer
4-10ng/ml
PSA value that is suggestive of prostate cancer
10ng/ml or more
scans to detect metastasis of prostate cancer
radionuclide bone scan- bone metastasis
CT scan of abdomen and pelvis- lymphnodes, if postive ct of chest may be indicated to rule out lung involvment
Prostate cancer labs
PSA, CBC w/differential
Prostate cancer other diagnostics
Needle biopsy, pelvic ct scan, pelvic MRI, bone scan
Differential dx prostate cancer
Bone pain, hematospermia, macroscopic hematuria, renal failure, sx of advanced prostate cancer
sx of possible spinal cord compression
acute neurologic symptoms such as weakness, numbness, urinary retention, urinary incontinence or fecal incontinence.
American Joint Committee on Cancer (AJCC) TNM
TNM stands for
Extent of primary tumor (T category)
Whether the cancer has spread to nearby lymph nodes (N category)
Absence or presence of distant metastases (M category)
Categories with most treatment options
T1 and T2
T1 and T2 treatment options
active surveillance, radiation therapy, and Surgery
TX for
Prostate cancer T3 level, without metastatic spread
may be offered radiation therpay , hormonal therapy, or combination, as well as surgery
treatment for histological grade 2 very high-risk
radical prostatectomy, radiation therapy with or without hormonal therapy or androgen deprivation therapy
Hormone treatments for prostate cancer
oral estrogens, orchiectomy, luteinizing hormone-releasing hormone (LHRH), agonists, antiandrogens, and pregestational agents.
act by initially stimulating pituitary gonadotropin production and later inhibiting it.
PSA level after a radical prostatectomy
should fall to 0.2ng/ml
prostate radiation therapy PSA levels
PSA levels should fall and continue to decrease for 12 months after completion of therapy
complications of prostate cancer
metastatic disease
risks of prostate surgery
hemorrhage, injury to the obturator nerve, ureter, or rectum. Incontinence and impotence are also potential complications
