Genitourinary Conditions

Question 1

Benign Prostatic Hyperplasia (BPH)

Answer 1

 Enlargement of the prostate gland
 Most common problem of adult male
reproductive system
 Occurs in 50% of men over 50yrs of age
 Thought to be the result of endocrine
changes associated with ageing process

Question 2

Pathophysiology of BPH

Answer 2

Develops in inner part of prostate
 This enlargement gradually compresses
the urethra, eventually leading to partial
or complete obstruction

Question 3

Clinical Manifestations of BHP

Answer 3

Symptoms result from urinary obstruction
 Gradual onset
 Decrease in calibre & force of urinary
stream
 Difficulty in initiating voiding
 Intermittency (stopping & starting)
 Dribbling at end of urination
 Incomplete bladder emptying

Question 4

Clinical Manifestations of BHP

Answer 4

Urinary frequency
 Urgency
 Dysuria
 Bladder pain
 Nocturia
 incontinence

Question 5

what does TURP stand for?

Answer 5

Transurethral Resection of Prostate

Question 6

Prostate Cancer

Answer 6

 Malignant tumour of prostate gland
 Occurs in 1:11
 Most common cancer amongst men
 Third leading cause of cancer death in NZ
 Incidence in less in Maori
 Large increase in incidence of newly
diagnosed cases attributed to widespread use
of PSA as a screening procedure
 Incidence likely to continue increasing
because of population ageing

Question 7

Prostate Cancer continued…

Answer 7

 Usually asymptomatic in early stages
 Patient may have symptoms similar to BHP
-dysuria, hesitancy, dribbling, frequency,
urgency, haematuria, nocturia, retention,
interruption of urinary stream & inability to
urinate
 Pain in lumbosacral area that radiates down to
hips or legs may indicate metastases

Question 8

Diagnostic Studies of prostate cancer?

Answer 8

Blood test may show elevated Prostatespecific antigen (PSA)
 Normal PSA is 0-4.0mg/ml
 Rectal examination may reveal hard
prostate with asymmetric enlargement
with areas of induration or nodules

Question 9

Pelvic Inflammatory Disease (PID)

Answer 9

Infectious condition of the pelvic cavity that may
involve infection of the fallopian tubes (salpingitis),
ovaries (oophoritis), and pelvic peritoneum (peritonitis)
 Often the result of untreated cervicitis – the organism
infecting the cervix ascends higher into the uterus,
tubes, ovaries & peritoneal cavity
 Chlamydia trachomatis and Neisseria gonorrhoeae
are the most common causative organisms
 PID is the major cause of female infertility
 Silent PID can cause damage that cannot be reversed

Question 10

Risk Factors for PID

Answer 10

Women at increased risk of chlamydial
infections
-younger than 24 years
- multiple sex partners

Question 11

Clinical Manifestations of PID

Answer 11

Lower abdominal pain – starts gradually
& is constant, intensity may vary from
mild to severe
 Pain associated with intercourse
 Spotting after intercourse
 Abnormal vaginal discharge
 Fever & chills

Question 12

Complications of PID

Answer 12

Septic shock
 Ectopic pregnancies
 Infertility
 Chronic pelvic pain

Question 13

Endometriosis

Answer 13

The presence of normal endometrial tissue in
sites outside the endometrial cavity
 Most frequent sites are in or near ovaries, the
uterosacral ligaments & the uterovesical
peritoneum
 Usually occurs in late 20s, early 30s, white &
never had a full-term pregnancy
 Found in approx 10% of women of
reproductive age

Question 14

Clinical Manifestations of endometriosis?

Answer 14

Wide range of manifestations & severity
 Dysmenorrhoea
 Infertility
 Pelvic pain
 Dyspareunia
 Irregular bleeding

Question 15

Common Sites of Endometriosis

Answer 15

Uterine Prolapse - Downward displacement of the uterus
into the vaginal canal.

 First degree
prolapse
 Second degree
prolapse
 Third degree
prolapse

Question 16

Clinical Manifestations of Uterine

Prolapse

Answer 16

Vary with degree of prolapse
 Patient may describe a feeing of
“something coming down”
 Dyspareunia
 Dragging or heavy feeling in the pelvis
 Backache
 Bowel or bladder problems

Question 17

Cystocele and Rectocele

Answer 17

 Cystocele occurs when support
between the vagina and bladder is
weakened.
 Rectocele results from weakening
between the vagina and rectum.
 Woman may not be able to empty
bladder or bowel.

Question 18

Ectopic Pregnancy

Answer 18

The implantation of the fertilised ovum
anywhere outside the uterine cavity
 98% occur in the fallopian tube
 A life-threatening condition
 Risk factors include a history of PID,
prior ectopic pregnancy, use of IUD, in
vitro fertilization procedures

Question 19

Clinical Manifestations Of Ectopic

Pregnancy

Answer 19

Abdominal or pelvic pain
 Missed menses
 Irregular vaginal bleeding
 Other symptoms of pregnancy
 With rupture the risk of haemorrhage and
hypovolaemic shock is present