Male Genito-urinary System Flashcards
Benign prostatic hyperplasia (BPH)
Large prostate gland (pinches urethra)
Risk factors of BPH
Aging
Obesity
Especially increased waist circumference
Lack of physical activity
High amount of dietary animal protein
Alcohol consumption
Erectile dysfunction
Smoking diabetes
Complications of BPH
Urinary retention *
UTI
Overflow incontinence
Hydronephrosis
Urinary retention post void residual
> 200 cc
Signs of urinary retention
Bladder distinction
Sudden pain and inability to urinate
Post void residual >200cc
AKI
UTI
fever,Dysuria,Suprapubic pain , flank pain
Clinical manifestations of BPH
Nocturia
Frequency
Urgency
Dysuria
Bladder pain
Incontinence
Decreased urinary stream caliber and force
Intermittency
Hesitancy
Dribbling
Diagnostic studies of BPH
Detailed H&P
Digital rectal exam
Urinalysis/culture
Prostate-specific antigen (PSA)
Digital rectal exam (DRE)
Estimates prostate size , symmetry and consistency
Prostate specific antigen (PSA)
Screens for prostate cancer
May be elevated PSA to rule out cancer
Treatment BPH
Catheter insertion if possible
Pharmacological interventions
Possible surgery (in severe situations)
Least invasive to most
If needed they will put Catheter but will try not to intervene
What will you see in DRE
Smooth , symmetrical consistency and visual rectal exam BPH
Goals for BPH
Restore bladder drainage
Relieve the pt symptoms
Prevent or treat the complications of BPH
Nursing management bph
Active surveillance
Bladder scan
Dietary changes
Meds (avoid anticholinergics and decongestants)
Limit fluids at night
Bladder re training (timed voiding schedule)
Annual follow up
Pharmacological management for BPH
Alphaadrenergic blockers
, 5 alpha reductase inhibitors, 5a- reductase inhibitors
Alpha adrenergic blockers
Relax smooth muscle that surrounds the urethra
Facilitate urinary flow
Watch for hypotension
Does not shrink prostate
Adverse effects of adrenergic blockers
Abnormal ejaculation
Caution using when going for cataract surgery (delays healing) , floppy iris syndrome
Alpha adrenergic blocker meds
Tamsulosin
Doxazosin
(All end in sin bp drop)
5 a reductase inhibitors
Shrink prostate
Blocks enzyme necessary for conversion of tester one to DHT
Takes 3-6 months for improvement
High risk for developing prostate tumor
5 a reductase inhibitors side effects
Erectile dysfunction, decrease libido ,gyecomastia (male breast enlargement)
5a reductase inhibitors
Finasteride
Dutasteride
Jalyn (finasteride plus Tamsulosin)
Surgical management
TURP
TURP
Transurethral resection of the prostate
Post op care for TURP
Assess for hemorrhage
Bladder spasms
Urinary incontinence
Infection
Stool softeners and high fiber diet to prevent straining
Treat bladder spasms
Catherter care
Teach kegel excercse
What do blade spasms tell you post op TURP?
Too much fluid sitting in bladder and something is occluding it from draining.
Physician well order to irrigate it but if not clamp fluid and call doctor
Continuous bladder irrigation (CBI)
Remove blood clots
Ensure drainage of urine
Use aseptic technique
What can post turn pt use
Return to urinary continence
Refer to continence clinic if not normal within 12 months
Use penile clamp , condemn catheter, incontinence pads or briefs to manage dribbling and continue socialization activities
Prostate cancer
Slow growing cancer
Where does prostate cancer metastasize
Lymph node /lung/other organs/bone, spine*
High cure rate when localized can respond well when advanced
If a pt is hemorrhaging
You would see low BP high hr
Clinical manifestation of BPH
BPH symptoms
PSA elevated
DRE
Dysuria /hematuria
Paine (perineal Suprapubic rectal)
When DRE is done on prostate how is it?
Rough and asymmetrical
Diagnostic studies
PSA screening
DRE
Biopsy
Screening BPH recommendations
Age 55-69 should be screened every 2 years
Treatment PSC
Radiation
Brachytherapy
Cryotherapy and ablative hormone therapy
Chemotherapy
Surgical management of PSC
Radical prostatectomy
Prostatectomy
Retropubic
Perineal
Problem for retropubic
Not all pt qualify especially obese pt and more tissue being there
Perineal risk
Infection , bowel movement (increase fiber teaching)
Post op prostatectomy
Indwelling Cather
Surgical site drain
Hospital stay 1-3 days
Complications of prostatectomy
Erectile dysfunction
Incontinence, urinary retention
Hemorrhage *
Infection*
Wound dehiscence*
DVT /PE
What do we want to teach about incontinence during the first few months post prostatectomy
May be more prominent but as time goes on the gain muscles and regain strength
Catheter balloon for prostatectomy
20-30 ml
Brachytherapy
Usually done out pt
One and done situation
Caution- dont touch probes and limit amount of time not to be in room. Educate pregnant individual or children to stay out of room
Wear gloves and radiogown
Nursing management
Meds (chemo drugandstool softener)
Wound care /bladder irrigation
(E coli risk for perineal pt )
Pt teaching prostate cancer
Annual check up PSA /DRE
Brachytherapy radiation exposure
Signs of infection
Prevention
Erectile dysfunction causes
Diabetes , vascular disease, side effects of meds, result of surgery , trauma, stress, depression and others
Avoid smoking and alcohol use
How to manage erectile dysfunctions
Medication
Surgical
Psychosocial
( if pt is depressed look into therapy)
5 (PDE -5 )inhibitors
Not created for ED
Causes smooth muscle relaxation and increase blood flow
- do not combine with nitrate /nitroglycerin or alpha blockers of any form
(Can potentiate hypotensive effects of nitrate)
5(PDE-5) inhibitors
Adverse effects -hypotension, priapism(long erection 3-4 hours) , headache, flushing , dyspepsia
Priapism ** why we should treat not to take double dose)
Priapism
Medical emergency go to ER to get relieved
Long erection 3-4 hours
5(PDE-5 ) inhibitors meds
Sildenafil
Vardenafil
Tadalafil
FIL HAS AN ERECTILE DISFUNCTION
Nursing management non surgical erectile dysfunction
Vacuum device
Surgical management erectile dysfunction
Implant or penileprosthesis
Testicular cancer causes
Abnormal testicle development
History of down syndrom
HIV
History of testicular cancer
Infertility
Tobacco use
Undescended testicle history
Exposure to chemicals
Patho testicular cancer
Age 15-35
Can metastasize to other locations
If it’s on the right, spreads to the right and so on
Clinical manifestations of testicular cancer
PAINLESS mass in scrotum
Non tender and firm
Dull ache or heavy sense action in lower abdomen , perinatal area or scrotum
Diagnostic studies testicular cancer
Palpations of scrotal content (firm does not transilluminate)
Ultrasound
Lab (tumor markersO
AFP LDH
HCG
TREATMENT testicular
Surgery
Chemo therapy
Radiation
Orchiecctomy
Surgical removal of affected testis, spermatic cord , and regional lymph nodes
Seminomas
Do better with radiation and or chemo
Nonseminomas
Not responsive to radiation
Removal of lymph nodes
Chemotherapy *
Tend to be rapid growth
Nursing management testicular cancer
Wound care
Vitals
Teaching s/s of infection
Fertility options
Follow up
Self exams months
Teaching for trauma
Sudden onset of scrotal pain, tenderness, swelling n/v
Urinary cympoms
Fever(absence WBC or bacteria in urine )
Seek medical care!!^
Post surgical care/drain management
