Male Genito-urinary System Flashcards by Elizabeth Gausin

Benign prostatic hyperplasia (BPH)

Large prostate gland (pinches urethra)

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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

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Complications of BPH

Urinary retention *
UTI
Overflow incontinence
Hydronephrosis

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Urinary retention post void residual

> 200 cc

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Signs of urinary retention

Bladder distinction
Sudden pain and inability to urinate
Post void residual >200cc
AKI
UTI
fever,Dysuria,Suprapubic pain , flank pain

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Clinical manifestations of BPH

Nocturia
Frequency
Urgency
Dysuria
Bladder pain
Incontinence
Decreased urinary stream caliber and force
Intermittency
Hesitancy
Dribbling

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Diagnostic studies of BPH

Detailed H&P
Digital rectal exam
Urinalysis/culture
Prostate-specific antigen (PSA)

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Digital rectal exam (DRE)

Estimates prostate size , symmetry and consistency

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Prostate specific antigen (PSA)

Screens for prostate cancer

May be elevated PSA to rule out cancer

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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

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What will you see in DRE

Smooth , symmetrical consistency and visual rectal exam BPH

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Goals for BPH

Restore bladder drainage
Relieve the pt symptoms
Prevent or treat the complications of BPH

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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

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Pharmacological management for BPH

Alphaadrenergic blockers
, 5 alpha reductase inhibitors, 5a- reductase inhibitors

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Alpha adrenergic blockers

Relax smooth muscle that surrounds the urethra

Facilitate urinary flow

Watch for hypotension
Does not shrink prostate

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Adverse effects of adrenergic blockers

Abnormal ejaculation
Caution using when going for cataract surgery (delays healing) , floppy iris syndrome

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Alpha adrenergic blocker meds

Tamsulosin
Doxazosin

(All end in sin bp drop)

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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

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5 a reductase inhibitors side effects

Erectile dysfunction, decrease libido ,gyecomastia (male breast enlargement)

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5a reductase inhibitors

Finasteride
Dutasteride
Jalyn (finasteride plus Tamsulosin)

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Surgical management

TURP

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TURP

Transurethral resection of the prostate

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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

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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

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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