Male Reproductive Disorders

Question 1

list the clinical signs, diagnostic measures, and treatment approach of BPH.

clinical signs

Answer 1

static component: weak urinary stream, postvoid dribbling, frequency of urination, nocturia.

lower urinary tract symptoms suggestive of BPH might include: urinary frequency, urinary urgency, dribbling at the end of urination, nocturia, urinary retention, incontinence of urine, pain after ejaculation or during urination, and urine that has an unusual color or smell.

Question 2

list the clinical signs, diagnostic measures and treatment approach of BPH.

diagnostic measures

Answer 2

7 item questionnaire by the American Urological Association
questionnaire covers things like incomplete emptying, frequency, intermittency, urgency, weak stream, straining and nocturia.

questions rated 0 (mild) to 7 (severe)
Total scores: 
below 7=mild
8-20=moderate
over 20=severe

can be confirmed with digital rectal exam

Question 3

list the clinical signs, diagnostic measures, and treatment approach of BPH

treatment approaches

what is the biggest factor in determining treatment?

Answer 3

lifestyle changes, minimally invasive procedures, and surgery. Provider recommends treatment based on symptom severity, impact on daily life, and personal preferences.

How is quality of life for the patient?

Question 4

describe the incidence of prostate cancer and list the staging points.

Answer 4

prostate cancer is the most common nonskin cancer in the US and third to lung and colorectal cancer as a cause of cancer related death in US men.

staged by using the Gleason grading system:
stage TI: primary: asymptomatic and discovered on histological examination of prostatic specimens
stage T2: palpable on digital examination but confined to the prostate gland
stage T3: tumor is extended beyond the prostate
stage T4: tumors have pushed beyond the prostate to adjacent structures

Question 5

explain the diagnosis of prostate cancer and list treatment options

Answer 5

the diagnosis of prostate cancer is based on history and physical examination. It is confirmed through biopsy methods. For the biopsy, transrectal ultrasonography is used to guide a biopsy needle and document the exact location of the sampled tissue.

treatment options are based on the extent of the disease and the health of the man. They include options such as surgery, radiation therapy, and hormonal manipulations. Chemo is limited here.
Watchful waiting can be selected.
Also can do radical prostatectomy.
Metastatic disease is often treated with androgen deprivation therapy.

Question 6

explain the teaching regarding biomarker PSA

Answer 6

A positive PSA test indicates only the possible presence of prostate cancer. It can also be active in cases of BPH and prostatitis.

So patients do not need to worry that they automatically have cancer if their PSA levels come back elevated. Also, PSA values increase with age, so age specific ranges have been established.

Question 7

explain classes of drug therapy for BPH (prazosin tamsulosin, and finasteride)

prazosin
MOA
ae’s
nursing implications

Answer 7

Prazosin
MOA: competitive antagonist that produces selective blockade of alpha 1-adrenergic receptors. Result is dilation of arterioles and veins, relaxation of smooth muscle in the bladder neck, and prostatic capsule. So can benefit men with BPH.

ae’s: orthostatic hypotension, reflex tachycardia, and nasal congestion. Also first dose effect has 1% of patients losing consciousness 30-60 mins after admin.

nursing implications:
have pt. change positions slowly, inital dose should be small to minimize first dose effect, advise patients to avoid driving and other hazardous activities for 12-24 hours. Administering the inital dose immediately before going to bed eliminates the risk of a first-dose effect.

Question 8

explain classes of drug therapy for BPH (prazosin, tamsulosin, and finasteride)

tamsulosin
MOA
ae’s
nursing implications

Answer 8

MOA: blockade of alpha 1 receptors relaxes smooth muscle in the bladder neck, prostate capsule and prostatic urethra, thereby decreasing dynamic obstruction of the urethra.

ae’s: hypotension, fainting, dizziness,somnolence, nasal congestion.

implications: men anticipating cataract surgery should avoid alpha blocker therapy until after the procedure. (can cause floppy-iris syndrome–reduces the hoped for improvement and increases post op pain, while delaying recovery)
educate patients about slow position changes when first starting dose or dose is increased.

Question 9

explain classes of drug therapy for BPH (prazosin, tamsulosin, and finasteride)

Finasteride
MOA
ae’s
nursing implications

Answer 9

MOA:acts in reproductive tissue to inhibit 5 alpha reductase, the enzyme that converts testosterone to DHT. by decreasing DHT availability, finasteride promotes regression of prostate epithelial tissue and thereby decreases mechanical obstruction of the urethra.

ae’s: impotence, loss of interest in sex, trouble having an orgasm,
abnormal ejaculation, swelling in your hands or feet, swelling or tenderness in your breasts, dizziness, weakness, feeling like you might pass out, headache, runny nose, or skin rash.

nursing implications: the 5 alpha-reductase inhibitors increased the risk for prostate cancer. They also decrease PSA levels. Because PSA levels are elevated with prostate cancer, normal levels can reflect a false negative.