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Pathophysiology Final > Male Reproductive Disorders > Flashcards

Male Reproductive Disorders Flashcards

1
Q

Benign Prostatic Hyperplasia (BPH) Review

A
  • Enlargement of prostate gland resulting from increase in # of epithelial cells and amount of stromal tissue
  • most common urological problem in male adults
  • occurs in nearly all men with functioning testes
    (50% of men > 50 years; 80% of men > 80 years; Approx 25% will require treatment by 80 years
  • Does NOT predispose to the development of prostate cancer
  • Determined with digital rectal exam
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2
Q

What is the most common urological problem in male adults

A

BPH

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3
Q

Risk Factors BPH

A
  • Family history
  • Western cultures (more likely to experience obstructive problems)
  • Obesity
  • Diet high in zinc, butter, & margarine
  • Aging
  • Physical inactivity, diabetes
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4
Q

Protective Factors BPH

A
  • Diet of fruit & veggies; lycopene

- physical activity

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5
Q

Etiology - BPH

A
  • Endocrine/hormonal changes with aging
  • only party understood.
  • possible causes are excessive accumulation of dihydroxytestosterone (the principal intraprostatic androgen), stimulation by estrogen & local growth hormone action.
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6
Q

Pathophysiology - BPH

A
  • Develops in inner part of prostate
  • Cancer more likely to develop in outer part
  • Enlargement compresses urethra –> eventual partial or complete obstruction
  • leads to development of clinical symptoms
  • lower urinary tract symptoms (same symptoms as early UTI - urgency, hesitancy, dribbling, decline in urinary stream, feelings of incomplete bladder emptying, may have UTI and dysuria)
  • increased risk of UTI, compromised upper urinary tract function
  • bladder initially amplifies strength of detrusor contraction –> initially successful –> eventually overwhelms detrusor ability –> decline in urinary stream, feelings of incomplete bladder emptying.
  • may have UTI & hematuria (growth of blood vessels which are prone to disruption & bleeding)
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7
Q

BPH Clinical Manifestations

A
  • Bothersome “LUTS” - lower urinary tract symptoms
  • Gradual onset: may not be noticed until enlargement has been present some time. early symptoms usually minimal b/c bladder can compensate for small amount of resistance to urine flow.
  • Obstructive symptoms: decrease in calibre & force of urinary stream, hesitancy, intermittency, dribbling
  • Irritative symptoms (associated with inflammation or infection) - urinary frequency, urgency, dysuria, bladder pain, nocturia (often the presenting symptom), incontinence
  • Complications (urinary retention, UTI & possible sepsis, calculi (alkalinization of residual urine), renal failure from hydronephrosis, pyelonephritis or bladder damage)
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8
Q

LUTS - Lower Urinary Tract Symptoms

A
  • early symptoms are minimal because the bladder can compensate
  • nocturia - normally the first symptom
  • obstructive: difficulty initiating voiding, intermittency
  • Irritative: symptoms associated with inflammation or infection: pain, foul odor, urgency
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9
Q

Diagnostics - BPH

A
  • history and physical
  • DRE - digital rectal exam
  • AUA symptom scoring
  • PSA level (prostate specific antigen. not diagnostic of prostate cancer. useful for trending)
  • Urinalysis
  • Postvoid residual
  • Ultrasound
  • Cysto-urethroscopy
  • transrectal ultrasound for patients with abnormal DRE
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10
Q

BPH - Collaborative Care: watchful waiting

A

particularly for those with mild LUTS

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11
Q

BPH - Collaborative Care: Drug Therapy

A
  • 5a-Reductase inhibitors
  • a-Adrenergic receptor Blockers
  • Erectogenic drugs
    Its slow! a combination of drugs works the best!
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12
Q

5a-Reductase Inhibitors

A
  • Proscar
  • slow the growth of the prostate by inhibiting the changes of Testosterone. Dutasteride or finasteride. Take 6 months to reduce effects. Reduces the size of the prostate by reducing the amount of hormone.
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13
Q

a-Adrenergic receptor blockers

A
  • Rapaflo (silodosin)
  • Terazosin or Tamulosin
  • selectively relaxes smooth muscle, improvement of symptoms. Terazosin. Fatigue, dizziness, retrograde ejaculation (semen enters bladder instead of penis). Systemic relief rather than treating underlying cause
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14
Q

Erectogenic Drugs

A
  • Tadalafil (Cialis) can treat both BPH and ED symptoms
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15
Q

Invasive Therapy - TURP (GOLD STANDARD)

A

Transurethral resection of the prostate (GOLD STANDARD)
- removal of prostate surgery using resectoscope inserted through urethra; not used as much now d/t less invasive technologies

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16
Q

Invasive Therapy - TUIP

A
  • Transurethral incision of the prostate
  • local anesthetic
  • as effective as TURP
  • monderate to severe symptoms &small prostates who are poor surgery candidates; done under local anesthesia
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17
Q

Invasive Therapy: Prostatectomy

A
  • complete removal of the prostate
  • surgery of choice for larger prostate
  • if radical - entire prostate gland, seminal vesicles & part of bladder neck removed
  • regrowth occurs over period of 1-15 years
  • prostate cancer may still develop if total prostate not removed
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18
Q

Minimally invasive - do not require hospitalization or catheterization. Reduce symptoms

A
  • TUMT
  • TUNA
  • Laser prostatectomy (uses laser to reduce small amounts that can be eliminated in the urine)
  • urethral stents - opening the narrowing
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19
Q

BPH - Health Promotion

A
  • to screen or not to screen? value of the PSA test
  • manage symptoms with lifestyle changes - decrease alcohol and caffeine, limit cold and cough medications, maintain normal fluid intake levels, urinate on 2-3 hour schedule
  • Consider treatment options
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20
Q

Prostate Cancer

A
  • Malignant tumour of prostate gland
  • Androgen-dependent adenocarcinoma (overgrowth of cells in a gland)
  • majority of tumours in outer aspect of prostate
  • usually slow growing but progressive if left untreated
  • can metastasize through direct extension, lymph system, or bloodstream
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21
Q

Causes of Prostate Cancer

A
  • Approximate 1 in 7 men will be diagnosed with prostate cancer during their life-time
  • causes are poorly understood
    Genetic - Black > White > Asian
    Dietary factors? Same as for BPH
    Environmental factors
    Hormonal changes associated with aging
22
Q

Risk Factors: Prostate Cancer

A
  • > 50 years of age
  • Ethnicity: Black > White > Asian
  • Family history
  • High levels of testosterone
  • Diet high in fats & low in vegetables & fruits
  • Occupational exposure to cadmium
  • Genetic link - mutations in luminal and basal cells of the prostate. Also links to genetic mutations causing breast cancer
23
Q

Prostate Cancer - Prevention (3)

A
  1. Eat a wide variety of fruits & vegetables each day (consumption of tomatoes, tomato-based products, & garlic may protect against prostate cancer)
  2. Be physically active
  3. Maintain a healthy weight
24
Q

Clinical Manifestations (very similar to BPH)

A
  • generally asymptomatic during early stages
  • Urinary symptoms may occur (similar to BPH)
  • pain in lumbosacral area that radiates to hips or legs when coupled with urinary symptoms may indicate metastasis
  • early recognition & treatment important to control growth, prevent metastasis (to pelvic nodes, bones, bladder, lungs & liver), & preserve QOL
25
Q

Urinary symptoms of prostate cancer

A
  • difficulty starting or stopping urination
  • slow stream
  • painful urination or ejaculation
  • Dribbling
  • frequent urination
  • Loss of urinary control
  • blood in urine or ejaculate
  • night-time voiding
26
Q

Clinical manifestations of advanced prostate cancer:

A
  • weight loss
  • fatigue
  • backache or sciatica-like pain, or swelling of legs that doesn’t go away
27
Q

Diagnosis of Prostate Cancer

A
  • often diagnosed before symptoms occur
  • DRE
  • PSA screening - not recommended, but useful to trend
  • Not specific to prostate cancer
  • prostate biopsy required for diagnosis
  • Controversy as to whether routine screening should be recommended; many people live and die with prostate cancer but not from in
  • PCA 3 gene - gene is urine specific to prostate
  • transluminal ultrasound if suspected
  • biopsy to confirm (based on cell type)
28
Q

PSA Screening - No provincial screening program in BC

A
  • If screening is going to be done, men between the ages of 55 and 69 most benefit from it. Routine screening not recommended over the age of 70. (CDC)
29
Q

PSA Screening - PSA is used for:

A
  • monitored established prostate cancer & metastatic disease or detection of early recurrence, where prostate cancer is already known
  • Diagnostic adjunct in combination with other tests in symptomatic men
  • Screening tool
30
Q

Diagnosis: Grading and Staging

A
  • Whitmore-Jewett (sages A-D)
  • TNM Classification System (tumour - characteristics of the primary tumour/nodes - involvement of lymph nodes/metastasis - evidence of spread)
  • Gleason Score (2-10) - grading of tumour based on history, provides an indication of the risk for spread (based on how well-differentiated tumour cells appear on microscopic analysis; poorly differentiated cells are associated with more aggressive forms of cancer)
31
Q

Treatment of Prostate Cancer (most treatments have very undesirable side effects including):

A
  1. Hormonal side effects
  2. Specific surgical side-effects
  3. Chemotherapy and radiation therapy side effect
32
Q

Hormonal Side Effects

A

hot flashes, muscle atrophy, loss of libido - can fell like they are going into menopause

33
Q

Specific surgical side effects

A

risk for incontinence or “dribbling”

risk for impotence

34
Q

Chemotherapy and Radiation therapy side effects

A
  • depends on the type of therapy

- common side-effects may include (N&V, fatigue, hair loss)

35
Q

Social impact of prostate cancer

A
  • effect on relationships with family and friends

- sexual challenges & relationship with partner

36
Q

Physical impact of prostate cancer

A
  • Side Effects of treatment

- physical functioning (ADLs & IADLs)

37
Q

Spiritual impact of prostate cancer

A
  • existential questions
  • religious considerations
  • guilt, fear, view of suffering
38
Q

Psychological impact of prostate cancer

A
  • denial, fear, uncertainty, embarrassment

- losses (effect on sexual functioning)

39
Q

DRE - Digital Rectal Exam

A

Prostate should be evaluated for size, symmetry and consistency. In BPH, the prostate is symmetrically enlarged, form, and smooth.

40
Q

Transrectal ultrasonography (RUS) and Cysto-urethroscopy

A

this scan is indicated in patients with elevated PSA and abnormal DRE. Helps differentiate between prostate ca and BPH. Biopsies can be taken during this procedure
- cysto-urethroscopy is done allowing internal visualization of the urethra and bladder if the diagnosis is uncertain AND in patients scheduled for prostatectomy

41
Q

Goals of BPH Collaborative Care

A
  • restore bladder drainage, relieve symptoms and prevent/treat complications
  • Treatment is generally based on the degree to which the symptoms bother the patient or the degree to which complications are present vs the size of the prostate
42
Q

TURP: Postop Care

A
  • main complications: hemorrhage, bladder spasm, urinary incontinence, infection
  • manage CBI - rate determined by colour of drainage. Goal is light pink with no clots. Small clots are expected for 24-36 hr, but bright red blood can indicate hemorrhage
  • Avoid activities that increased abdominal pressure (straining)
  • Remove CBI 2-4 days postop; trial of void 6h after cath removal
  • urinary dribbling/incontinence common initially; can usually improve with Kegel exercises over first 2 months postop
  • Dietary interventions/bowel protocol to avoid straining: adequate fluid intake
43
Q

New Test for diagnosing prostate cancer

A

Prostate Cancer Associated 3 gene specific to prostate cancer cells. If present in the urine, indicates prostate ca. more accurate than PSA. Once diagnosis is made, bone scan, CT and/or MRI will determine extent of spread

44
Q

Radical Prostatectomy for Prostate Cancer

A
  • removal of entire prostate, seminal vesicles, part of bladder –> because cancer tends to be many different locations within the gland.
  • catheter in place for 1-2 weeks postop
  • risk for erectile dysfunction and incontinence
  • may be possible to do nerve-sparing procedure to spare nerves responsible for erection.
45
Q

Cyrosurgery

A

destroys cancer cells by freezing tissue.

46
Q

Chemotherapy for prostate cancer

A
  • limited to treatment of those with hormone-resistant cancer. late-stage disease
47
Q

Hormone therapy

A

block androgen (testosterone) production to reduce tumour growth; may be used as adjunct therapy before suergery or radiation

48
Q

Testicular Cancer

A
  • relatively rare
  • 5-year survival rate of 96%
  • most common type of cancer in males ages 15-29 years
  • more common: (in right testicle, in males with hx of undescended testes, in males with a family hx of testicular anomalies or cancer)
  • predisposing factors: HIV, orchitis, maternal exposure to diethylstilbestrol, testicular ca in contralateral tetis
49
Q

Testicular Cancer: Clinical Manifestations and Complications

A
  • slow or rapid onset depending on type of tumor
  • painless lump, scrotal swelling, and/or feeling of heaviness
  • scrotal mass usually nontender and very firm
  • sometimes concurrent lower abd/scrotal/perianal dull ache or heavy sensation - Diagnosis: (palapation of firm mass, ultrasound, serum alpha-fetoprotein, LDH, and hCG; CBC/LFTs, CXR and/or CT abdo/pelvis to detect metastases)
50
Q

Testicular Cancer: Collaborative Care

A
  • early recognition; TSE from age of 15
  • Fertility and sperm banking should be discussed pre-op. Tx can affect both erections and fertility
  • Surgery (orchiectomy or radical orchiectomy - removal of affected testis, spermatic cord, and regional lymph nodes)
  • Post-op care: surveillance, chemotherapy/radiation
  • 97% remission rates with early recognition
  • treatment-related toxicity significant

Pathophysiology Final (7 decks)

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