Male Reproductive Disorders

Question 1

Prostatic pain conditions - Category 1

Answer 1

Acute bacteria prostatitis

Question 2

Prostatic pain conditions - Category 2

Answer 2

Chronic bacteria prostatitis

Question 3

Prostatic pain conditions - Category 3

Answer 3

Non bacterial prostatitis, prostatodynia, chronic prostatitis/chronic pelvic pain syndrome

Question 4

Prostatic pain conditions - Category 4

Answer 4

Asymptomatic inflammatory prostatitis

Question 5

Category 3 - Non bacterial/chronic pelvic pain syndromes - diagnostic tests

Answer 5

Physical exam is unremarkable
Might have tenderness at prostate
Urine test with white or red blood cells
No bacteria present

Question 6

Category 3 - Non bacterial/chronic pelvic pain syndromes - treatment

Answer 6

NSAIDS or alpha blocker to relax muscle in prostate

PT

Question 7

Category 3 - Non bacterial/chronic pelvic pain syndromes - Symptoms

Answer 7

Blood in urine or semen
Inc urine urgency and frequency
Dec urinary stream
Pain or burning with urination
Pain patters vary - suprapubic, perineal, low back, scrotum, urethra, penis)

Question 8

PT implications in prostatitis

Answer 8

Screen for fever/chills, frequent and painful urination, erectile dysfunction
Unknown cause of back pain in younger males (under 45) may be chronic prostatitis (more of a spasm of PFM)

Question 9

Benign prostatic hyperplasia (BPH) is what

Answer 9

Enlargement of prostate gland

Grows from pea size to walknut shape

Question 10

Benign prostatic hyperplasia (BPH) - epidemiology

Answer 10

Commonly begins around 40-50 yrs old
75% of males over 50 yrs old
Theory based on hormonal changes related to aging

Question 11

Benign prostatic hyperplasia (BPH) - growth of prostatic tissue takes over

Answer 11

true prostate tissue which encroaches on prstatic urethra leading to symptoms

Question 12

Benign prostatic hyperplasia (BPH) - symptoms

Answer 12

Urinary obstruction
Hesitancy and itnermittency
Weak stream
Terminal dribbling
Overflow incontinence
Straining to void
Trigone hypertrophy

Question 13

Benign prostatic hyperplasia (BPH) - advanced symptoms of urinary retention

Answer 13

Post void residual
Bladder infection
Bladder, kidney stones
Hematuria
Retention, kidney failure, death

Question 14

Benign prostatic hyperplasia (BPH) - diagnosis

Answer 14

Digital rectal exam
Urodynamic tests
Abdominal US
Elevated PSA levels call for tissue biopsy

Question 15

Benign prostatic hyperplasia (BPH) - treatment

Answer 15

Mild - monitor condition
Meds - Alpha adrenergic blockers to relax bladder neck, 5 alpha reductase inhibitors to shrink glandular tissue
Surgical - TURP, TUIP

Question 16

Benign prostatic hyperplasia (BPH) - PT implications

Answer 16

Screen for obstructed voiding
Bladder training if overactive or inc freqnecy
Strength training for incontinence related to BPH procedures

Question 17

Benign prostatic hyperplasia (BPH) - PT implications - screen for obstructed voiding

Answer 17

Urinate more than every 2 hours or more than once a night
Difficulty in starting urine flow
Weak flow of interrupted stream
Sensation of incomplete bladder emptying

Question 18

Prostate cancer - epidemiology

Answer 18

1st most common cancer in men
2nd leading cause of cancer death
Most common malignancy diagnosed in men
4th leading source of neoplastic metastasis to spine
Bony metastases are common to spine, ribs, pelvis

Question 19

Prostate cancer - risk factors

Answer 19

Age over 50
African American (2:)
Family hx
High fat diet
Alcohol consumption
Environmental toxins
Geography (US and Scandinavian)

Question 20

Prostate cancer - symptoms

Answer 20

Early in disease is asymptomatic

Late in disease - hematuria, impotence, metastasis to bone

Question 21

Prostate cancer - diagnosis

Answer 21

Digital rectal exam
Elevated PSA levels calls for tissue biopsy
TRUS
Urodynamic tests
Abdominal US, CT and MRI
Bone scan (only if PSA over 20 to check for metastasis)

Question 22

Prostate cancer - treatment

Answer 22

Watchful waiting being used more often
Radiation therapy
Hormonal therapy (androgen deprivation meds)
Surgery

Question 23

Prostate cancer - treatment - surgery - adverse effects of surgery

Answer 23

Sexual - ED (7/10 due to injury to nerves innervating penis)
Urinary - stress incontinence
Urinary obstruction - scar tissue btw urethra and bladder neck

Question 24

Prostate cancer - post prostatectomy

Answer 24

Hospital stay 2-5 days
Pain mngmt and antibiotics
Catheter in place for 1 to 3 wks
Allow time for healing

Question 25

PT implications with prostate cancer

Answer 25

Screening men with pre existing prostate conditions Establish baseline for urinary function and note changes over time Non mechanical back pain in thoracic, lumbar, and sacral area may be metastatic spread to axial skeleton

Question 26

PT implications with prostate cancer - what else besides screening

Answer 26

Pre-operative pelvic floor training After radical prostatectomy - PFM reed, biofeedback Complications of med tx include infection, incontinence, sexual dysfunction Exercise

Question 27

Male urinary incontinence - epidemiology

Answer 27

Wide range reported in lit due to surgical technique and defining incontinence (6-87%) Post prostatectomy incontinence up to 60% Incidence is equal to females - just happens later in life

Question 28

Males and continence

Answer 28

Urethral pressure is more than bladder pressure

Question 29

Males and continence - major contributors

Answer 29

``` Smooth mm sphincter - removed in prostatectomy, loss of tonic mm support Striated urethral sphincter Levator ani Bulbocavernosus urethral mucosa ```

Question 30

Male urinary incontinence - treatment

Answer 30

Medication Surgery Injection of bulking agents Pelvic floor muscle exercises

Question 31

Male urinary incontinence - treatment - PT

Answer 31

``` Education PFM training Biofeedback Focus on urethral mechanism with most effective cues to retract penis Breath training with PFM integration Train pre activation of PFM before exertion Facilitation of PFM Bladder training ```

Question 32

Screening questions for pelvic floor - for all patients!

Answer 32

``` Do you ever leak urine or stool Do you ever wear a pad Do you have pain with intercourse Do you have genital or pelvic pain Do you have difficulty emptying your bladder completely Do you have constipation ```

Question 33

Testicular cancer - epid

Answer 33

One of the most curable cancers (greater than 95%) Less than 1% of all cancers Most common solid tumor of young adult, males 15-35 Greater risk in higher SES White:Black 5:1 Tx is surgical removal of the testis

Question 34

Testicular cancer - PT

Answer 34

``` Post surgical: lymphedema tx Posture and mvmnt dysfunction Possible sexual dysfunction Side effect from chemo and radiation ```

Question 35

ED is what

Answer 35

Inability to achieve or maintain erection sufficient for satisfactory sexual performance

Question 36

ED - organic

Answer 36

85% of men over 50 years Impeded blood flow Impeded nerve transmission

Question 37

ED - psychogenic

Answer 37

``` 70% of men less than 35 years Anxiety Fear Depression Stress/hypertonicity ```

Question 38

ED risk factors

Answer 38

``` Age Smoking Medical history - DM, CAD, Hypothyroid, hypopituitary, hypertension, chronic uremia, NM disease, psych, alcoholism Surgical hx Medications - antihypertensives ```

Question 39

ED treatment

Answer 39

``` Control of underlying med condition Evaluate medication list Monitor testosterone therapy Counseling PFM strengthening program Biofeedback for relaxation Surgical - penile implant Mechanical - penis pumps ```

Question 40

Sexual dysfunction screening

Answer 40

screen for cauda equina post operative complication Sex is an ADL too!!!

Question 41

Screening for sexual dysfunction - what do you say

Answer 41

Start with open ended ubiquity style question Continue inquiry with specific questions Follow up with positive response and open ended question