Male Reproductive Disorders Flashcards
Prostatic pain conditions - Category 1
Acute bacteria prostatitis
Prostatic pain conditions - Category 2
Chronic bacteria prostatitis
Prostatic pain conditions - Category 3
Non bacterial prostatitis, prostatodynia, chronic prostatitis/chronic pelvic pain syndrome
Prostatic pain conditions - Category 4
Asymptomatic inflammatory prostatitis
Category 3 - Non bacterial/chronic pelvic pain syndromes - diagnostic tests
Physical exam is unremarkable
Might have tenderness at prostate
Urine test with white or red blood cells
No bacteria present
Category 3 - Non bacterial/chronic pelvic pain syndromes - treatment
NSAIDS or alpha blocker to relax muscle in prostate
PT
Category 3 - Non bacterial/chronic pelvic pain syndromes - Symptoms
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)
PT implications in prostatitis
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)
Benign prostatic hyperplasia (BPH) is what
Enlargement of prostate gland
Grows from pea size to walknut shape
Benign prostatic hyperplasia (BPH) - epidemiology
Commonly begins around 40-50 yrs old
75% of males over 50 yrs old
Theory based on hormonal changes related to aging
Benign prostatic hyperplasia (BPH) - growth of prostatic tissue takes over
true prostate tissue which encroaches on prstatic urethra leading to symptoms
Benign prostatic hyperplasia (BPH) - symptoms
Urinary obstruction Hesitancy and itnermittency Weak stream Terminal dribbling Overflow incontinence Straining to void Trigone hypertrophy
Benign prostatic hyperplasia (BPH) - advanced symptoms of urinary retention
Post void residual Bladder infection Bladder, kidney stones Hematuria Retention, kidney failure, death
Benign prostatic hyperplasia (BPH) - diagnosis
Digital rectal exam
Urodynamic tests
Abdominal US
Elevated PSA levels call for tissue biopsy
Benign prostatic hyperplasia (BPH) - treatment
Mild - monitor condition
Meds - Alpha adrenergic blockers to relax bladder neck, 5 alpha reductase inhibitors to shrink glandular tissue
Surgical - TURP, TUIP
Benign prostatic hyperplasia (BPH) - PT implications
Screen for obstructed voiding
Bladder training if overactive or inc freqnecy
Strength training for incontinence related to BPH procedures
Benign prostatic hyperplasia (BPH) - PT implications - screen for obstructed voiding
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
Prostate cancer - epidemiology
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
Prostate cancer - risk factors
Age over 50 African American (2:) Family hx High fat diet Alcohol consumption Environmental toxins Geography (US and Scandinavian)
Prostate cancer - symptoms
Early in disease is asymptomatic
Late in disease - hematuria, impotence, metastasis to bone
Prostate cancer - diagnosis
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)
Prostate cancer - treatment
Watchful waiting being used more often
Radiation therapy
Hormonal therapy (androgen deprivation meds)
Surgery
Prostate cancer - treatment - surgery - adverse effects of surgery
Sexual - ED (7/10 due to injury to nerves innervating penis)
Urinary - stress incontinence
Urinary obstruction - scar tissue btw urethra and bladder neck
Prostate cancer - post prostatectomy
Hospital stay 2-5 days
Pain mngmt and antibiotics
Catheter in place for 1 to 3 wks
Allow time for healing
PT implications with prostate cancer
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
PT implications with prostate cancer - what else besides screening
Pre-operative pelvic floor training
After radical prostatectomy - PFM reed, biofeedback
Complications of med tx include infection, incontinence, sexual dysfunction
Exercise
Male urinary incontinence - epidemiology
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
Males and continence
Urethral pressure is more than bladder pressure
Males and continence - major contributors
Smooth mm sphincter - removed in prostatectomy, loss of tonic mm support Striated urethral sphincter Levator ani Bulbocavernosus urethral mucosa
Male urinary incontinence - treatment
Medication
Surgery
Injection of bulking agents
Pelvic floor muscle exercises
Male urinary incontinence - treatment - PT
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
Screening questions for pelvic floor - for all patients!
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
Testicular cancer - epid
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
Testicular cancer - PT
Post surgical: lymphedema tx Posture and mvmnt dysfunction Possible sexual dysfunction Side effect from chemo and radiation
ED is what
Inability to achieve or maintain erection sufficient for satisfactory sexual performance
ED - organic
85% of men over 50 years
Impeded blood flow
Impeded nerve transmission
ED - psychogenic
70% of men less than 35 years Anxiety Fear Depression Stress/hypertonicity
ED risk factors
Age Smoking Medical history - DM, CAD, Hypothyroid, hypopituitary, hypertension, chronic uremia, NM disease, psych, alcoholism Surgical hx Medications - antihypertensives
ED treatment
Control of underlying med condition Evaluate medication list Monitor testosterone therapy Counseling PFM strengthening program Biofeedback for relaxation Surgical - penile implant Mechanical - penis pumps
Sexual dysfunction screening
screen for cauda equina
post operative complication
Sex is an ADL too!!!
Screening for sexual dysfunction - what do you say
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Continue inquiry with specific questions
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