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NURS 412 Final Exam > Male Reproductive Disorders & Surgeries > Flashcards

Male Reproductive Disorders & Surgeries Flashcards

1
Q

Benign Prostatic Hyperplasia (BPH)

A
  • non-inflammatory enlargement of prostate gland resulting from increase in # of epithelial cells and amount of stromal tissule
  • MOST COMMON UROLOGICAL PROBLEM IN MALE ADULTS
  • 1/2 men will experience BPH in their lifetime and 1/2 of these men with have lower UTI symptoms
    -Occurs in nearly all men with functioning testes
  • research is unclear whether BPH predisposes men to the development of prostate cancer
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2
Q

Etiology of BPH

A

Hormonal changes with aging

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3
Q

Pathophysiology of 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 (LUTS - lower urinary tract symptoms)
  • 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 and hematuria
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4
Q

Risk Factors BPH (5)

A
  • aging
  • physical inactivity
  • diabetes
  • obesity
  • familial history in first-degree relative
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5
Q

Protective Factors BPH

A
  • diet of fruit & veggies; lycopene (red pigment)
  • physical activity
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6
Q

BPH Clinical Manifestations

A

Bothersome ‘ LUTS’ result from obstruction
Gradual onset: may not be noticed until enlargement has been present for some time. nocturia is often the presenting symptom

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7
Q

BPH: obstructive symptoms

A
  • decrease in the calibre & force of urinary stream, hesitancy, intermittency, dribbling
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8
Q

BPH: Irritative Symptoms

A

Associated with inflammation or infection
- Urinary frequency, urgency, dysuria, bladder pain, nocturia, incontinence

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9
Q

BPH: Complications

A
  • urinary retention, UTI & possible sepsis, calculi, renal failure
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10
Q

Diagnostics

A
  • history and physical
  • DRE
  • PSA levels - not helpful diagnostically.
  • Urinalysis with culture
  • postvoid residual
  • ultrasound
  • cysto-urethroscopy
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11
Q

DRE - BPH

A

prostate should be evaluated for size, symmetry and consistency. in BPH - prostate is symmetrical, enlarged, firm and smooth

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12
Q

BPH Collaborative Care: Active Surveillance

A

“watchful waiting”
- dietary changes (decreasing caffeine & artificial sweeteners, limiting spicy or acidic foods)
- avoiding decongestants & anticholinergic medications (prevent bladder contraction)
- restricting evening fluid intake
- timed voiding schedule

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13
Q

BPH - Drug Therapy
- combination therapy most effect

A
  • 5a-reductase inhibitors - inhibits conversion of testosterone into DHT in prostate gland. (dutasteride or finasteride)
  • a-adrenergic receptor blockers - selectively relax smooth muscle of prostate, bladder neck & proximal urethra. Tamulosin. provide symptomatic reief
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14
Q

BPH - Invasive therapy

A
  • when obstruction is severe, severe LUTS, recurrent UTI, hematuria, bladder stones, or upper urinary tract distress -> intermittent or indwelling catheter may temporarily relieve symptoms
  • TURP (transurethral resection of the prostate) - GOLD STANDARD.
  • Transurethral incision of the prostate (TUIP) moderate to severe symptoms & small prostates. done under local and as effective as TURP in symptom relief
  • prostatectomy: surgery of choice for larger prostates. remove the entire prostate, seminal vesicles & part of bladder neck.
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15
Q

BPH - Minimally invasive Therapy

A
  • Transurethral microwave thermotherapy (TUMT) - heat causes death of tissue
  • Transurethral needle ablation (TUNA) - increases temperature & causes localized necrosis
  • Laser prostatectomy - visual or U/S guidance
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16
Q

TURP

A
  • GOLD STANDARD
  • Done under spinal or general anesthetic
  • associated with good outcomes in 90% of patients
  • HOLD ASA or anticoagulants preop
  • Pain and UTI are most common preop problems necessitating TURP
17
Q

TURP: Preop Care

A
  • Urinary drainage must be restored before surgery
  • use of lidocaine jelly ++ helpful
  • may require coude (curved tip) catheter
  • antibiotics usually given before invasive procedures
  • patient education on common alterations in sexual function is important - retrograde ejaculation not harmful but orgasms might be less pleasurable
18
Q

TURP: Postop Care
- 4 main complications

A

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

19
Q

Prostate Cancer

A
  • malignant tumour of prostate gland
  • Androgen-dependent adenocarcinoma (overgrowth of cells in a gland) - after age of 50 men have increased DHT - potent form of testosterone that leads to development of prostate ca
  • 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
20
Q

Prostate Cancer - Causes

A
  • approx 1 in 7 men will be diagnosed with prostate cancer during their lifetime
  • age
  • ethnicity
  • family
  • diet
21
Q

Prostate-Cancer Risk Factors

A
  • > 50 years of age
  • 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 BRAC1 and BRAC2.
  • Testosterone and DHT are essential to growth & development of prostate -> play important but poorly understood role in cancer development
22
Q

Prevention of Prostate Cancer (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
23
Q

Clinical Manifestations of Prostate Ca

A

Generally asymptomatic during early stages
Urinary symptoms may occur (similar to BPH)
- 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

24
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
25
Q

Diagnosis of Prostate Ca

A
  • DRE: gold standard. feels hard nodular and asymmetrical
  • often diagnosed before symptoms occur
  • PSA screening: NOT RECOMMENDED. not specific to cancer but when cancer exists it is useful marker of tumour volume.
  • prostate biopsy required for diagnosis
  • transluminal ultrasound if suspected
  • Prostate Cancer Associated 3 (PCA3) is a gene in urine specific to prostate cancer
  • After diagnosis: Bone scan, CT, MRI
26
Q

PSA Screening

A
  • No provincial screening program in BC - if screening is going to be done, men between the ages of 55 and 69 most benefit
  • PSA is used for monitoring 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
  • PSA Screening NO LONGER RECOMMENDED
27
Q

Diagnosis of Prostate Ca: Staging and Grading (3)

A

Whitmore-Jewett - stages A-D
TNM Classification System
- tumor: characteristics of the primary tumor
- nodes: involvement of lymph nodes
- Metastasis: evidence of spread
Gleason scale (2-10)
- grading of tumour based on histology
- 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

28
Q

Collaborative Care: Prostate Cancer

A

Watchful waiting - chemo is not standard.
Chemotherapy - not standard. treatment for those with hormone-resistant cancer in late-stage disease
Hormone therapy - block testosterone production to reduce tumour growth. selection or combination of bilateral orchiectomy, estrogens, gonadotropin-releasing hormone analogs, & anti-androgens
Radical prostatectomy - removal of entire prostate, seminal vesicles, part of bladder -> risk for ED & incontinence, catheter in place for 1-2 weeks
Cryotherapy - injection of liquid nitrogen that destroys cancer cells by freezing tissue. Risks: if not done carefully it can damage surrounding tissue

29
Q

Treatment Side Effects Prostate Ca

A

Hormonal side-effects: hot flashes, muscle atrophy, loss of libido, ED, gynecomastia, cardiovascular disease
Specific surgical side effects: risk for incontinence or ‘dribbling’, risk for impotence
Chemotherapy an radiation therapy SE: depends on type of therapy, nausea, vomiting, fatigue, hair loss

30
Q

Testicular Cancer

A
  • Relatively rare
  • 5 year survival rate
  • Most common type of cancer in males age 15-29
  • 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 synthetic estrogen (diethylstibestrol), testicular ca in contralateral testis
31
Q

Testicular Cancer: clinical manifestations

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
32
Q

Diagnosis of Testicular Cancer

A
  • palpation of firm mass
  • ultrasound
  • serum alpha-fetoprotein, LDH, and hCG, CBC/LFTs
  • CXR and/or CT abdo/pelvis to detect metastases
33
Q

Testicular Cancer: Collaborative Care

A
  • early recognition: TSE from the age of 15
  • fertility and sperm banking should be discussed preop, Tx can affect both erections and fertility
  • surgery: orchiectomy or radical orchiectomy (removal or affected testis, spermatic cord, and regional lymph nodes)
  • postop care: surveillance, chemotherapy/radiation
  • 97% remission rates with early recognition
  • treatment-related toxicity significant
34
Q

Vasectomy

A
  • Def’n: bilateral surgical ligation of the vas deferens for the purpose of sterilization
  • 15-30 min in duration
  • outpatient procedure under local anesthesia
  • usually irreversible
  • does NOT affect production of hormones nor ejaculation
  • Not ‘reliable’ until 6 months postop: alternate forms of contraceptions should be used until verification occurs

NURS 412 Final Exam (12 decks)

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