Male Reproductive System

Question 1

What are some basic affects of aging on the Male Reproductive System?

Answer 1

Testes become smaller
Thickening of Seminiferous tubules
Postate gland enlarges***
Sclerotic changes in local blood vessels (results in ED)
Hormonal changes

Question 2

What is Prostatitis?

Answer 2

Multiple disorders that cause pelvic pain and discomfort ranging from acute bacterial infection

Question 3

What are the categories of prostatitis?

Answer 3

Category I - Acute bacterial
Category II - Chronic bacterial
Category III - Chronic prostatits/chronic pelvic pain syndrome
Category IV - Asymptomatic inflammatory prostatits

Question 4

What are some manifestations of Category I and II Prostatitis?

Answer 4

Urinary frequency, Urgency, Nocturia, Dysuria
Urethral discharge
High Fever
Chills
Malaise
Myalgia
Arthraligia
Pain (low back, sacral, Groin/pelvis, lower abs)
UTI

Question 5

What are manifestations of Category III Prostatits?

Answer 5

Urinary frequency, urgency
Dysuria
ED
Ejaculatory pain
Decreased libido
Pain (low back, sacral, pelvis/groin)
UTI

Question 6

What are manifestations of Category IV Prostatitis?

Answer 6

Asymptomatic infertility

Question 7

What are some special implications for the PT with prostatitis?

Answer 7

pt will have Urinary problems (frequent UTIs)
May include ED
Low back pain along with SxS in 19-1 should raise alarm
Bicycle seats suck
High muscle tone in pelvic floor (relaxation techniques)

Question 8

What is BPH?

Answer 8

Benign Prostatic hyperplasia

-age-related non malignant enlargement of prostate gland

Question 9

What manifestations come from BPH?

Answer 9

Urine flow restricted
Narrowing of urethra
decreased urine stream
Difficulty initiating or continuting stream
Nocturia (residual volume high)
Higher risk of UTIs

Question 10

How can you tell the difference between carcinoma or BPH?

Answer 10

Carcinoma can be felt (grows outside) when palpating the prostate
PSA levels

Question 11

How do you diagnose BPH?

Answer 11

History
Palpation (digital rectal exam)
Urodynamic tests (flow rate and force of stream)
PSA (prostate specific antigen) can be used to rule out cancer, higher levels are in cancer)

Question 12

What are treatment options for BPH?

Answer 12

Meds if mild (Flowmax)
Transurethral resection of prostate (TURP)
-requires anesthesia
-Bleeding, incontinece, impotence, retrograde ejaculation are side effects
Transurethral incision of the prostate (TUIP)

Question 13

What is the difference between transurethral incision (TUIP) and Transurethral resection (TURP)?

Answer 13

TUIP is less invasive
TUIP is done if pt can't do anesthesia
Uses electric current or laser to make incisions
No tissue is removed
Catheter is left in for 1-3 days post op

Question 14

What are some complications with advanced BPH?

Answer 14

Urethral obstruction

Renal failure and death if not treated

Question 15

Why should PT’s care about BPH?

Answer 15

Common in men over 50 (4 questions)
-How much do you pee (especially at night)
-Trouble starting or continuing?
-Weak flow?
-Do you get it all out?
MAKE SURE TO DO PELVIC FLOOR EXERCISES!!

Question 16

What are the risk factors for prostate cancer?

Answer 16

>50 years old
African American
Geography (US and Scandinavian)
Family History
Environment (Cadmium)
High-Fat diet
Alcohol consumption

Question 17

Which hormone is Postate carcinoma related to?

Answer 17

Testosterone

Question 18

Where does Prostate cancer spread to?

Answer 18

Seminal vesicles and urinary bladder
Then musculoskeletal system (axial) and lungs
Then hits lymph nodes in obturator, iliac, and periaortic

Question 19

What are some clinical manifestations of Prostate CA?

Answer 19

Hard to diagnose until later stages (doesn’t push on urethra)

Question 20

How is Prostate CA diagnosed?

Answer 20

• DRE screen (digital rectal exam)
• PSA blood test (4-10ng/ml is caused by BPH, prostatitis, or cancer) Greater than 10 50% increase in risk of prostate cancer
• Ultrasound
• Biopsy is needed to confirm
• MRI

Question 21

What are treatment options for Prostate CA?

Answer 21

Sugery (radical prostatectomy)
Radiation
Hormonal therapy (LHRH antagonists, dec testosterone, pharmacologic castration)

Question 22

What are side effects of hormonal manipulation?

Answer 22

Dec bone density, osteoporosis
Loss of libido
Impotence
Hot flashes
Gynecomastia
Bloating and pedal edema
Nausea, vomiting, diarrhea
Wt gain/redistribution
MI, CVA, DVT

Question 23

What are some special implications for the PT with prostate cancer?

Answer 23

Look for unexplained back pain (metastasis to bones)
Postop considerations
-Medications and radiation adverse effects
-Incisional stuff
-Lifting restrictions
-Urinary incontinence

Question 24

What is Testicular torsion?

Answer 24

Abnormal twisting of spermatic cord

Question 25

What are some clinical manifestations with testicular torsion?

Answer 25

Sever scrotal pain and swelling
Nausea
Vomitting
Tachycardia may be present

Question 26

What can cause testicular torsion?

Answer 26

Vigorous physical exercise

Congenital abnormalities

Question 27

What special implications do you want to take as a PT for testicular torsion?

Answer 27

Referred pain from groin
Ask pt if he has noted scrotal swelling or tenderness, 
feels feverish or nauseated,
Problems with urination
urethral discharge
-Medical emergency

Question 28

What are some risk factors for ED?

Answer 28

Age
Smoking
Medical Hx (take a guess, it’s probably on there)
Surgical Hx (TURP, couple others)
Medications (HTN, tranquilizers, amphetamines)

Question 29

What are some special implications to the PT for ED?

Answer 29

Assess ED in males with pelvic floor problems

Can be predictor of ischemic heart disease