Male-specific GU Flashcards
BPH MEANS
Benign Prostatic Hyperplasia
BPH
Condition in which the prostate gland increases in size
Outflow of urine from the bladder to the urethra is disrupted
What urine output occurs with BPH
low due to obstruction
= Postrenal
The older you get the ______ likely men are to have BPH
MORE
BPH Risk factors
Aging
Obesity
- Especially increased waist circumference
Lack of physical activity
High amount of dietary animal protein
Alcohol consumption
Erectile dysfunction
Smoking (vasoconstriction)
Diabetes
Initiative s/s of BPH
Nocturia (often first recognized symptom)
Frequency
Urgency
Dysuria
Bladder pain
Incontinence
Obstructive s/s of BPH
Decreased urinary stream caliber and force
Intermittency
Hesitancy
Dribbling
Complications of BPH
Urinary retention (main complication)
Urinary tract infection (UTI)
- sits in bladder and bacteria grows
Overflow incontinence
Hydronephrosis
Acute Kidney Injury (AKI)
Urinary retention shows through
bladder distention
sudden pain
inability urinate
post-void residual greater than 200
AKI shows through
low GFR
Increased BUN and Creatinine
BPH can increase UTI to
urosepsis
What type of pain does BPH pts present?
suprapubic and flank
dysuria
High fever
Dx of BPH
Detailed H&P
Digital rectal exam (DRE)
Estimates prostate size, symmetry and consistency
Urinalysis/Culture
Prostate-specific antigen (PSA) – r/o cancer
Screens for prostate cancer (high)
During a DRE, what does BPH feel like?
smooth
symmetrical
Tx of BPH
Catheter insertion, if possible, for retention
Pharmacological interventions
Possible surgery (in severe situations)
Goals of Tx BPH
Restore bladder drainage
Relieve the patient’s symptoms
Prevent or treat the complications of BPH
Nursing Management of BPH
Active surveillance
Bladder scan
Dietary changes
Medication
Avoid anticholinergics and decongestants (urine retention)
Limit fluids at night
Bladder re-training (timed voiding schedule)
Annual follow up
What nutritional foods need to be decreased with BPH pts
caffeine
high fats
meat
Alpha-adrenergic Blockers
Relax the smooth muscle that surrounds the urethra
Facilitates urinary flow through the urethra
symptom improvement days to weeks
Adverse effects of Alpha Blockers
LOW BP
Abnormal ejaculation
Caution when going for cataract surgery
FLOPPY IRIS SYNDROME
Does Alpha Blockers decrease the size of the prostate?
no
Types of Alpha Blockers
Silodosin (Rapaflo)
Alfuzosin (Uroxatral)
Doxazosin (Cardura)**
Prazosin (Minipress)
Terazosin (Hytrin)
Tamsulosin (Flomax)**
Quick way to remember Alpha meds
-sin goes down and so does BP
5-alpha reductase inhibitors do
Shrink enlarged tissue
Reduce the size of the prostate gland
3-6 months for improvement
5-alpha reductase inhibitors have adverse effects
Increased risk of high-grade prostate tumor
ED/decreased libido
Gynecomastia (breast enlargement)
5α-Reductase inhibitors do
Blocks enzyme necessary for conversion of testosterone to DHT
↓ Size of prostate gland
Which med is more effective for larger prostates with bothersome symptoms?
5a-reductase
5a Reductase inhibitor types
Finasteride (Proscar)
Dutasteride (Avodart)
Jalyn (finasteride plus tamsulosin)
Surgical Mgmt of BPH
Outpatient therapies to invasive
TURP
Stents
tuip
Open Prostatectomy
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Laser prostatectomy
TURP means
Transurethral resection of the prostate
What is used for TURP?
Murphy Drip
Is hematuria normal for TURP?
Yes
Post-Op for TURP complications
Hemorrhage
Bladder spasms
Urinary incontinence
Infection
Occlusions
CBI (continuous bladder irrigation)
Remove blood clots
Ensure drainage of urine
Use aseptic technique
After TURP we want them to be on what to prevent straining?
stool softeners
high fiber diets
Bladder spasms are treated with
-clamp the fluid because of the blood clot caught
need irrigation
Post-Op Care for TURP
care
catheter care
kegel
signs of infection observe
To manage dribbling and continue social activities after
penile clamp
condom catheter
incontinence pads or brief
Patho of Prostate CA
SLOW growing
What is the most common CA in men?
prostate CA
Prostate CA can metastasize to
Lymph node/lung/other organs/bone
High cure when local
Prostate CA feels like what during DRE?
asymmetrical
rough
S/S of Prostate CA
BPH symptoms
PSA elevated extreme
DRE – rough and asymmetrical
Dysuria/hematuria
Pain
Perineal
Suprapubic
Rectal
Dx of Prostate CA
PSA screening HIGH ELEVATED
DRE
Screening recommendation
Age 55-69 should be screened every 2 years
Biopsy - actual dx
Tx for Prostate CA
Radiation/chemo
Brachytherapy
Cryotherapy and ablative hormone therapy
Chemotherapy
Radical Prostatectomy
Post-Op Care for Prostatectomy
indwelling catheter inflate to 20-30
site drain
stay in hospital for 1-3 days
increase fiber and stool softeners
Complications of Prostatectomy
Erectile dysfunction (ED)
Incontinence, urinary retention
Hemorrhage
Infection
Wound dehiscence
DVT/PE
The first few months after prostatectomy is more prominent for
incontinence
With brachytherapy for Prostate CA
don’t touch probes and limit time the to them
4-6 ft away with gloves and radioactive gown
no pregnant or children in the room due to radiologic
use separate restroom and flush toilet twice after use
Pt Teaching of Brachytherapy
Annual check-up PSA/DRE
Brachytherapy radiation exposure to partner
Signs of infection
Prevention
Erectile dysfunction
Inability to achieve or maintain an erection sufficient for sexual intercourse
- incidence increases with age
Causes of erectile dysfunction
systemic, psychologic, or meds
Diabetes, vascular disease, side effects of medication, results of surgery, trauma, stress, depression, and others
avoid smoking and alcohol use
Dx of erectile dysfunction
pt complaint
assessment DM, CVD, low testosterone levels
5(PDE-5) inhibitors use
Cause smooth muscle relaxation and increases blood flow
5(PDE-5) inhibitors not be used with
nitrates (nitroglycerin)
- potentiate hypotension
Alpha
- hypotension priapism, HA, flushing, dyspepsia
Priapism
erection longer than 4 hours
Priapism is a
emergency
intracavernosal injection
5(PDE-5) inhibitors Types of meds
Sildenafil (Viagra)
Vardenafil (Levitra)
Tadalafil (Cialis)
5(PDE-5) inhibitors end in
-afil
Phil has erectile dysfunction
Other tx in Ed
vacuum device
implant or prosthesis (no before scans)
psychosocial
Nurses should figure out about a pt with Ed
Hx
support or counseling
teach contributing factors
meds
risks
priapism
The halflife of 5PDE is
long 4-17.5 hours
Testicular CA Causes
Abnormal testicle development
Exposure to certain chemicals
HIV infection
History of testicular cancer
History of undescended testicle
Infertility
Tobacco use
Down syndrome
Testicular CA affects
15-35 age males
Metastasize to where from Testicular CA
Tumors on right side may spread to right side of the lymph nodes
Tumors on left side may spread to back of the abdomen
S/S of testicular CA
Painless mass in scrotum
Nontender and firm
Later : Dull ache or heavy sensation in lower abdomen, perianal area, or scrotum
Dx of Testicular CA
Firm scrotum when palpated
-no light through testicles
Ultrasound
Tumor markers (hCG)
Tx of Testicular CA
Surgery
Chemotherapy
Radiation
Orchiectomy
Surgical removal of the affected testis, spermatic cord, and regional lymph nodes
Seminomas
Radiation and/or chemotherapy
Very sensitive to radiation therapy
Nonseminomas
Not responsive to radiation
Removal of lymph nodes
More rapid growth
Chemotherapy
Nursing Mgmt of Testicular CA
wound care
VS
Teach infection signs, fertility bank, follow up, and self exam monthly
Male Breast CA
Uncontrolled growth of abnormal cells in breast tissue
Male breast cancer is a rare disease
Male Breast CA risks
Hyperestrogenism
Family history of breast cancer
Radiation exposure
S/S of Male Breast CA
Swelling/lump in breast area,
Dimpling of skin or nipple erythema
Nipple discharge
Nipple inversion
Ultrasonography and MRI
Dx of Male Breast CA
MRI
Ultrasound
Lab studies
Bx
don’t need a mammogram
Tx of Male Breast CA
Surgery
Chemotherapy
Hormone therapy
Radiation therapy
Nursing Mgmt of SURGERY or therapy of Male Breast CA
monitor VS
Incision and JP Drain Care
Pain mgmt
emotional support
PT teaching of Male Breast CA
test positive for BRCA gene mutation should be aware of what breasts look and feel
self-breast exams
clinic exams at 35 for at-risk
monitor for infections
Testicular Trauma
Result from sports injuries, kicks to the groin, motor vehicle accidents, or falls and injury
85% from blunt trauma
15% from penetrating trauma
1% from degloving (skin off)
Scrotal hematoma
bleeding into the scrotal wall
Is scrotal trauma emergent?
if blood supply is compromised
Teaching scrotal trauma
Sudden onset of scrotal pain, tenderness, swelling, nausea, and/or vomiting
Pain mgmt
Urinary symptoms
Fever (with absence of WBCs or bacteria in urine)
