REPRODUCTIVE + URINARY SYSTEMS Flashcards
what are 4 types of prostatitis/prostatodynia
- Acute bacterial
- Chronic bacterial
- Nonbacterial/prostatodynia/CPPS
- Asymptomatic inflammatory
Is prostatodynia/CPPS is common or uncommon?
common!
What is the presentation of Prostatodynia/CPPS
- 2nd degree pelvic floor dysfunction
- History of sitting increasing pain
What is the presentation of Prostatodynia/CPPS
- 2nd degree pelvic floor dysfunction
- History of sitting increasing pain
- Peripheral and central pain sensitization
- Urinary frequency, urgency, dysuria, nocturia
- Pain in penis, testicles, perineum
- Suprapubic pain
- Painful ejaculation, decreased libido, ED
What is suprapubic pain a sign of
Sign of bladder impairment
how is prostatodynia/cpps mANAGED?
- Pain medication (TAD*, anticonvulsants)
- Alpha blockers
- Physiotherapy
- CBT/mindfulness therapy
How is a physio involved with treatment of prostatodynia?
- Screening
- Non mechanical pain onset and pattern, sitting exacerbation, Onset/presence of other pain in urinary genital area
- Pelvic floor specific scope
What are common findings that need to be addressed in pelvic floor physio
- Increased pelvic floor resting tone
- Decreased pelvic floor proprioception
- Decreased pelvic floor motor control
- +/- trigger points
- Sitting (Limit if pain increases)
- Need pain sensitization education/rx
What is the most effective level of prostate cancer detection and diagnosis
PSA SCREENING
- Protein
- manufactured in prostate
- Liquefies the semen
- Allows sperm to swim freely
- Dissolves the cervical mucous cap, allowing the entry of sperm
What are normal PSA levels
0-0.25 ng per milliliter
Do you need to have elevated PSA levels to have prostate cancer
no - can have cancer without elevated levels
What are some causes of false + PSA Levels?
- Prostate infection, UTI
- Irritation
- BPH
- Age
- Recent ejaculation
What are some complications to radical prostatectomy
- Infection
- Incontinence (30%)
- ED (5-30%)
- Denervation injuries
What are signs and symptoms to screen for for prostate cancer
- Nonmechanical “musculoskeletal”pain
- night waking
- men >50
+/- urology signs and symptoms
what are some side effects of ADT (hormone therapy) as treatment for prostate cancer
- Osteoporosis, fracture
- fatigue, increased body fat, decrease lean body tissue
What are some pelvic floor specific scope things to watch out for with prostatectomy
- Post op incontinence
- Erectile dysfunction
- Education
- Treatment
What are some pelvic floor specific scope things to watch out for with radiation
- Radiation B and B urgency
- Incontinence (2-5yrs after treatment)
___% of men have erectile dysfunction
10%
___ men seek medical treatment for ED each year
22/1000
disease accounts for ___% of erectile dysfunction
70%
Psychological factors account for ___% of erectile dysfunction
20%
What is endometrial
tissue outside of the uterus
What are risk factors for endometriosis
- Postponed pregnancy
- Early menarche
- Shorter cycles (<27 days, longer bleeding)
- Family history
- Autoimmune
Endometriosis occurs with ____ menstruation
retrograde
____% of women have endometriosis
7-60%
___% of infertile women have endometriosis
50% q
Are the extent of endo lesions an indication of the pain experienced?
no
What is the etiology of endometriosis
- retrograde menstruation - blood flow up into body rather than out
- Tissue implants in pelvis and abdomen
- can implant throughout the body
- Implants respond to cyclical hormonal changes
- lesions swell -> stretch and compress organs + nerves
- Over time create adhesions
What does the presentation of endometriosis depend on?
the location of implants
What are some possible presentations of endometriosis
- Dyspareunia (pain with intercourse)
- GI pain, cyclical LBP
- Pain on defecation
- Groin or suprapubic pain
- Menorrhagia (heavy periods)
- Dysmenorrhea (painful periods)
How do you get a definitive diagnosis of endometriosis
Laparoscopy
A laparoscopy allows for a definitive diagnosis and ….
treatment! gets rid of adhesions but you get scar tissue. will normally only do two of them
What are the goals of the medical management of endometriosis
pain relief + fertility!
No cure
What are 4 interventions for endometriosis?
NSAIDS
Hormones (IUD or OCP)
Laparoscopy
Hysterectomy
How do PTS screen for endometriosis
- Cyclical LBP, hip, groin - non-mechanical
- Dyspareunia - thrusting or deep, might not be able to identify pain location
- Differential - hip, groin, lb, dyspareunia
How can PT contribute to the treatment of Endometriosis
- education
- pain sensitization
- pacing and grading to return to activity
- Pelvic floor specific scope
Endometrial carcinoma is the ____ most common cancer in women (ranking)
4th
What is the presentation of endometrial carcinoma
- Abnormal vaginal bleeding
- metastases - lymph, lung, live, bones of the lower extremity
What would be the PT role in the treatment of Endometrial carcinoma
- Post op lymphedema
- Disuse atrophy
What is the pelvic floor specific scope for endometrial carcinoma
- Iatrogenic (illness caused by treatment)
- Pelvic organ prolapse
What causes cervical cancer
HPV infection
How is cervical cancer preventable?
- regular screening
- early intervention
- HPV vaccination
___% of the population acquire HPV infection in their lifetime
75%
What is the presentation of cervical cancer
- HPV usually asymptomatic
- Early stage cancer asymptomatic
- advanced disease: change in menstrual bleeding, pelvic or LBP (uncommon)
5 methods of preventing cervical cancer
- Barrier contraceptives
- Life long monogamous sex
- Abstinence
- Vaccine
- Pap smear
What is the PT treatment for cervical cancer
- Post op lymphedema
- Disuse atrophy
What is the pelvic floor specific scope for cervical cancer?
Pelvic organ prolapse
Where does ovarian cancer arise
fallopian tube fimbria - not on surface of ovaries
ovarian cancer is in __% OF women
2%
What is the prevention method for women at low risk of ovarian cancer
Fallopian tube removal during routine surgery
What is the prevention method for women at highrisk of ovarian cancer
genetic testing and prophylactic surgery
What is the 5 year survival of ovarian cancer if diagnose in situ? diagnosed advanced?
90% in situ
70% if diagnosed advanced
What are symptoms you can screen for with ovarian cancer
- Abdominal discomfort
- Pelvic pain or swelling
- Bloating or intestinal gas
- Constipation
- Frequent urination
- Vaginal bleeding
- Fatigue
- Nausea
- Fever
What are the red flags of ovarian cancer
- Gait disturbances
- Dyspnea
- Thoracic or shoulder girdle pain
- Weight loss
- Fatigue
4 types of pelvic organ prolapse
- Cystocele
- Rectocele
- Uterine prolapse
- Enterocele
