Week 14- Genitourinary System 2 Flashcards
The process of micturition (voiding or bladder-emptying) and continence involves a complex interplay of…
-Nerves (cortex of brain, brainstem, parasympathetic, and preganglionic sympathetic)
-Detrusor smooth muscle of the bladder
-Internal urethral sphincter (involuntary smooth muscle)
-External urethral sphincter, part of the pelvic floor muscles (voluntary skeletal muscle); innervated by the pudendal nerves
The pelvic floor has ___ layers
3
Complaint of involuntary urine loss
Urinary incontinence
Only _____% of incontinent adults seek medical care
20-50
Urinary incontinence is related to…
-Falls in older adults
-Pressure sores
-Skin breakdown
-UTIs
-Institutionalization
-Depression
-Isolation
True or false: Many people have more than one type of incontinence
True
Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing
Stress urinary incontinence (SUI)
Stress urinary incontinence occurs during activities that increase _______________
Intraabdominal pressure
Pathogenesis of SUI
-Weakness or loss of tone in PFM
-Internal urethral sphincter failure
-Hypermobility of the ureterovesical junction
-Damage to the pudendal nerve (e.g., infection, tumor, childbirth)
Complaint of involuntary loss of urine associated with urgency
Urgency urinary incontinence (UUI)
Urgency urinary incontinence I is related to…
Detrusor instability (the bladder contracts at small volumes)
Urgency urinary incontinence (UUI) often happens in response to ____________
Triggers
Inflammation of the prostate gland can be…
-Acute/chronic
-Bacterial/nonbacterial
-Symptomatic/asymptomatic
True or false: All categories of prostatitis have inflammation
False
Category ____ of prostatitis is more commonly seen in the PT clinic
III
Bacterial infection of the prostate gland as a result of GU infection (bacteria or virus), sexually transmitted infections (STIs)
Acute bacterial prostatitis (category I)
Acute bacterial prostatitis has ___________ voiding and __________ voiding
-Irritative
-Obstructive
Type of pain associated with acute bacterial prostatitis
Suprapubic, rectal, sacral, low back, perineum
Systemic symptoms associated with acute bacterial prostatitis
Fever, chills, nausea, emesis, arthralgia, myalgia, and malaise
Recurrent infection of the prostate
Chronic bacterial prostatitis (category II)
-Low-grade symptoms as for category I
-Flare-ups of pelvic pain
-Voiding problems
-Sexual dysfunction
Chronic bacterial prostatitis (category II)
Pain and urinary dysfunction with inflammation but without infection
IIIA
Pain and urinary dysfunction without inflammation or infection
Previously known as chronic nonbacterial prostatitis
IIIB
-GU, lower abdominal/pelvic, and low back pain (worse by sitting, squatting, and bending)
-Irritative voiding and obstructive voiding
-Sexual dysfunction
-Disturbed quality of life
Chronic prostatitis/chronic pelvic pain syndrome
-No symptoms
-WBCs and inflammatory markers are found in semen or prostate tissue
-Usually being diagnosed when looking for causes of infertility or when testing for prostate cancer
Asymptomatic inflammatory prostatitis (category IV)
Non-malignant enlargement of the prostate gland
Benign prostatic hyperplasia (BPH)
BPH has a prostate volume of _____ mL
> 30 mL
BPH occurs with lower __________ symptoms and __________
-Urinary tract
-Bladder outlet obstruction
____% of men ≥ 50 y/o experienced BPH symptoms
70
BPH risk factors
-Age over 40
-Family history of BPH
-Diabetes
-Heart disease with use of beta blockers
-Obesity
True or false: As men age, the ratio of new prostate cells to old prostate cells shifts in favor of lower cell death
True
Pathogenesis of BPH
-The increased growth of new prostate cells (hyperplasia, not hypertrophy) occurs primarily inward, encroaching on the urethra (benign prostate obstruction)
-As the prostate enlarges, the urethra becomes obstructed, interfering with the normal flow of urine, resulting in urine backing up the ureters and pooling in the kidney
BPH symptoms
-Painful urination
-Blood in the urine
-Unexplained lower back, pelvis, hip, or upper thigh pain
-Sexual dysfunction
Common BPH assessments
-Digital rectal exam (DRE)
-Prostate specific antigen (PSA) blood test
PSA is secreted by ___________
Prostatic epithelia cells
True or false: PSA rises slowly with aging
True
PSA is strongly correlated to ____________
Prostate volume
Norm for PSA blood test
< 4 ng/mL
BPH PT implications
-Identify the presence of obstructed voiding (4 questions on next slide)
-Medical referral may be required
-Lifestyle education and pelvic physical therapy
-Sides effects from the medications to treat BPH
-Screening questions
Side effects from the medications to BPH
-General muscle weakness, drowsiness, dizziness, tachycardia, and postural orthostatic hypotension
-Erectile dysfunction (ED) and loss of libido
-Gynecomastia (enlargement of a man’s breasts)
-Possibility of falls from dizziness and loss of balance
The most common cancer in American men
Prostate cancer
Prostate cancer is the ____ most common cause of male death from cancer
2nd
___ in ___ American men will develop prostate cancer!!!
1
6
______________ (glandular cells) accounts for 98% of primary prostatic tumors
Adenocarcinoma
Prostate cancer usually starts in the outer portion of the prostate and spreads ____________
Inwardly
True or false: The relationship between testosterone/androgens and prostate cancer fully understood
False
True or false: We know the precise cause of prostate cancer
False
______________ influences the normal growth and development of the prostate
Testosterone
Most prostatic adenocarcinomas are characterized by small- to moderate-size disorganized glands that infiltrate the _________ of the prostate
Stroma
True or false: Prostate cancer invades adjacent local structures and includes lymphatic metastasis
True
Obstructive symptoms of prostate cancer
-Urinary urgency, frequency, hesitancy, dysuria, hematuria, difficulty initiating or continuing the urine stream, and decreased urine stream
-Similar to BPH typically present in later stages
True or false: Bony metastasis occurs more often to appendicular skeleton than to the axial skeleton
False
(axial, appendicular)
True or false: Bony metastasis may come in the form as sacral and lumbar pain
True
Clinical manifestation of prostate cancer
A dull, vague ache may be noted in the rectal, sacral, or lumbar spine region, and the individual may have difficulty walking
PT implications for prostate camcer
-Screening for referral
-Complications of medical treatment
-Pre-hab and rehab for prostate surgery
