Week 6- Men’s Health Physiotherapy Flashcards
What is included in mens health Physiotherapy
- post surgical removal or reduction of prostate of the prostate gland
- incontenence issues, pelvic floor weakness, post-void dribble
- pelvic pain, sexual health issue (many will not present due to embarrassment)
What is the prostate gland
- Produces seminal fluid
- found at the base of the bladder
- what can go wrong? (Hyperplasia, cancer). Enlargement leads to hyperplasia. Inflammation leads to prostatits. Cancer
Prevalence of prostate cancer
1 in 11 Australian men, most common >65yrs
Risk factors for prostate cancer
- age
- obesity
- family history prostate or breast cancer
What are symptoms of prostate cancer
- difficulties with urination
- blood in urine or semen
- pain during sex/ orgasm
How is prostate cancer detected
- digital rectal exam
- biopsy
- PSA testing
What are the management approaches to prostate cancer
- watchful waiting (some are slow growing and if older man, likely something else will kill them before the prostate cancer will and therefore surgery isn’t worth it)
- active surveillance
- surgical approaches (TURP, removal of prostate gland (open vs lap))
- radiotherapy
- hormone therapy
Surgical approach for prostate cancer
- radical prostatectomy for stage 1-2 cancers
- removal of entire prostate gland, surrounding tissues, seminal vessels
- open removal
- laparoscopic
What are the 2 open surgical approaches
-Radical Retropubic
• Lower abdo incision under GA/spinal
• Lymph node resection if local spread
-Radical Perineal
• Surgical incision between anus and perineum
• Less common due to↑risk side effects
• Unable to access LNs
• Shorter op, less pain -?easier recovery
What are the advantages to laparoscopic over open surgery
- Small incisions
- ↓ blood loss
- ↓ post-op pain
- Faster recovery
- ↓ length of stay
Note:
• Still requires catheterisation
• Similar rates of ED & UI for open prostatectomy
What are surgical risks
- Standard risks for surgery
- Highly vascularised area
- Near abdominal structures
- Development of a Lymphocele
What are surgical side effects
*Urinary incontinence
- Stress incontinence (SUI) – most common
• Problems with urethral sphincter control
- Urge incontinence (UUI)
• Oversensitivity of bladder stretch as it fills
- Overflow incontinence/urinary obstruction – rare
• Trouble fully emptying
• Prolonged urination
• Narrowing of bladder outlet
*Impotency (erectile dysfunction)
• Under60=1in4
• Over70=3in4
• Lower rates with nerve sparing approach
• Ability to obtain erection normally returns slowly
• Try to regain early post-op
- Loss of fertility
- Lymphoedema
- Decrease in length
- Inguinal hernia
What does TURP stand for?
Trans-urethral resection of prostate
What is TURP used for
Used to treat non-cancerous prostate enlargement —> Benign Prostatic Hyperplasia
Not used for curative management of prostate Ca, but may be used for advanced Ca
Explain TURP
- Removal of inner part of gland that surrounds urethra – quick, 1-2 day admission
- Nil surgical incision, scope is passed through urethra – cauterisation of tissue
- Under GA or spinal – catheterisation
What are side effects of TURP
- Post-op bleeding
- Ongoing urinary problems
- Retrograde ejaculation
- Erectile dysfunction
- Infertility
What are post op management- education
- Deep breathing
- Supportive cough
- Circulation
- Pelvic floor
Post op management- mobility
What are post op education
- Surgeon to direct (especially return to driving/work)
- Avoid repetitive movements 4-6/52
- No lifting >5kg for 4/52 (or can say no more then the milk in the fridge for visual)
- Light lifting from 10-12/52
- Avoid jarring activities 12/52
- Consider symptoms (pain, SUI)
- Best post op exercise (start with less then you think you can do and should aim for 30min walk by 6 weeks)
When should pelvic floor exercises be commenced
Ideally pre op, as this gives them a chance to learn and get good at before the surgery which makes it easier after surgery. Start post op, once the catheter is removed.
What education should be given around pelvic floor for men and women
- diet and fluid intake
- bladder and bowel habits
- defaecation dynamics
- lifestyle changes
What education should be given around good dietary habits
- 1.5-2L/day (“straw-coloured” urine = hydrated) note not needing to be clear
- More for hot weather / exercise / breastfeeding
- Urgency/frequency/OAB:
- Reduce caffeine, alcohol, fizzy/sugary drinks
- Adequate fibre:
- Wholegrain/multigrain options
- Fruit, vegies (“2 & 5”)
- Legumes, nuts/seeds
- Fibre supplements (e.g. psyllium)
