Week 7: Male Disorders Flashcards
How does the male reproductive system change with aging?
- The frequency, duration and rigidity of erections gradually decline as men age (erectile dysfunction): blood flow decreases.
- Levels of the male sex hormone (testosterone) tend to decrease reducing libido.
Andropause (Male menopause)
Period later in life when testosterone production has decreased enough to cause significant symptoms.
Low testosterone may develop certain characteristics associated with aging including:
- Decreased libido
- Decreased muscle mass
- Increased abdominal fat
- Thin bones that easily fracture (osteoporosis)
- Decreased energy level
- Slowed thinking
- Anemia
- Increases the risk for CAD
Benign Prostatic Hyperplasia
Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue.
Does BPH predispose men to prostate cancer?
It does not predispose to development of prostate cancer.
Etiology and Pathophysiology of BPH
- Not completely understood.
- Thought to result from endocrine changes related to the aging process.
- Enlargement gradually compresses the urethra (partial or complete obstruction)
BPH: compression leads to clinical symptoms including
Postrenal acute renal injury
Risk factors for BPH
- Family history
- Environment
- Obesity
- Increased waist circumference
- Diet
- Polyunsaturated fatty acids
Clinical Manifestations of BPH
- Symptoms usually gradual in onset
- Early symptoms usually minimal because bladder can compensate
- Worsen as obstruction increases.
Transurethral Resection (TURP)
- Removal of obstructing prostate tissue using resectoscope inserted through urethra.
- Relatively low risk
Transurethral Resection (TURP) Procedure
- Performed under spinal or general anesthesia and requires hospital stay.
- Bladder irrigated for first 24 hours to prevent mucus and blood clots.
- Patients must stop anticoagulants before surgery.
Transurethral Resection (TURP) Complications
- Bleeding
- Clot retention
- Hyponatremia
- Retrograde ejaculation
Transurethral Needle Ablation (TUNA)
- Increased temperature of prostate tissue for localized necrosis
- Low-wave frequency used
- Only tissue in contact with needle is affected
- Outpatient using local anesthesia and sedation
- Lasts 30 minutes with little pain and quick recovery
Prostate Cancer: Etiology and Pathophysiology
- Androgen (testosterone) dependent carcinoma
- Majority of tumors occur in outer aspect of the gland
- Usually slow growing
Prostate cancer spreads by three routes
- Direct extension
- Through lymph system
- Through bloodstream
Prostate Cancer Incidence
- High-fat diet associated with risk
- Exposure to certain chemical may be associated with higher risk.
- History of BPH is NOT a risk factor.
- African Americans have highest incidence.
- Having a first-degree relative with prostate cancer increases risk.
Clinical Manifestations of Prostate Cancer
Usually asymptomatic in early stages. May experience symptoms similar to BPH.
- Dysuria
- Hesitancy
- Dribbling
- Frequency
- Urgency
- Hematuria
- Nocturia
- Retention
- Interruption of urinary stream
- Inability to urinate
What could indicate metastasis of prostate cancer?
Pain in lumbosacral area that radiates to hips or legs, when coupled with urinary symptoms
Once cancer (prostate) has spread to distant sites, pain management becomes
A major problem
Radial Prostatectomy
- Entire prostate gland, seminal vesicles and part of bladder neck are removed.
- Retroperineal lymph node dissection usually done.
- Considered most effective for long-term survival.
- Patient catheterized for 1-2 weeks postop.
Major complications of radical prostatectomy
Erectile dysfunction and incontinence
Complications of Radical Prostatectomy
- Hemorrhage
- Urinary retention
- Infection (high risk d/t incision location)
- Wound dehiscence
- DVT
- Pulmonary emboli
Cryosurgery (Cryoablation)
- Surgical technique that destroys cancer cells by freezing the tissue.
- Initial and second-line treatment after radiation fails.
Complications of Cryosurgery
- Damage to urethra
- Urethrorectal fistula
- Urethrocutaneous fistula
- Tissue sloughing
- Erectile dysfunction
- Urinary incontinence
- Prostatitis
- Hemorrhage
Radiation Therapy
- External beam radiation
- Most widely used method of radiation for prostate cancer
- Used to treat cancer confined to prostate and/or surrounding tissue.
Brachytherapy
- Implantation of radioactive seed into prostate gland
- Spares surrounding tissue
- Placement guided by trans Rectal ultrasound
- Best suited for stage A or B
Common side effects of brachytherapy include
Irritative or obstructive urinary problems
Prostate Cancer: Drug Therapy
- Hormonal Therapy
- Hormone refractory or castrate-resistant
Prostate Cancer: Hormonal Therapy
- Androgen deprivation is primary therapeutic approach
- Focused on reducing levels of androgens to reduce tumor growth.
- Can be used before surgery or radiation to reduce tumor size and in advance disease.
Hormone Refractory or Castrate-Resistant
-Tumors can become resistant to therapy within a few years
What is often the first sign that therapy for prostate cancer is no longer effective?
Elevated PSA levels
Types of Hormonal Therapy include
- Luteinizing hormone-releasing hormone agonists
- Androgen receptor blockers
- Estrogen
Luteinizing Hormone-Releasing Hormone Agonists
Causes testicles to stop making testosterone
Androgen Receptor Blockers
Prevent androgens like testosterone from mediating their biological effects in the body (i.e spironolactone)
