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What is BPH?
- glandular units in the prostate that undergo an increase in the number of cells, resulting in enlargement of the prostate gland
- when it enlarges it causes bladder outlet obstruction
increase in number of cells
What happens when bladder outlet is obstructed?
- Urinary retention
- Overflow urinary incontinence
- Bladder stones
- Inability to void
Assessment of BPH
- urinary pattern - frequency, nocturia
- lower urinary tract symptoms - hesitancy, intermittency, reduced force and size of urinary stream, sensation of incomplete bladder emptying, post-void dribbling
- hematuria - possibly related to UTI
How is the prostate examined?
palpated through the rectal wall by digital examination
Lab assessment for prostate issues
- Prostate-specific antigen - for prostate cancer, prostatitis
- CBC - infection, anemia
Drug therapy for BPH
- 5-alpha reductase inhibitor
- Flomax - increase urine flow
- alpha blockers
- estrogens and androgens
Nonsurgical therapy for BPH
- Drug therapy
What is a TURP?
transurethral resection of the prostate - lighted scope up penis and remove prostate in small pieces - remove enough to open up urethra so they can urinate - prostate may grow again
Continuous bladder irrigation with TURP
- three way urinary catheter with 30-45 mL retention balloon
- traction via taping to patient's abdomen or thigh
- patient will have an uncomfortable urge to void continuously
- give antispasmodic meds for bladder spasms
- at risk for bleeding 24 hrs post-op - want to see only watered down, dark red bleeding (not bright red or ketchup)
What post-catheter care is required after continuous bladder irrigation?
- monitor fluid intake - 2000-2500/day to decrease dysuria and keep urine clear
- teach patient that they may feel burning in urination, and have some urinary frequency, dribbling and leakage but this will resolve in several days
What is prostate cancer?
- most common invasive cancer among men in the US
- one of the slowest growing malignancies and metastasizes in a predictable pattern
- first symptoms are related to BPH
What would you feel on palpation of a prostate with cancer?
What test will be abnormal if the patient has prostate cancer?
- PSA - above 4 ng/mL
- a biopsy is necessary to confirm
Is prostate cancer curable?
Yes - surgery if it's caught early
Is TURP curative for prostate cancer?
No it just promotes urination
Is bilateral orchiectomy curative or palliative for prostate cancer?
palliative - slows spread of disease by removing main source of testosterone
Post-op care after a radical prostatectomy
- hydration IV therapy
- wound drains
- prevent emboli/pulmonary complications
- laxatives/stool softeners
- indwelling urinary catheter - will be discharged with it
Complications of prostatectomies
Nonsurgical management of prostate cancer
- hormone - androgen deprivation
- CAM - lykopene (tomato substances), omega 3 fatty acids and soy protein
What is ED?
inability to achieve or maintain an erection for sexual intercourse
What is organic ED?
gradual deterioration of function r/t diabetes, HTN, smoking, alcohol, surgery or other causes
Psychological - related to stress, alcohol consumption
Interventions for Ed
- drug therapy (first line) - Viagra, Levitra, Cialis
- no alcohol before intercourse
Common side effects of drug therapy for ED
- facial flushing
- stuffy nose
- don't take nitrates = profound hypotension and reduced blood flow to vital organs
What are vacuum devices for ED?
- cylinder that fits over the penis and sits firmly against the body
- the vacuum draws blood into the penis to maintain an erection
- a rubber ring (tension band) is placed around base of penis to maintain the erection and the cylinder is removed
What drugs are used for ED when injecting the penis?
vasodilating - Caverject, Paverine, Regitine
What is an intraurethral applications for ED?
- alprostadil is self-administered suppository that is placed in the urethra with an applicator
- erection occurs in about 10 min and lasts 30-60 min
- burning of the urethra can occur after application, as well as syncope
What is the surgical management for ED?
- prosthesis - penile implant which is semirigid, malleable or hydraulic inflatable and multicomponent or one-piece
- the reservoir is placed in the scrotum
- major disadvantage - device failure; infection
What ages is testicular cancer most common in?
it is rare but it is the most common malignancy in men 15-34 years old
How can testicular cancer be detected?
- testicular self-examination
- biomarker proteins (present during embryonic development but abnormal in adults)- Alpha-fetoprotein (AFP); Beta human chorionic gonadotropin (hCG); elevated LDH
- CT scan
What are the two types of testicular cancer tumors?
- Germ cell - arise from sperm-producing cells
Interventions for testicular cancer
- surgery - main treatment
- sperm banking pre-op
- nonsurgical - chemo/radiation
What is a hydrocele?
- cystic mass filled with straw colored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing swelling of the tissue surrounding the testes
- usually painless
- can be ginormous
- more common in older men
How are hydrocele's treated?
- drained via needle and syringe
- removed surgically
What is a spermatocele?
- sperm containing cyst the develops on the epididymis alongside the testicle
- normally small and asymptomatic and require no interventions
What is a varicocele?
- cluster of dilated veins behind and above the testis
- can cause infertility
- removed through an inguinal incision and the spermatic veins are ligated in the spermatic cord
What almost always eliminates the possibility of penile cancer?
Circumcision in infancy
Epidermoid (squamous) carcinoma?
- in uncircumcised men
- constricted prepuce that cannot be retracted over the glans
- prepuce remains down around the tip of the penis
- emergency situation = circumcision required
- in uncircumcised men
- prepuce has not been returned to normal position after being retracted and forms a constricting band around the glans
- emergency situation = circumcision required
- uncontrolled and long-maintained erection without sexual desire
- causes penis to become large and painful
- shuts of fresh blood supply
- can't pee
What causes priapism?
- thrombosis of veins of corpora cavernosa
- sickle cell disease
- abnormal reflex
- some drug effects
- recreational drugs
- prolonged sexual activity
Interventions for priapism
- to improve the venous drainage of the corpora cavernosa
- warm enemas
- urethral or suprapubic catheterization
- large-bore needle or surgical intervention
- inflammation of the prostate gland
- - acute bacterial or chronic bacterial
- nonbacterial/chronic pelvic pain syndrome
- asymptomatic inflammatory prostatitis
- inflammation of the epididymis resulting from an infection or noninfectious sources (trauma)
- treatment = bedrest with scrotum elevated on a towel and scrotal support when ambulating
- comfort measures
- acute testicular inflammation resulting from trauma or infectoin
- treatment = bedrest with scrotal elevation, ice and analgesics/antibiotics
get this 20 days after adult male has mumps after pubery - 20% of men