male reproductive problems

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male reproductive problems
2011-12-10 16:16:49
male reproductive problems

male reproductive problems
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  1. 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
  2. Hyperplasia
    increase in number of cells
  3. Hypertrophy
  4. What happens when bladder outlet is obstructed?
    • Urinary retention
    • Overflow urinary incontinence
    • UTIs
    • Bladder stones
    • Inability to void
    • Hydroureter
    • Hydronephrosis
  5. 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
  6. How is the prostate examined?
    palpated through the rectal wall by digital examination
  7. Lab assessment for prostate issues
    • Prostate-specific antigen - for prostate cancer, prostatitis
    • BUN/Creatinine
    • CBC - infection, anemia
  8. Drug therapy for BPH
    • 5-alpha reductase inhibitor
    • Flomax - increase urine flow
    • alpha blockers
    • estrogens and androgens
    • antimuscarinic
  9. Nonsurgical therapy for BPH
    • Drug therapy
    • Thermotherapy
  10. 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
  11. 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)
  12. 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
  13. 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
  14. What would you feel on palpation of a prostate with cancer?
  15. What test will be abnormal if the patient has prostate cancer?
    • PSA - above 4 ng/mL
    • a biopsy is necessary to confirm
  16. Is prostate cancer curable?
    Yes - surgery if it's caught early
  17. Is TURP curative for prostate cancer?
    No it just promotes urination
  18. Is bilateral orchiectomy curative or palliative for prostate cancer?
    palliative - slows spread of disease by removing main source of testosterone
  19. Post-op care after a radical prostatectomy
    • hydration IV therapy
    • wound drains
    • prevent emboli/pulmonary complications
    • antibiotics
    • analgesics
    • laxatives/stool softeners
    • indwelling urinary catheter - will be discharged with it
    • antispasmodics
  20. Complications of prostatectomies
    • Urinary incontinence
    • ED
  21. Nonsurgical management of prostate cancer
    • radiation
    • hormone - androgen deprivation
    • chemotherapy
    • cryotherapy
    • CAM - lykopene (tomato substances), omega 3 fatty acids and soy protein
  22. What is ED?
    inability to achieve or maintain an erection for sexual intercourse
  23. What is organic ED?
    gradual deterioration of function r/t diabetes, HTN, smoking, alcohol, surgery or other causes
  24. Functional ED?
    Psychological - related to stress, alcohol consumption
  25. Interventions for Ed
    • drug therapy (first line) - Viagra, Levitra, Cialis
    • no alcohol before intercourse
  26. Common side effects of drug therapy for ED
    • headache
    • facial flushing
    • stuffy nose
    • don't take nitrates = profound hypotension and reduced blood flow to vital organs
  27. 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
  28. What drugs are used for ED when injecting the penis?
    vasodilating - Caverject, Paverine, Regitine
  29. 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
  30. 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
  31. What ages is testicular cancer most common in?
    it is rare but it is the most common malignancy in men 15-34 years old
  32. 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
    • ultrasound
    • CT scan
    • MRI
  33. What are the two types of testicular cancer tumors?
    • Germ cell - arise from sperm-producing cells
    • Non-germ
  34. Interventions for testicular cancer
    • surgery - main treatment
    • sperm banking pre-op
    • nonsurgical - chemo/radiation
  35. 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
  36. How are hydrocele's treated?
    • drained via needle and syringe
    • removed surgically
  37. What is a spermatocele?
    • sperm containing cyst the develops on the epididymis alongside the testicle
    • normally small and asymptomatic and require no interventions
  38. 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
  39. What almost always eliminates the possibility of penile cancer?
    Circumcision in infancy
  40. Epidermoid (squamous) carcinoma?
    Penile cancer
  41. Phimosis
    • 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
  42. Paraphimosis
    • 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
  43. Priapism
    • uncontrolled and long-maintained erection without sexual desire
    • causes penis to become large and painful
    • shuts of fresh blood supply
    • can't pee
  44. What causes priapism?
    • thrombosis of veins of corpora cavernosa
    • leukemia
    • sickle cell disease
    • DM
    • malignancies
    • abnormal reflex
    • some drug effects
    • recreational drugs
    • prolonged sexual activity
  45. Interventions for priapism
    • to improve the venous drainage of the corpora cavernosa
    • meperidine
    • warm enemas
    • urethral or suprapubic catheterization
    • large-bore needle or surgical intervention
  46. Prostatitis
    • inflammation of the prostate gland
    • - acute bacterial or chronic bacterial
    • nonbacterial/chronic pelvic pain syndrome
    • asymptomatic inflammatory prostatitis
  47. Epididymitis
    • 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
  48. Orchitis
    • acute testicular inflammation resulting from trauma or infectoin
    • treatment = bedrest with scrotal elevation, ice and analgesics/antibiotics
  49. Mumps orchitis
    get this 20 days after adult male has mumps after pubery - 20% of men