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Prostate cancer vs benign prostatic hypertrophy Similarities
bladder neck obstruction, nocturia, postvoid dribbling, reduced size and force of urinary stream, hesitancy, frequency
benign prostatic hypertrophy
uniform enlargement, nontender, PSA not usually elevated, or mildly elevated, and stable
stony hard nodule palpated on prostate by clinician performing DRE, often but not always accompanied by elevated PSA
1st class meds
works by depriving the prostate of DHT (androgen). Examples:proscar and Avodart , can cause decreased libido and erectile function
Women of childbearing age should not touch pill because it is a teratogen
2nd class meds
alpha blocking agents.
Works by directly shrinking prostate and also decreases blood pressure.
Examples- Avodart and Flomax.
Use cautiously in patients being treated for hypertension with another agent
transurethral resection of prostate (no incision, cystoscopy uses)
Foley w/ 30-40cc balloon - constant urge to void
hematuria normal; continuous bladder irrigation
Less tissue able to be removed and urethral scarring/strictures possible
retropubic, perineal, suprapubic
retropubic - through abdominal incision
perineal - between anus and testes
suprapubic - incision in the bladder, uses finger to remove BPH tissue
Complication early postop-hemorrhage
Urine in bedside drainage should be pink with small clots, not bright red
Watch closely for complications, clot in tubing, bladder spasms
aggressive treatment- need Radical Prostatectomy
all prostate tissue is removed
- Likely devastating complications:
- · Erectile dysfunction
- · Urinary incontinence (long term)Radiation seed often used for noninvasive cases
Functional vs organic
Functional - physiological cause; episodic event (stress, sexual trauma)
Organic - gradual deterioration due to disease process (#1 cause - diabetes)
Meds- Viagra, Cialis, Levitra
work by systemic vasodilation
Side effect- hypotension, nausea, facial flushingContraindicated in pt’s receiving nitrates
disease of young healthy males- 15-35. Pt presents with testicular lump. Usually unilateral
Encourage testicular self exam in young
Orchiectomy of affected testicle done, but before pt should be offered sperm donation
If hesitant, explain benefits and encourage
If retroperitoneal lymph nodes are also to be removed, the procedure becomes long and complex, necessitating a large abdominal-thoracic incision and longer hospital stay
Good prognosis if caught early
often caused by sepsis, or trauma. May see massive edema. Maintain scrotal elevation, ice
cystic mass - straw colored fluid around testes resulting from impaired lymphatic drainage.
drained with needle and syringe or repaired surgically
sperm-containing cyst on the epididymis besire the testicle.
small, asymptomatic, no interventions
if painful, they are removed
dilated veins behind/above testes
palpated, feel like braided or wormlike veins
varicocelectomy preformed through inguinal incisionand spermatic veins are ligated in the cord
Scrotal trauma: testicular torsion
Usually from sports injuries
- Very painful, edema and bruising usually
- Spermatic cord becomes twisted causing lack of blood flow. The testicles are very sensitive to changes in blood flow. The concern is necrosis, gangrene and loss of testicle
Priapism- undesirable >4hr erection
Can be dangerous, urologic emergency.
Be aware of bladder status, pt may need suprapubic catheter placed to prevent bladder rupture.
Causes: use of ED drugs without ED; sickle cell disease, diabetes, leukemia, neuropathy
Phimosis and paraphimosis
Inability to move foreskin of penis either down over distal end, or retract back from distal end (glans)
Treatment-circumcision, this is more complex of a surgery after adolescence as nocturnal erections threaten suture line. Give pt barbiturate and drugs preventing nocturnal spontaneous erections until healed
Proponents of circumcision- cleaner, less complications like phimosis
Risk of penile cancer almost nil as penile cancer almost exclusively disease of the non-circumcised
Should be no effect on sexual performance whether circumcised or not