114 Ch. 75

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  1. Prostate cancer vs benign prostatic hypertrophy Similarities
    bladder neck obstruction, nocturia, postvoid dribbling, reduced size and force of urinary stream, hesitancy, frequency 
  2. benign prostatic hypertrophy
  3. uniform enlargement, nontender, PSA not usually elevated, or mildly elevated, and stable
  4. Prostate cancer
  5. stony hard nodule palpated on prostate by clinician performing DRE, often but not always accompanied by elevated PSA
  6. 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
  7. 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
  8. TURP
    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
  9. retropubic, perineal, suprapubic
    retropubic - through abdominal incision

    perineal - between anus and testes

    suprapubic - incision in the bladder, uses finger to remove BPH tissue
  10. 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
  11. 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
  12. Erectile dysfunction

    Functional vs organic
    Functional - physiological cause; episodic event (stress, sexual trauma)

    Organic - gradual deterioration due to disease process (#1 cause - diabetes)
  13. Meds- Viagra, Cialis, Levitra
    work by systemic vasodilation 

    Side effect- hypotension, nausea, facial flushingContraindicated in pt’s receiving nitrates
  14. Testicular cancer

    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
  15. Orchitis
  16. often caused by sepsis, or trauma.  May see massive edema. Maintain scrotal elevation, ice
  17. Hydrocele
    cystic mass - straw colored fluid around testes resulting from impaired lymphatic drainage. 

    drained with needle and syringe or repaired surgically
  18. spermatocele
    sperm-containing cyst on the epididymis besire the testicle. 

    small, asymptomatic, no interventions

    if painful, they are removed
  19. varicocele
    dilated veins behind/above testes

    palpated, feel like braided or wormlike veins

    varicocelectomy preformed through inguinal incisionand spermatic veins are ligated in the cord
  20. 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
  21. 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
  22. 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
  23. Circumcision
    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
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114 Ch. 75
2014-04-22 22:17:57
114 75

Med-Surg I Chapter 75
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