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95 Cards in this Set
- Front
- Back
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most common urologic problem in males
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benign prostate hyperplasia
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possible causes of BPH
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excessive accumulation of dihydroxytestosterone (principal intraprostatic hormone)
stimulation by estrogen local growth hormone action |
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where does BPH usually occur?
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INNER part of prostate
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risk factors for BPH
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family history
environment obesity (increased weight circumference) diet (saturated fats) |
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obstructive vs irritable symptoms of BPH
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obstructive (more common in western world): decrease in caliber or force of urinary stream; difficulty in initiating urination; intermittency; dribbling
irritative: urinary frequency and urgency; dysuria; bladder pain; nocturia; incontinence |
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complications of BPH
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acute urinary retention
UTI and sepsis incomplete bladder emptying with residual urine provides medium for bacterial growth |
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diagnostic studies for BPH
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DRE (digital rectal exam)
U/A with culture PSA level (to rule out prostate cancer) serum creatinine (to rule out renal insufficiency) TRUS scan (FOR PATIENTS WITH ABNORMAL DRE AND ELEVATED PSA) uroflometry cystourethroscopy (internal visualization of urethra and bladder) |
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who is a cystourethroscopy for?
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those who have an uncertain diagnosis and in patients who are scheduled for a prostatectomy
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who is "watchful waiting" indicated for in BPH?
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if there are only mild symptoms (0-7 on AUA scale)
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dietary changes recommended for BPH?
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decrease caffeine, artificial sweeteners, limit spicy or acidic foods, avoid decongestants and anticholinergics, restrict evening fluid intake
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drug therapy for BPH
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5-a-reductase inhibitors (Finasteride/Proscar), Dutasteride/Avodart); decrease the size of the prostate; take 3-6 months for improvement
a-adrenergic blockers (Tamsulosin/Flomax, Doxazosin/Cardura); promotes smooth muscle relaxation in prostate; facilitates urinary flow; improvement in 2-3 weeks |
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side effects of 5-a-reductase inhibitors
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decreased libido
decreased volume of ejaculation ED these do NOT treat hyperplasia*** |
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side effects of a-adrenergic receptor blockers
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orthostatic hypotension
dizziness retrograde ejaculation nasal congestion |
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saw palmetto for BPH; side effects?
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may alleviate nocturia, improve urinary flow, reduce residual bladder volume
side effects: mainly GI, may increase BP, increase risk of bleeding |
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invasive therapy for BPH indicated when? what is done?
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decrease in urine flow sufficient to cause discomfort
persistent residual urine acute urinary retention hydronephrosis intermittent catheterization can reduce symptoms and bypass obstruction |
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TURP
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transurethral resection
GOLD STANDARD removal of obstructing prostate tissue using resectoscope inserted through urethra outcome for 80-90% is excellent relatively low risk performed under spinal or general anesthesia and requires hospital stay |
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after TURP, what is done? possible complications of TURP?
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bladder irrigated for first 24 hours to prevent mucus and blood clots
complications: bleeding, clot retention, dilutional hyponatremia, retrograde ejaculation |
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TUMT
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transurethral microwave therapy
outpatient procedure; delivers microwaves directly to the prostate through a transurethral probe |
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laser prostatectomy
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delivers a laser beam transurethrally to cut or destroy parts of the prostate
common procedure: visual laser ablation of the prostate (VLAP) takes several weeks to reach optimal results |
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disadvantages of laser prostatectomy
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post-procedure catheterization (up to 7 days) needed because of edema and urinary retention
delayed sloughing of tissue takes several weeks to reach optimal effect retrograde ejaculation |
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instruct patient to minimize urinary stasis how?
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to void q2-3h when first feeling urge
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CBI
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continuous bladder irrigation, rate dependent upon color of drainage (should be light pink without clots)
BLADDER SPASMS (normal side effect) |
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how much fluid is to be taken in daily post-op for BPH?
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2 to 3 L
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prostate cancer
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androgen-dependent adenocarcinoma
majority of tumors grow on the OUTER aspect of the gland usually slow growing |
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etiology of prostate cancer
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high-fat diet associated with increased risk
exposure to certain chemicals HISTORY OF BPH IS NOT A RISK FACTOR!!! |
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s/s of prostate cancer
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dysuria
hesitancy dribbling frequency urgency hematuria nocturia retention interruption of urinary stream inability to urinate pain in lumbosacral area that radiates to hips or legs, when coupled with urinary symptoms, could indicate metastasis once cancer has spread to distant sites, pain management becomes major problem |
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two primary screening tools for prostate cancer
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PSA blood test- elevated levels indicate prostatic pathology (not necessarily cancer); maker of tumor volume when cancer exists; also used to monitor success of treatment
DRE (digital rectal exam)- abnormal prostate findings include hardness, nodular and asymmetric *elevated levels of PAP also indicate prostate cancer ********** |
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PAP
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prostatic acid phosphatase
elevated levels indicate prostate cancer |
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watchful waiting for prostate cancer is indicated when?
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life expectancy is less than 10 years
presence of significant comorbid disease presence of low-grade, low-stage tumor |
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radical prostatectomy
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not usually an option for late-grade cancer
entire gland, seminal vesicles, and part of bladder neck are removed retroperineal lymph node dissection usually done considered most effective for long-term survival |
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who is a radical prostatectomy best for?
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men under 70 in good health with cancer confined to prostate
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post-radical prostatectomy? what will patient have to use?
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catheter for one to 2 weeks!!
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major complications of radical prostatectomy
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ED and incontinence
hemorrhage, urinary retention, infection |
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hormonal therapy for prostate cancer
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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 advanced disease estrogen LH-RH agonists androgen receptor blockers |
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orchiectomy
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surgical removal of testes for advanced stages of prostate cancer
may be done alone or with prostatectomy reduces circulating testosterone by 90% |
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side effects of orchiectomy
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hot flashes
ED loss of libido irritability weight gain loss of muscle mass osteoporosis |
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chemotherapy in prostate cancer
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primarily limited to treatment for those with hormone-resistant prostate cancer in late stages
palliation |
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prostatitis
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most common urologic problem
men younger than 50 acute and chronic |
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common causes of acute prostatitis; s/s
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E. coli, Klebsiella, gonorrhea, chlamydia
fever, chills, back pain, dysuria, cloudy urine |
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common causes of chronic prostatitis; s/s
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E. coli, Klebsiella, gonorrhea, chlamydia (recurrent episodes of infection)
milder than acute, but same symptoms (fever, chills, back pain, dysuria, cloudy urine) |
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management of prostatitis
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antibiotics
pain management anti-inflammatory agents SUPRAPUBIC catheter fluids ejaculation ** |
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cancer of the penis most often associated with what?
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HPV and uncircumsized men
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treatment of penile cancer
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laser removal of growth
radical resection of the penis radiation chemotherapy |
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testicular cancer is more common in men with what condition?
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cryptorchidism
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testicular cancer common in men of what ages?
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15-34
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manifestation of testicular cancer
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slow OR rapid
lump in scrotum, scrotal swelling, dull ache or heavy sensation in lower abdomen, perineal area or scrotum |
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when is the testicular self-exam best performed?
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after a warm bath or shower (heat relaxes the scrotum)
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diagnostics for testicular cancer
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Alpha-fetoprotein (AFP), LDH, hCG --TUMOR MARKERS
ultrasound computed tomography MRI lymphangiograms |
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complications of testicular cancer
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azoospermia (infertility..unmeasurable sperm count in semen)
oligospermia (low sperm count) potential for metastasis |
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interventions for testicular cancer
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sperm storage (for infertility)
radical retroperitoneal lymph node dissection and orchiectomy (to try to prevent metastasis) |
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psychogenic causes of ED
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anxiety
depression fatigue guilt stress marital discord excessive alcohol consumption |
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organic causes of ED
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CVD
DM HTN renal disease cancer surgery on colon, bladder, prostate neurologic causes priapism hormonal deficiency |
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treatment options for ED
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oral meds (viagra, levitra, cialis)
urethra suppositories (MUSE) injection therapy (caverject, trimix, bimix) vacuum constrictive device surgery sex therapy |
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common side effects from drug therapy for ED
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headaches
facial flushing diarrhea |
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men who take what should not take ED drugs?
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nitrates
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do not take ED drugs with what kind of food?
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high fat meal
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intraurethral applications?
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prostaglandin-E is a self-administered suppository that is placed in the urethra with an applicator
erection occurs in about 10 minutes and lasts 30 to 60 minutes burning of the urethra occurs after application |
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priapism; causes?
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uncontrolled and long-maintained erection without sexual desire
causes the penis to become large and painful can occur from: thrombosis of veins of corpora cavernosa leukemia sickle cell disease DM malignancies abnormal reflex some drug effects recreational drugs (COCAINE) prolonged sexual activity |
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peyronie's disease
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curved or crooked penis, caused by plaque formation in one of the corpora cavernosa of the penis
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management of priapism
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urologic emergency
goal of intervention is to improve the venous drainage of the corpora cavernosa MEPERIDINE urinary or suprapubic catheterization large-bore needle or surgical intervention |
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hydrocele
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cystic mass, usually filled with straw-colored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing a swelling of the tissue surrounding the testes
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diagnosis of hydrocele
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light TRANSILLUMINATED, unlike with cancer/tumor
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treatment for hydrocele
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may be drained via needle and syringe or may be removed surgically
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spermatocele
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a sperm-containing cyst develops on the epididymis alongside the testicle
usually small and asymptomatic |
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treatment for spermatocele?
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normally they are small and require no interventions
if they become large enough to cause discomfort, a spermatocelectomy is performed |
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how does hydrocele occur?
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interference with lymphatic drainage of the scrotum and swelling of the tunica vaginalis that surrounds the testis
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varicocele
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dilation of the veins that drain the testis
above and behind the testis |
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complication of varicocele
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INFERTILITY
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treatment for varicocele
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varicocelectomy performed through an inguinal incision in which the spermatic veins are ligated in the cord
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where does varicocele usually occur?
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usually on the left side of the scrotum as a consequence of retrograde blood flow from the left renal vein
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torsion
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involves twisting of the spermatic cord that supplies blood to the testes and epididymis and occurs most often during puberty
SURGICAL EMERGENCY |
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diagnosis of torsion?
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absence of cremasteric reflex
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blood flow after a torsion must be returned after how long?
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4-6 hours!!!!
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cryptorchidism
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results when the testicles fail to descend; mainly a pediatric problem
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treatment for cryptorchidism
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injections of B-HCG luteinizing hormone-releasing hormone or testosterone optional to promote descent of testicles
orchidopexy surgical procedure optional |
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phimosis; cause
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constriction of the uncircumsized foreskin around the head of the penis, making retraction difficult
usually associated with poor hygiene techniques |
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paraphimosis; complication of?
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edema of the retracted uncircumsized foreskin, preventing normal return over the glans
ulcer can develop if it remains contracted |
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epididymitis
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inflammation of the epididymis resulting from an INFECTION OR NONINFECTIOUS SOURCE such as trauma
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infections that cause epididymitis
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gonorrhea, chlamydia
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treatment for epididymitis
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bedrest with scrotum elevated on a towel, scrotal support when ambulating
comfort measures epididymectomy |
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orchitis (mumps)
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acute testicular inflammation resulting from trauma or infection
generally occurs after bacterial or viral infection |
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treatment for orchitis
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bedrest with scrotal elevation
application of ice analgesics antibiotics |
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hypospadias
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urologic abnormality in which the urethral meatus is located on the ventral surface of the penis anywhere from the corona to the perineum
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epispadias
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an opening of the urethra on the dorsal surface of the penis
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causes of hypospadias
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hormones
environment genetics |
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cause of epispadias
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complex birth defect
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common causative organisms of prostatitis
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E. coli, klebsiella, psuedomonas, enterobacter, proteus, chlamydia, N. gonorrheae, group D strep
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complications of BPH
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UTI
hydrouretersas (backup of urine) hydronephrosis (backup of urine into kidneys) pyelonephritis renal failure |
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urethritis; cause; s/s; treatment
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commonly caused by chlamydia
s/s: urgency, frequency, and burning with urination; purulent D/C tx: antibiotics |
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epididymitis; cause; s/s; treatment
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same causes as prostatitis (chlamydia and gonorrhea)
s/s: sudden scrotal pain, scrotal edema tx: antibiotics, injection of procaine around spermatic cord |
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orchitis; cause; s/s; tx
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cause: bacteria and gonorrhea
s/s: sudden scrotal pain, N/V, pain radiating to inguinal canal tx: antibiotics, injection of procaine around spermatic cord, bedrest with scrotal elevation, analgesics |
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risk factors for prostate cancer
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age
ethnicity family history |
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what kind of catheterization is CONTRAINDICATED with acute prostatitis??
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URETHRAL
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risk factors for BPH
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family history
environment diet |
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radical orchiectomy
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surgical removal of a testis, spermatic cord and regional lymph nodes
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