Male Reproductive Disorders

Front 1

what disorders involves prostate gland?

Back 1

Beinign prostatic hypertrophy or BPH, prostate cancer, and prostatitis.

Front 2

what is the most affected male reproductive organ?

Back 2

The prostate gland

Front 3

What is the enlargement of the prostate gland also called?

Back 3

Benign prostatic hyertrophy or hyperplasia which becomes a problem when enlargement puts pressure on the urethra making it narrow for the urine to pass through

Front 4

what are the clinical manifestations of BPH?

Back 4

Hesistancy-decreased force of stream, post-void dribbling-nocturia, sensation of incomplete emptying or retention

Front 5

what test diagnose BPH?

Back 5

DRE, PSA, U/A,urine culture

Front 6

What is the management of BPH?

Back 6

Catherization( indwelling or intermittent catherization temporarily.
Watch and see and drug therapy

Front 7

What drugs are used to treat
Drug therapy BPH

Back 7

Androgen deprivation
Proscar

Front 8

How is the mamagement of BPH dtermined?

Back 8

Depends on the severity of obstruction and patient condition.

Front 9

For releif from acute urinary retention will be catherized if he goes to emergency room with?

Back 9

A coude urethral cathether which has a curved tip help it pass through the prostatic or bladder neck blockage.
He may be prescribed an indwelling cathether or intermittent catherization temporarily intil a definitive treatment is initiated.

Front 10

Watcful waiting is used for what client?

Back 10

Clients who have few or mild signs and symptoms ad who is periodically assessed for progression of symptoms

Front 11

what is BPH treatment aimed at?

Back 11

Decreasing the size of the prostate if hyperplastic tissues is androgen- dependent or relaxing the prostate muscle

Front 12

Proscar A 5 alpha reductase inhibitor, what does it do?

Back 12

Androgen deprivation-Blocks the conversion of testosterone to dihydrosterone which mediates prostate growth in androgen- sensitive tissues.

Front 13

What is the expected outcome of Proscar TX?

Back 13

The reduction ofthe size of prostate with concomittant decrease in PSA count.

Front 14

Prostate muscle relaxation
name the Alpha adrenergic blockers?

Back 14

Hytrin(Terazosin)
Cardura(doxasin)
Flomax(tamsulin)

Front 15

Hytrin, cardura, flomax are used to relief what type of BPH?

Back 15

Symptomatic

Front 16

What relieves signs of urinary obstruction?

Back 16

Smooth muscle relaxation within and around the prostate

Front 17

Why is the pt started on a lower dose and advised to take at hour of sleep?

Back 17

Because these drugs cause orthstatic hypotension

Front 18

In addition to traditional medicine what herbal therapy is used to treat urinary symptoms?

Back 18

Saw Palmetto

Front 19

BPH SURGERY
What does TURP mean?

Back 19

Transurethral resection of prostate

Front 20

What are some post op concerns that the nurse is responsible for?

Back 20

control Pain/Spasms
excessive Bleeding
maintain hydration to control infection
maintain bladder Irrigation

Front 21

BPH
What are the Closed Surgeries?

Back 21

Retropubic approach
monitor dressing( there should be no urine on the dressing.
Suprapubic approach
Monitor output from suprapubic catheter and urethral cathether seperately
Perineal approach
Avoid rectal tubes, therometers& enemas

Front 22

What is the most approach often performed after TURP?

Back 22

The retropubic approach whed which is indicated when the prostate gland is large and there is no coexisting bladder abnormality.

Front 23

what is the retropubic approach?

Back 23

Allows the surgeon to remove the hyperplastic tissue directly through an abdominal incision

Front 24

what is the nurse rsponsible for after the retropubic approach?

Back 24

Monitor the urine output via a foley cathether and abdominal dressing

Front 25

If there is trace of urine on the dressing this is an indication of what?

Back 25

This means leakage of urine from the bladder

Front 26

when there is a coexisting bladder abnormality what approach is used?

Back 26

Suprapubic approach is indicated.The incision is made through the bladder permitting its expoloration then, the hypertrophic tissue is removed using a finger.

Front 27

What is the nurse responsible for postoperatively,(The suprapubic approach)?

Back 27

Abdominal incision and urine output from both aa suprapubic cathether and a urethral cathether

Front 28

what preparation is needed for perineal approach?

Back 28

A good bowel prepartion with neomycin enema is done before sugery to prevent infection

Front 29

What is the the perineal approach?

Back 29

The surgeon makes an incision
between the scrotum and the rectum and then removes the hypertrophied prostate tissue from below.

Front 30

Although PA is associated with less operative time and bleeding but what higher incidence?

Back 30

Impotence, urinary incontinence, and infection than the other approaches

Front 31

what does the nurse monitor?
Perineal approach

Back 31

Monitor the dressing over the perineal incision as well as the attached drains for excessively bleeding.
Monitor urinary ouput is monitor carefully

Front 32

PA
Trauma to the incision is avoided by?

Back 32

Avoiding rectal tubes, Thermoeters, and enemas

Front 33

What are the newer methods?

Back 33

Laser incision of the prostate and balloon dilation of the prostate that may entail less risks and shorter hospitalization

Front 34

Post-Prostate surgery
what are some potential diagnosis?

Back 34

Hemorrhage, pain, fluid volume excess

Front 35

what does the nurse check immediately after surgery?

Back 35

The V/S, his urine output via cathethers

Front 36

why are Irrigation systems often ordered?

Back 36

To prevent formation of blood clots which cause obstruction, distention, and hemorrrhage

Front 37

In continuous bladder irrigation,what gauge needle is used?

Back 37

3-way gauge 18-22 with a 30-45 cc ballon Foley cathether is inserted &Isotonic saline is used as the irrigant.

Front 38

In the first 24 what is assess frequently?

Back 38

The character of the urine

Front 39

What is considered normal output on first day of surgery?

Back 39

A light red to red output with occasional clots and first day post op.

Front 40

Day of surgery or first if brigt red output indicates what?

Back 40

Surgeon is notified because that indicates arterial bleeding so nurse must check V/S. increase the CBI rate and notify the SURGEON STAT

Front 41

During the rest of hospital stay what color is output?

Back 41

Clear to pink.Hemmorrhage is normal.

Front 42

How to prevent hemmorrhage?

Back 42

Traction on the cathether is secured to the thighs or abdomen tightly ti apply pressure on the bleeders surrounding the bladder of the prostate

Front 43

In this case what should the nurse ?
TURP

Back 43

Nurse should not manipulate the cathether ot retape it

Front 44

How is pain controlled

Back 44

By presribed analgesics

Front 45

Altered comfort due to bladder spasms maybe minimize by the use of?

Back 45

Antispasmodics
Baolidone or Opiod suppository or Ditropan

Front 46

When does turp syndrome occur?

Back 46

During or after TURP when pt absorbs a large amount of fluid since venous sinuses are opened during surgery

Front 47

After a turp pt show what signs?

Back 47

s/s of FVE which include decreased HCT and HGB, bradycardia, nausea, and confusion. In this case, diuretics and fluid restriction may be instituted.

Front 48

what are Discharge instructions fter a prostatectomy?

Back 48

Drink adequate amount of fluids
Do not have sexual intercourse for 6 wks
Avoid strenous activities
Empty bag Q 3-4 hours

Front 49

Watch for signs and symptoms of complictions depending on surgical approach?

Back 49

Bleeding
Stress incontinence
Retrograde ejaculation
UTI/Epidiymitis
Deep Vein Thrombosis is a possibility pt still need to be taught about it

Front 50

Discharge instuctions after a prostatectomy include what?

Back 50

Increased fluid intake to prevent infections
Refraining from sexual intercourse for 6 wks
avoiding strenuous activities & long driving
emptying urinary drainage bags q 3-4 hrs
switch from a leg bag to a drainage bag at night to prevent reflux
may also experience Symptoms of UTI or Epididymitis
How to perform kegel exercises to minimize stress incontenence and decrease semen durin ejaculation
or backward ejaculation

Front 51

If pt has increased bleeding, what is he to do?

Back 51

Rest, increase his fluids and then notify the MD
If frank bleeding, large clots and decrease in urine output, must call Doc stat

Front 52

Prostate cancer

Back 52

The most common form of cancer in men and second leading cause of cancer death in men after lung cancer. Higher incidence in men 65 and older, African american men.

Front 53

what is prostate cancer associated with?

Back 53

The presence of androgen since it is never found in those who have no testicles or those who had testes removed

Front 54

is the tumor slow growing in prostate cancer?

Back 54

Yes. Slow growing and is spread by direct extension via lymphatics and via blood stream

Front 55

in the early stage of prostate cancer it is what?

Back 55

ASymptomatic, eventually the pt may have S/S similar to BPH and S/S of metastasis.

Front 56

Where does the pain radiate in prostate cancer?

Back 56

Pain in lumbosacral area radiating to the hips or legs within malaisw may indicate metastasis to the bone,

Front 57

Where can prostate cancer met to?

Back 57

It can also met to liver, the brain and lungs

Front 58

how is screened for prostate cancer done?

Back 58

DRE And PSA
DRE of PG where gland may feel hard and unilaterally enlarged.
Increased PSA levels are indicative of prostate pathology but not necessarily cancer

Front 59

How is definitive diagnosis made after a DRE and PSA are abnormal?

Back 59

Biopsy of tissue.
The nurse needs to encourage alll to have a annual DRE and PSA level check starting at 50 to detect cancer early

Front 60

The management of Prostate cancer depends on what?

Back 60

The staging of the disease.
Staging is based on tumor growth and spread

Front 61

In stage 1 and 11 what happens?

Back 61

The cancer is confined to the prostate and the chance of a 5 yr survival is 100% after a radical prostatectomy and radiation

Front 62

How is Radiation treatment given?

Back 62

given in a form of external beam or interstitial implant of radioactive seeds

Front 63

In stage 3 the cancer is spread where?

Back 63

spread to semivesicles and is further managed with hormone therapy

Front 64

in stage 4 where has it spread to?

Back 64

spread to surrounding tissues and distant organs,
is further managed with chemotherapy and Orchietomy

Front 65

How is the decision made for treatment?

Back 65

Joint decision between pt and physican,
Surgery made be delayed if pt asymptomatic, if the tumor is slow growing, if pt is elderley, monitoring is then done with annual DRE and PSA

Front 66

what is a radical prostatectomy?

Back 66

A surgical procedure which involves the removal of the bladder neck, entire prostate gland, part of seminal vesicles and regional lymph nodes

Front 67

what is the nursing care for Prostatectomy?

Back 67

Control pain
Incision care
Care of drains including CBI

Front 68

How does the nurse Prevent DVT?

Back 68

Administer heparin SQ and the application of anti-embolism stockings.

Front 69

What does the nurse teach the patient after prostatectomy?

Back 69

Regarding incontinence, infection, and impotence as possible complications

Front 70

What is Radiation?

Back 70

An external beam or interstitual radioactive implants (bradytherapy)

Front 71

Radiation is used on which age group?

Back 71

Primary treatment especially in men over 70 yrs old who are considered poor surgical risk. It may be curatively for portate cancer that is confined to the prostate or as pallitive TX for late prostate cancer

Front 72

When is external beam done? Radiation

Back 72

Week period is the most widely used approach

Front 73

what is bradytherapy/

Back 73

using a radioactive seed implants placed in the PG is suitable in early prostate cancer

Front 74

what complication happens for either Radiation therapy?

Back 74

cystitus, incontinence, impotence, diarrhea, may result- most side-effects are temporary

Front 75

what does prostate cancer growth largely depend on?

Back 75

availability of androgen and therfore hormonal therapy focuses on decreasing the level of androgen production

Front 76

what is an example of hormonal therapy?

Back 76

Use lupron which is a gonadotropin releasing hormone that inhibits the secretion of pituitary gonadotropins leading to decresed testosterone production

Front 77

How is the hormonal therapy Lupron given?

Back 77

SQ, it is expensive,has a slow onset, and cause hot flashes, loss of libido, impotence and gynecomastia.

Front 78

Has chemotherapy show an increase in survival rate in late stage cancer?

Back 78

No but may be used for pallitive TX especially when the cancer is resistant to hormone TX

Front 79

What is Prostatitis?

Back 79

inflammation of the prostate is common problem in men
IT can be acute or chronic is non bacterial

Front 80

What is acute bacterial prostatitis?

Back 80

S/S Burning, frequency and urgency of urination, fever, perineal

Front 81

what is Bacterial prostatitis usually due to?

Back 81

Escherichacoli, Enterobacter, and klebsiella

Front 82

what are the manifestions of acute bacterial prostatitis ?

Back 82

may include burning frequency, urgency in urination, fever, and perineal pain esp during or after ejaculation

Front 83

what are the s/S in chron bacterial prostatitis?

Back 83

S/S are usually milder.

Front 84

what is the cause of non-bacterial prostatitis?

Back 84

The cuase of non bacterial is unknown and prostate secretions are negative for infection or inflammation
Manifestations are similar to non-chronic bacterial prostatitis, with painful prostate being the major complaint

Front 85

what is the TX of Prostatitis?

Back 85

Bacterial Acute
Pt is put on antibiotics Levaquin IV if severe for a month, rest and refrain from sexual activity.
After acute stage- pt put on antibiotis AB to eradicate infection and prevent chronic prostatitis

Front 86

what is given in chronic prostatitis?

Back 86

The same antibiotics but lower dose and a longer period.

Front 87

Although non-bacterial prostatis have negative cultures what antibiotics are given?

Back 87

Doxycline with positive results
Pts are advised to take measure to relieve perineal pain, by taking analgesics, warm sitz bath and perform regular sexual activity.
Sexual activity is believed to help decreas the congestion of PG
Pt cannot transmit the disiese to their partners

Front 88

disorders of TEstes/ Scrotum

what is testicular cancer?

Back 88

Most common cancer in males aged 15-35
survival rate>90%
Major risk factor is cryptorchidism
Manifestations pain less hard nodule on testes

Front 89

what is testicular cancer?

Back 89

A rarwe but it is most common in males 15-35, eg scott hamilton, and lance Armstrong.

Front 90

what is an undescended testicle?

Back 90

Cryptorchidism It increase the risk for this cancer 35 times the normal population. Other predisposing factors are maternal exposure to DES and Family HX of testicular cancer

Front 91

What is the classic sign of testicular cancer?

Back 91

Painless hard nodule on the testicle, loss of weight and weakness or signs of metastasis.

Front 92

Where does the tumor spread to in testicular cancer?

Back 92

Bones, chect, lungs, liver, and brain via lymphatics

Front 93

Testicular cancer screening

Back 93

monthly testicular self -Exam starting at age 13 or 15 for early detection of testicular
It done after a warm bath which makes the skin loose and makes the testes easier to examine

Front 94

what is the DX of testicular cancer?

Back 94

on clinical assessment.
Biopsy is NOT done to prevent the spread of malignant cells along the spermatic cord or sac
Although tumor markers are not specific TC elevation of TM is a presence of tumor in the body

Front 95

when is Testicular cancer finally diagnosed?

Back 95

after Orchiectomy

Front 96

Testicular Torsion

Back 96

Twisting of the spermatic cord and testes R/T sudden pull on cremasteric muscle and arteries and veins cutting off blood supply
Can occur due to vigorous activity or trauma
Manifested by: chief complaint Scrotal pain and accompained by swelling
DX Testicular scan and doppler Ultrsound
to assess for decreased or absent blood flow to testicle
ER TX shound be initiated in 6-12 hrs since it can lead to necrosis and eventually sterility
TX Orchipexy- untwisting of spermatic cord and immobilizing the testicle by suturing it to scrotum
Orchidectomy- only if testicle is necrotic

Front 97

Benign Scrotal Masses

Back 97

Hydrocoele, most common benign scrotal mass and it non-tender collection of clear amber within outer covering of testicle. if large cause pain and I &D may be done, otherwise left alone
SPERMATOCOELE contains cysts in epididymid. contains dead spermatozoa R/T leakage in of sperm which occurs d/T infection and trauma.
It is non-tender mass attached to epididymid& contains milky fluid and sperm . usually requires no TX
Varicole is a condition where there are dilated vein int he scrotum which forms a mass. This is secondary to incompetent values or obstruction of gonadadal vein and is usually noted on left scrotum B/C pressure of renal vein
Manifestations: Complians of pain may be relieved by masturbation or scrotal support, can decrease sperm count and cause atrophy, leading to infertility, if this a problem it is ligated
TX Radiation Radical orchiectomy followed by retroperitoneal lymph node dissection (RPLND)
Nursing care : Control pain. control swelling and wound care, by monitoring hematoma, drainage, and bleeding. ice pack, and analgesics.
TX combination chemotherapy is why most men survive

Front 98

Epididymis and Orchitis

Back 98

Epididdymis associated with STDs, prostatitis or UTI in older men trauma, instumentation, most common intrascrotal inflammatory condition in men.usually in tose uner 35 yrs old with chlamydia and gonorrhea.
ORCHITIS inflammation or infection of testes
Most common infectious cause: post pubertal mumps
Asssociated with STDs, trauma and hydrocoeole
Manisfeatations local swelling andpain, sometimes fever.
TX both conditions Pin control with NSAIDS, scrotal support, Sitz bath, ice pack, bed rest. avoid sex stimulation and lifting.
Antibiotics for control of inflammation.
To prevent Orchitis in post -pubrtal boy who is exposed to mumps, gamma globulin must be given or infertility may result

Front 99

Disorders of Penis
Cancer of penis

Back 99

Is a psychologically devastating diagnosis. although rare it occur in men between 40-70 never seen in jewish or muslem population
Associated with uncircumcised/tight foreskin(phimosis), >50. multiple sex partners, HPV, poor hygiene, UV radiation
Chief manifestation painless lesion on tip of penis, may be nodular, wart like or red velvety in appearance. The lesion may be accompanied by ulceration, bleeding, or foul smelling discharge mistaken for STD which delays diagnosis.
No screening for penile cancer and asc has no recommendation for routine circumcision to prevent penile cancer
DX by Biopsy
Tx with topical chemo, external beam radiation or laser removal of lesion.
Sever cases TX is amputation of penis. Penetomy, pt will void sitting down,or urethrosotomy creaate in perineum. Systemic shem given for distan met

Front 100

Priapism

Back 100

Painful persistent eretion not associated with sexual arousal more than 6 hrs,
Cause by impaired blood flow to corporacavernosa secondary to impaired clotting mechanisms or filure of mnormal; Autonomic response that facilitate return to non-erect state
If prolonged cause penile necrosis and impotence by spinal cord trama/tumors, sickle cell, anemia, leukemia, diabetes mellitusand drugs
Vasoactive injectiond, alcohol, psychotropics, marijuana/cocaine
Tx Sedatives, aspiration of blood, injection of smooth muscle relaxants, shunting procedure

Front 101

Phimosis and paraphimosis

Back 101

Phimosis- Tight foerskin/ prepuce R inaability to retract it
Paraphimosis -tight foeskin inability to pull it forward from retracted position
These two conditions only happens in men and boys who are not circumcised

Front 102

Phimosis

Back 102

may be congential or may be cause by edema due to infection, inflammation or trauma
S/S may include redness, edema with tenderness and purulent discharge
Tx antibiotic therapy and good genital hygiene to control infection

Front 103

Paraphimosis

Back 103

Nurse pull forskin back to ot clean it and put in cathether. Report it to Md if forskin cannot be gently pull back B/C can cuse penis to swell and necrosis.
Tx warm soaks, treat swelling by pressing penis with hand or wrapping the penis in a tight bandgae then pull back foreskin, in unscuccessful small incision is made in the trapped foreskin to loosen it.
Circumsion may be considered to preven tcancer and recurrance
Tx done with general anesthesia sutures covered with petroleum dressing.
The nurse responsiblilities
monitor incison for excessive bleeding and teaching pt about prper wound care. Refrain from sex for 1-2 wks, taking barbiturates or estrogen which are usually prescribed for several days to prevent nocturnal erection while wound is not yet healed

Front 104

Erectile dysfunction

Back 104

Failure to achieve penile tumescence of adequate rigidity or duration for successful intercourse
Physiologic (organic) versess psychogenic causes
Major ED results from psychologic causes - DM, vascular diseases,procedures -prostatectomy and various medications- HTN, psychotropics, alcohol and marijuana
Psychogenic ED is often associated stress, depression, difficulty in a relationship, low self esteem
To differentiate a nocturnal penile test is done
DX hormonal levels and vascular studies, penile blood flow, duplex doppler ultrasound
Tx Based on underlying cause
Erectogenic drugs Tadalafil(cialis)
Vacum constriction device applied to flaccid penis to produce erection, device is remove for intercourse but babd is left to maintain erection
Vasoactive drugs
Alprostadil( urethral supp)
Papaverine& phentolamine injection
Nitroglycerine paste
Surgery Semi rigid or inflatable prosthesis is becoming common tx alternative for those with ED
they have cmplications, infections,extrusion of prothesis through skin,
pain and swelling or mechanical failur
pt teaching use of device,appropriate underwear, healing time and when right time to resume sex