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135 Cards in this Set

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What is Benign prostatic hyperplasia (BPH)?
* BPH is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue. It is the most common urologic problem in male adults. It occurs in about 50% of men over 50 and 90% of men over 80 years of age. (Normal function of aging for the male & it also decreases the risk for developing prostate cancer).
What does BPH results from?
Although the cause of BPH is not completely understood, it is thought that BPH results from endocrine changes associated with the aging process. Possible causes include excessive accumulation of dihydroxytestosterone (the principal intraprostatic androgen), stimulation by estrogen, and local growth hormone action.
What are the risk factors for developing BPH?
a family history of BPH (particually involving first-degree relatives), environment, and diet.
Western Culture VS. Eastern Culture and BPH...
Men from the western culture are more likely to develop obstructive BPH, even though they both develop BPH around the same time.
What increases risk factors for developing BPH?
- obesity
- a diet high in saturated fatty acids (butter, beef, etc...)

(individuals who eat lots of fruits and vegetables are thought to have a lower risk for BPH). Also, physical activity and moderate alcohol consumption also has been found to decrease the risk of BPH.
What is the overall cause of the symptoms experienced by the patient with BPH?
Urinary obstruction
What are the clinical manifestations of BPH?

Symptoms fall into 2 groups:
OSTRUCTIVE SYMPTOMS
- decrease in the caliber and force of the urinary stream.

- difficulty in initiating voiding.

- intermittency (stopping and starting stream several times while voiding).

- dribbling at the end of urination.
What are the clinical manifestations of BPH?

Symptoms fall into 2 groups:
IRRITATIVE SYMPTOMS
- urinary frequency
- urgency
- dysuria
- bladder pain
- nocturia
- incontinence

(these are associated with inflammation or infection).
What is the name of a tool used to assess voiding symptoms associated with obstruction?
The American Urological Association (AUA) Symptom Index for BPH
What is a major complication of BPH that leads to surgical intervention?
Acute urinary retention
What is a complication of BPH that may lead to the use of antibiotic therapy?
Urinary tract infection (UTI)

* UTI's are secondary to urinary retention. Longterm UTI's can lead to urinary sepsis. Residual urine causes a favorable environment for bacterial growth. Calculi may develop in the bladder because of the alkalinization of the residual urine.
BPH and Residual alkalinized urine in the bladder can cause what other complication?
Calculi

* Although bladder stones are eight times more common in men with BPH, the risk of renal calculi is not significantly increased.
What is a less common, but more serious complication that is associated with obstruction caused by BPH if treatment for acute urinary retention is delayed?
Renal failure

* hydronephrosis (distension of pelvis and calyces of kidney by urine that cannot flow through the ureter to the bladder), pyelonephritis, and bladder damage if treatment for acute urinary retention is delayed.
What is the primary method used to diagnose BPH?
History and Physical Examination (H&P)

Digital Rectal Examination (DRE)
How does the person with BPH prostate differ from the normal prostate in relation to the digital rectal examination?
The health care provider can estimate the size, symmetry, and consistency of the prostate gland. In BPH the prostate is symmetrically enlarged, firm, and smooth.
What results are found on serum PSA of a patient with BPH?
The results are slightly elevated.

PSA normal range:
<4 ng/ml
Men with BPH are least likely to develop what other prostate problem?
Prostate Cancer
BPH affects which part of the prostate in comparison with which part is affected by prostate cancer?
BPH affects the internal cells of the prostate.

Prostate cancer affects the outer cells of the prostate.
What other test would most likely be ordered for the patient with BPH in order to rule out renal insufficiency?
Serum Creatinine
What test is indicated in patients with an abnormal DRE and elevated PSA?
A transrectal ultrasound (TRUS) scan is typically indicated.
Explain what occurs during a transrectal ultrasound scan (TRUS).
This examination allows for accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer. Biopsies can be taken during the ultrasound procedure.
Explain what is Uroflowmetry.
Uroflowmetry is a study that measures the volume of urine expelled from the bladder per second, and is helpful in determining the extent of urethral blockage and thus the type of treatment needed. Postvoid residual urine volume is often measured to determine the degree of urine flow obstruction.
What is Cystourethroscopy?
a procedure allowing internal visualization of the urethra and bladder, and is often performed if the diagnosis is uncertain and in patients who are scheduled for prostatectomy.
What is the goal of collaborative care in patients that suffer from BPH?
1. Restore bladder drainage
2. Relieve the patient's symptoms.
3. Prevent or treat the complications of BPH.
What is treatment based on in the patient with BPH?
Treatment is generally based on the degree to which the symptoms bother the patient or the presence of complications rather than the size of the prostate.
What is the most conservative initial treatment for patients with BPH?
"Watchful Waiting" when there are no symptoms or mild ones. (AUA symptom scores 0 to 7).
What are some measures (dietary) that can be taken by the individual with BPH that could possibly relieve symptoms?
- decreasing intake of caffeine and artificial sweetners,
- limiting spicy or acidic foods,
- avoiding medications such as decongestants and anticholinergics, and
- restricting evening fluid intake.
What type of schedule may help the male with BPH?
A timed voiding schedule may reduce or eliminate symptoms.
What are some drugs used to treat men with BPH?
5-α-reductase inhibitors and α-adrenergic receptor blockers. Combination therapy using both types of these drugs has been shown to be more effective in reducing symptoms than using one drug alone.
How does 5-α-reducetase Inhibitors work on the patient with BPH?
These drugs work by reducing the size of the prostate gland.
What is the action of Finasteride (Proscar) on the prostate?
Proscar blocks the enzyme 5-α-reductase, which is necessary for the conversion of testosterone to dihydroxytestosterone, the principal intraprostatic androgen. This drug results in regression of hyperplastic tissue through suppression of androgens. Finasteride is an appropriate treatment option for individuals who score between 12 and 26 on the AUA symptom index for BPH.
How long does it take on average for Finasteride to become effective?
3 to 6 months.
What is a major drug alert for Finasteride (Proscar)?
- Patient should be aware of potential side effect of erectile dysfunction.

- Women who may be or are pregnant should not handle tablets.
What are the side effects of 5-α-redactase drugs such as Finasteride (Proscar) and Dutasteride (Avodart)?
- decreased libido

- decreased volume of ejaculate

- erectile dysfunction
Why would α-Adrenergic receptor blockers which are used for reduction of BP be used for men with BPH?
These drugs promote smooth muscle relaxation in the prostate. α1-adrenergic receptors are abundant in the prostate and are increased in hyperplastic prostate tissue. Relaxation of the smooth muscle ultimately facilitates urinary flow through the urethra. Currently, the α-adrenergic blockers are the most widely prescribed drug for the patient with BPH who is experiencing moderate symptoms without the presence of other complications. These agents demonstrate a 50 - 60% efficacy in improvement of symptoms. Improvement of symptoms occurs within 2 to 3 weeks.
How long does it take to see improvement of symptoms in men taking α1-adrenergic receptor blockers?
2 to 3 weeks.
Can you list several other α1-adrenergic receptor blockers?
alfuzosin (UroXatral)
doxaxosin (Cardura)
terazosin (Hytrin)
tamsulosin (Flomax)
What are some common side effects of α1-adrenergic receptor blockers?
- Orthostatic hypotension
- dizziness
- retrograde ejaculation
- nasal congestion
Does α1-adrenergic receptor blockers cure BPH?
No, although these drugs offer symptomatic relief of BPH, they do not treat hyperplasia.
What herbal therapy from plants have been used in the management of BPH?
Saw palmetto has been shown to improve urinary symptoms and urinary flow measures.
What is the TURP procedure and how is it done?
Transurethral resection of the prostate (TURP) is a surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. TURP has long been considered the "gold standard" surgical treatment for obstructing BPH.
What type of anesthesia is used for the TURP procedure?
The TURP is performed under a spinal or general anesthetic.

*Note: Due to other health problems in older men, TURP is most often done with spinal anesthesia to decrease adverse effects.
Why is it necessary to irrigate the bladder following the TURP?
To prevent obstruction from mucus and blood clots.

* No external surgical incision is made. A resectoscope is inserted through the urethra to excise and cauterize obstructing prostatic tissue. A large three-way indwelling catheter with a 30-ml balloon is inserted into the bladder after the procedure to provide hemostasis and to facilitate urinary drainage. The bladder is irrigated, either continuously or intermittently, usually for the first 24 hours to prevent obstruction.
What is done in the TUIP procedure for BPH?
Transurethral Incision of the Prostate - Involves making transurethral slits or incisions into prostatic tissue to relieve obstruction. Effective for men with relatively little prostatic enlargement.
What is the TUMT?
Transurethral Microwave Thermotherapy is an outpatient procedure that involves the delivery of microwaves directly to the prostate through a transurethral probe in order to raise the temperature of the prostate tissue to about 113 degrees Fahrenheit . The heat causes death of tissue, thus relieving the obstruction. A rectal temperature probe is used during the procedure to ensure that the rectal temperature is kept below 110 degrees Fahrenheit to prevent rectal tissue damage.
What group of men can not have a TUMT done?
Men with rectal problems.
What are special considerations that must be monitored in certain men getting the TUMT done?
Anticoagulation therapy must be stopped 10 days before treatment.
What are some mild side effects that some men will experience after having the TUMT procedure done?
Occasional problems of bladder spasms, hematuria, dysuria, and retention.
What is the name of another procedure that is similar to the TUMT which causes localized necrosis of the prostate?
Transurethral Needle Ablation (TUNA)
How does the TUNA differs from the TUMT? (Transurethral Microwave Thermotherapy vs. Transurethral Needle Ablation).
(Transurethral Microwave Thermotherapy vs. Transurethral Needle Ablation).

TUNA differs from the TUMT in that low-wave radiofrequency is used to heat the prostate. Only prostate tissue in direct contact with the needle is affected, thus allowing greater precision in removal of the target tissue. The extent of tissue removed by this process is determined by the amount of tissue contact (needle length), amount of energy delivered, and duration of treatment. Seventy percent of patients undergoing TUNA report an improvement in symptoms, making this an attractive treatment option for men with BPH.
Where and how should the BPH patient expect to have his TUNA done?
This procedure is performed in an outpatient unit or a physicians office using local anesthesia and intravenous or oral sedation. The TUNA procedure typically last for 30 minutes. The patient typically experiences little pain and an early return to regular activities.
What are the complications related to having a TUNA (Transurethral needle ablation) done?
Transurethral needle ablation

Urinary retention, urinary tract infection, and irritative voiding symptoms (frequency, urgency, and dysuria). Some patients require a urinary cathether for a short duration. Patients typically have hematuria for up to a week.
What is the Laser Prostatectomy?
The use of laser therapy through visual or ultrasound guidance is an effective alternative to TURP in treating BPH. The laser beam is delivered transurethrally through a fiber instrument and is used for cutting, coagulation, and vaporization of prostatic tissue.
What are two types of Laser Proxtatectomies?
Visual laser ablation of the prostate (VLAP) &
Interstitial laser coagulation (ILC).
What are the advantages of having the VLAP instead of the TURP?
The advantage of this procedure over TURP include minimal bleeding both during and after the procedure, faster recovery time, and ability to perform the surgery on patients taking anticoagulants.
What is the ILC procedure and what does it consist of?
It is another approach to laser prostatectomy. The prostate is viewed through a cystoscope. A laser is used to quickly treat precise areas of the enlarged prostate by placement of interstitial light guides directly into the prostate tissue.
How do Intraprostatic Urethral Stents work?
Provides relief of symptoms from obstruction in patients who are poor surgical candidates.
What are the complications of urethral stents?
Chronic pain, infection and encrustation.

(The longterm effects are not known).
Prior to surgery, urinary drainage must be restored. What type of urinary cathether is often used to do this?
A urethral catheter such as a Coudé (curved-tip) catheter may be needed to restore drainage.
When using a Coudé catheter to relieve an obstruction, what type of pain relief is provided for the patient?
In many healthcare settings 10ml of sterile 2% Lidocaine gel is injected into the urethrabefore insertion of the catheter.
What important information should the patient be given about all types of prostatic surgeries in relation to sexual function?
All types of prostatic surgery generally result in some degree of retrograde ejaculation. The patient should be informed that the ejaculate may be decreased in amount or totally absent. This may decrease orgasmic sensations felt during ejaculation. Retrograde ejaculation is not harmful because the semen is eliminated during the next urination.
What should the preoperative patient expect after surgery?
After surgery the patient will have a standard catheter or a triple-lumen catheter. Bladder irrigation is typically done to remove clotted blood from the bladder and ensure drainage of urine.
What is continuous bladder irrigation and how is it done?
continuous bladder irrigation (CBI) is done with sterile normal saline solution or another perscribed solution. If the bladder is manually irrigated (if ordered) 50ml or irrigation solution should be instilled and then withdrawn with a syringe to remove clots that may be in the bladder and catheter. CBI is a continuous flow of approximately 3000 ml of sterile NS hung by gravity.
What is the major problem with manual irrigation of the bladder?
Painful bladder spasms often occur as a result.
How should the urine drainage look following prostate surgery?
Ideally the urine drainage should be light pink without clots.
How long should you expect to see blood clots following prostate surgery?
Blood clots are expected after prostate surgery for the first 24 to 36 hours.
What should be done if bladder spasms develop?
If bladder spasms develop, the catheter should be checked for clots. If present, the clots should be removed by irrigation so that urine can flow freely. Belladonna and opium suppositories, or other antispasmodics (e.g., oxybutynin [Ditropan]) along with relaxation techniques, are used to relieve the pain and decrease spasm.
As the nurse, what can the patient be taught after removal of the urinary catheter in order to increase sphincter tone?
Sphincter tone can be strengthened by having the patient practice Kegel exercises (pelvic floor muscle technique) 10 to 20 times per hour while awake. The patient should be encouraged to practice starting and stopping the stream several times during urination.
What type of diet should the postoperative patient have?
A diet high in fiber and stool softners to prevent the patient from straining while having a bowel movement. Straining increases intraabdominal pressure, which can lead to bleeding at the operative site. A diet high in fiber facilitates the passage of stool.
What important discharge teaching should you give the patient who has had surgery to correct BPH?
1) caring for an indwelling catheter (if one is left in)
2) managing urinary incontinence
3)maintaining oral fluids between 2000 and 3000 ml per day;
4) observing for s/s of urinary tract and wound infection
5) preventing constipation
6) avoiding heavy lifting (more than 10 IB
7)refraining from driving or intercourse after surgery as directed by the physician.
What is prostate cancer?
prostate cancer is a malignant tumor of the prostate.

It is an androgen-dependent adenocarcinoma. The majority of the tumors occur in the outer aspect of the prostate gland. Prostate cancer is usually slow growing.
How does prostate cancer spread?
It can spread by three routes:

1. direct extension,
2. through the lymph system 3. or through the bloodstream.
What are three nonmodifiable risk factors for developing prostate cancer?
Age, ethnicity, and family history.
What type of diet is though to be associated with an increase risk for prostate cancer?
A high fat diet.
Does a history of BPH increases a person's risk of getting prostate cancer?
No, it actually seems to decrease the risk.
What are the symptoms of prostate cancer?
Prostate cancer is usually asymptomatic in the early stages. Eventually the patient may have symptoms similar to those of BPH, including dysuria, hesitancy, dribbling, frequency, urgency, hematuria, nocturia, retention, interruption of urinary stream, and inability to urinate. Pain in the lumbosacral area that radiates down to the hips or legs, when coupled wiht urinary symptoms, may indicate metastasis.
What are the two primary screening tools used to diagnose prostate cancer?
The two primary screening tools are DRE and a blood test for prostate-specific antigen (PSA), a glycoprotein produced by the prostate. On DRE an abnormal prostate may feel hard, nodular, and asymmetric.
What are the normal Prostate-specific antigen (PSA) levels?
0 to 4 ng/ml

Mild elevations in PSA may occur with aging, BPH, recent ejaculation, drugs (e.g. finasteride [Proscar]), herbs (e.g. saw palmetto), acute or chronic prostatitis, or after long bike rides. In addition, cystoscopy, indwelling urethral catheters, and prostate biopsies may also produce an elevation.
What are some other laboratory test that can detect prostate cancer?
Elevated levels of prostatic isoenzyme or serum acid phosphatase (prostatic acid phospatase [PAP]) is another indicator of prostate cancer.
Why is serum alkaline phosphatase increased in some men with prostate cancer?
because there is metastasis to the bone.
Is the DRE or PSA definitive test for prostate cancer?
No. Neither PSA nor DRE is a definitive diagnostic test for prostate cancer. If PSA levels are elevated or if the DRE is abnormal, a biopsy of the prostate tissue is indicated. Biopsy of the prostate tissue is necessary to confirm the diagnosis of prostate cancer.
How is the Biopsy for prostate cancer diagnosis done?
The biopsy is typically done using TRUS because it allows the physician to visualize the prostate and pinpoint abnormalities. When a suspicious area is located, a special biopsy needle is inserted into the prostate to obtain tissue sample.
What is the Gleason scale and how is it used?
With this scale, tumors are graded from 1 to 5 based on the degree of glandular differentiation. Grade 1 represents the most well differentiated (most like the original cells), and grade 5 represents the most poorly differentiated (undifferentiated). The Gleason score is a number from 2 to 10. This scale is used to predict how quickly the cancer will progress.
What are two common classification systems used for staging prostate cancer?
Whitmore-Jewett and the tumor, node, metastasis (TNM) systems.
What is the idea behind conservative therapy for patients who have prostate cancer?
Prostate cancer is relatively slow growing. Therfore a conservative approach to management of prostate cancer is "watchful waiting" (also known as "deferred treatment"). The rationale is that more men were dying with prostate cancer rather than dying from it. The decision to adopt a strategy of watchful waiting is appropriate where there is 1) a life expectancy less than 10 years, 2) presence of significant comorbid disease, and 3) presence of a low grade, low-stage tumor. These patients are typically followed with frequent PSA measurements, along with DRE, to monitor the progress of the disease.
What is a radical prostatectomy?
With radical prostatectomy, the entire prostate gland, seminal vesicles, and part of the bladder neck (ampulla) are removed. The entire prostate is removed because the cancer tends to be in many different locations within the gland. In addition, a retroperitoneal lymph node dissection is usually done. A radical prostectomy is the surgical procedure considered preferred treatment for men younger than 70 years of age who age who are in good health and with the cancer confined to the prostate (stages A and B).
Explain Stage A of the Whitmore-Jewett Staging classification of prostate cancer.
A1 < 5% of prostatic tissue neoplastic.

A2 > 5% of prostatic tissue neoplastic, all high-grade tumors.
Explain Stage B of the Whitmore-Jewett Staging classification of prostate cancer.
B1 nodule < 2cm and surrounded by palpably normal tissue

B2 nodule > 2cm or multiple nodules
Explain Stage C of the Whitmore-Jewett Staging classification of prostate cancer.
C1 Minimal extracapsular extension

C2 Large tumor involving seminal vesicles, adjacent structures, or both
Explain Stage D of the Whitmore-Jewett Staging classification of prostate cancer.
D1 Pelvic lymph node metastases or ureteral obstruction causing hydronephrosis

D2 Distant metastases to bone, viscera, or other soft tissue structures.
What is the difference between the retropubic, perineal, and the supropubic approach to radical prostatectomy?
With the more common retropubic approach, a low midline abdominal incision is made to assess the prostate gland and the pelvic lymph nodes can be dissected.

With the perineal resection, an incision is made between the scrotum and the anus. This procedure cannot remove lymph nodes.

The suprapubic approach involves an abdominal incision in vertical fashion.
What is brachytherapy?
Brachytherapy involves placing radioactive seed implants into the prostate gland, allowing higher radiation doses directly in the tissue while sparing the surrounding tissue (rectum and bladder). The radioactive seeds are placed in the prostate gland with a needle through a grid template and ultrasound ensure accurate placement of the seeds.
What is an orchiectomy and why is it done?
A bilateral orciectomy is the surgical removal of the testes that may be done alone or in combination with prostatectomy. For advanced stages of prostate cancer (stage D) an orchiectomy is one treatment option for cancer control. Testosterone, produced by the testes, stimulates growth of the prostate cancer. An orchiectomy reduces the circulating testosterone levels by 90%. It may also decrease bone pain and shrink the prostate which decreases obstruction of urinary flow.
What are the side effects of orchiectomy?
Hot flashes, erectile dysfunction, loss of sex drive, and irritability. Weight gain and loss of muscle mass, which are also common, can alter a man's physical appearance. Osteoporosis has also been reported as a consequence of orchiectomy.
What are the nurses plan of care for a patient with prostate cancer?
1) be an active participant in the treatment plan, 2) have satisfactory pain control, 3) follow the therapeutic plan, 4) understand the effect of the therapeutic plan on sexual function, and 5) find a satisfactory way to manage the impact on bladder or bowel function.
What is prostatitis?
Prostatitis is a broad term that describes a group of inflammatory and noninflammatory conditions affecting the prostate gland. It is the most common urologic problem in men younger than 50 years of age.
What are the clinical manifestations of acute bacterial prostatitis?
fever, chills, back pain, and perineal pain, along with acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine. The patient may also have acute urinary retention caused by prostate swelling. With DRE the prostate is extremely swollen, very tender, and firm. The complications of prostatitis are epididymitis and cystitis.
What should be known about chronic bacterial prostatitis and chronic prostatitis/pelvic pain?
Chronic bacterial prostatitis and chronic prostatitis/pelvic pain syndrome manifest with similar symptoms that are generally milder than those associated with acute bacterial prostatitis. These include irritative voiding symptoms (frequency, urgency, dysuria), backache, perineal/pelvic pain, and ejaculatory pain. Obstructive symptons are uncommon unless the patient has coexisting BPH. With DRE, the prostate feels enlarged and firm (often boggy) and is slightly tender with palpation. Chronic prostatitis can predispose the patient to recurrent urinary tract infections. The clinical features of prostatitis can be mimicked by urinary tract infection. However, acute cystitis is not common in men.
What diagnostic test are usually done for prostatitis?
Urinalysis (UA), culture, and WBC count.
How is antibiotic therapy usually carried out in patients with prostatitis?
Antibiotics are usually given orally for up to 4 weeks for acute bacterial prostatitis. However, if the patient has high fever or other signs of impending sepsis, hospitalization and intravenous antibiotics are perscribed. Patients with chronic bacterial prostititis are given oral antibiotic therapy for 4 to 16 weeks.
What is Hypospadias?
a urologic abnormality in which the urethral meatus is located on the ventral surface of the penis anywhere from the corona to the perineum.
What is Epispadias?
an opening of the urethra on the dorsal surface of the penis, is a complex birth defect that is usually associated with other genitourinary tract defects.
What is Phimosis?
is a constriction of the uncircumcised foreskin around the head of the penis, making retraction difficult. It is caused by edema or inflammation of the foreskin, usually associated with poor hygiene techniques that allow bacterial and yeast organisms to become trapped under the foreskin.
What is Paraphimosis?
is edema of the retracted uncircumcised foreskin, preventing normal return over the glans. An ulcer can develop if the foreskin remains contracted.
What is Priapism?
is a painful erection lasting longer than 6 hours. The condition may constitute a medical emergency.
What is Peyronie's disease?
It is sometimes referred to as curved or crooked penis and is caused by plaque formation in one of the corpora cavernosa of the penis.
What is Epididymitis?
Epididymitis is an acute, painful inflammatory process of the epididymis, usually secondary to an infection process (sexually transmitted or nonsexually transmitted), trauma, or urinary reflux down the vas deferens. It is usually unilateral. Swelling may progress to the point that the epididymis and testis are indistinguishable. In men younger than 35 years of age, the most common cause is through sexual transmission of either gonorrhea or chlamydia.
What does conservative treatment for epididymitis involve?
Conservative treatment consists of bed rest with elevation of the scrotum, use of ice packs, and analgesics. Ambulation places the scrotum in a dependent position and increases pain. Most tenderness subsides within 1 week, although swelling may last for weeks or months.
What is Orchitis?
Orchitis refers to an acute inflammation of the testes. In orchitis, the testis is painful, tender, and swollen. It generally occurs after an episode of bacterial or viral infections such as mumps, pneumonia, tuberculosis or syphilis. It can also be a side effect of epididymitis, prostatectomy, trauma, infectious mononucleosis, influenza, catheterization, or complicated urinary tract infection.
What is Mumps orchitis and what could it contribute to in those who are infected with the mumps?
Mumps orchitis is a condition contributing to infertility and could be avoided by childhood vaccination against mumps.
What is Cryptorchidism?
It is undescended testes.

This is a failure of the testes to descend into the scrotal sac before birth. It is the most common congenital testicular condition. It may occur bilaterally or unilaterally and may be the cause of infertility if corrective surgery is not done by 2 years of age. The incidence of testicular cancer is also higher if the condition is not corrected before puberty. Surgery is performed to locate and suture the testis or testes to the scrotum.
Absence of the vas deferens is a rare condition that can be associated with what other disorder?
Cystic fibrosis.
What are "DES sons"?
These are children of women who took diethylstilbestrol (DES) during pregnancy. The effects of DES on males can include undescended or underdeveloped testes, small penis, varicocele, or epididymal cysts. These males also have an increased risk of infertility and testicular cancer.
What is a Hydrocele?
A hydrocele is a nontender, fluid-filled mass that results from interference with lymphatic drainage of the scrotum and swelling of the tunica vaginalis that surrounds the testis.
What is a simple way to diagnose a patient with hydrocele?
Diagnosis if fairly simple because the mass can be seen by shining a flashlight through the scrotum (transillumination). No treatment is indicated unless the swelling becomes very large and uncomfortable, in which case aspiration or surgical drainage of the mass is performed.
What is a Spermatocele?
It is a firm, sperm-containing, painless cyst of the epididymis that may be visible with transillumination. The cause is unknown, and surgical removal is the treatment. It is difficult to distinguish the cyst from cancer.
What is a Varicocele?
It is a dilation of the veins that drain the testes. The scrotum feels wormlike when palpated. The cause of the problem is unknown. The varicocele is usually located on the left side of the scrotum as a consequence of retrograde blood flow from the left renal vein. Surgery is indicated if the patient is infertile, because persistent varicoceles are associated with 40% to 50% of cases of infertility. Repair of the varicocele may be through injection of a sclerosing agent or by surgical ligation of the spermatic vein.
What is Testicular torsion?
Testicular torsion involves a twisting of the spermatic cord that supplies blood to the testes and epididymis. It is most commonly seen in males younger than age 20. The patient experiences severe scrotal pain, tenderness, swelling, nausea, and vomiting. Urinary symptoms, fever, and WBCs or bacteria in urine are absent.
What test is done by examination to diagnose testicular torsion?
The cremasteric reflex is elicited by lightly stroking (with a reflex hammer or tongue blade) the inner aspect of the thigh in a downward direction. The mormal response is a contraction of the cremaster muscle that pulls up the scrotum and testis on the side stroked. In testicular torsion this reflex is absent on the side of the swelling.
Is testicular torsion considered a medical emergency?
Yes, because if blood supply to the affected testicle is not restored within 4 to 6 hours, ischemia to the testis will occur, leading to necrosis and the possible need for removal.
Is testicular cancer a rare occurance?
Yes. Testicular cancer is relatively rare, accounting for less than 1% of all cancers found in men.

However, testicular cancer is the most common type of cancer in young men between 15 and 34 years of age. In the US about 8,000 new cases of and 400 deaths from testicular cancer occur annually. The incidence of testicular cancer is four times higher in white males than in African American males, and it occurs more commonly in the right testicle than the left.
What are some predisposing factors for testicular cancer?
- age 15 - 34
- males who have had undescended testes (cryptorchidism)
- orchitis
- HIV infection
- maternal exposure to DES
- testicular cancer in the contralateral testes
- family history
What do most testicular cancers develop from on a cellular level?
Most testicular cancers develop from embyonic germ cells. The two types of germ cell cancers are seminomas and nonseminomas.

Although Seminoma germ cell cancers are the most common, they are the least aggressive. Nonseminoma germ cell tumors are rare, but are very aggressive.
What would the patient with testicular cancer notice on testicular self examination?
The patient may notice a painless lump in his scrotum, as well as scrotal swelling and a feeling of heaviness. The scrotal mass usually is nontender and very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum. Acute pain is the presenting symptom in about 10% of patients.
What are the clinical manifestations of testicular cancer?
Manifestations associated with metastasis to other systems are varied and include back pain, cough, dypnea, hemoptysis, dysphagia (difficulty swallowing), alterations in vision or mental status, papilledema, and seizures.
What is one way of differentiating a cancerous testicular mass from a hydrocele?
A cancerous mass is firm and does not transilluminate.
When is the easiest time to perform a testicular self examination?
During a shower or bath is the easiest time to examine the testes. Warm temperatures make the testes hang lower in the scrotum.
What is a vasectomy and how is it performed?
A vasectomy is the bilateral surgical ligation or resection of the vas deferens performed for the purpose of sterilization. The procedure requires only 15 to 30 minutes and is usually performed with the patient under local anesthesia on an outpatient basis. Vasectomy is considered a permanent form of sterilization, although some sucessful reversals (vasovasotomy) have been reported.
What should the patient expect after having a vasectomy?
after vasectomy, the patient should not notice any difference in the look or feel of the ejaculate because its major component is seminal and prostatic fluid. The patient will need to use an alternative form of contraception until semen examination reveals no sperm. This usually requires at least 10 ejaculations or 6 weeks to evacuate sperm distal to the surgical site.
What should the patient be told postoperatively after vasectomy?
No aggressive yardwork nor heavy lifting.
What is ED?
ED is Erectile dysfunction and is the inability to attain or maintain an erect penis that allows satisfactory sexual performance. Although sexual function is a topic that many individuals are uncomfortable discussing, health care providers must be able and willing to address ED.
When and why does ED occur?
ED can occur at any age, although the incidence increase with age. In fact, it is estimated that about 50% of all men between 40 and 70 have at least some degree of ED. The problem is increasing in all segments of the sexually active male population and affects both the male and his partner.
What are vacuum constriction devices?
Suction devices that can be applied to the flaccid penis to produce an erection by pulling blood up into the corporeal bodies. A penile ring or constrictive band is placed around the base of the penis to retain venous blood, thereby preventing the erection from subsiding. Special care must be taken in using these devices to prevent tissue bruising.
What are Intraurethral devices?
These interventions include the use of vasoactive drugs administered as topical gel, an injection into the penis (intracavernosal self-injection), or insertion of a medication pellet (alprostadil) into the urethra (intraurethral) using a medicated urethral system for erection (MUSE) device. These vasoactive drugs enhance blood flow into the penile arteries.
What are some of the possible side effects related to vasoactive medications for ED?
Side effects may include penile pain, priapism, corpral fibrosis, fibrotic nodules, and hypotension.