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Men's Health issues
Men's Health Issues By Lucy
| Question | Answer |
|---|---|
| Prostate Disorders | Prastatitis, Benign prostate hypertropy, and prostate cancer. |
| Prostate | Is incapsulated and has collagen. Produces the alkaline milky fluid that is used in semen and releases testosterone. |
| Prostatitis- 4 Types | Acute bacterial (ABP)- a lower urinary infection that is moving up. Chronic bacterial (CBP). Chronic prostatitis/pelvic pain syndrome. Asymptomatic inflammatory (AIP). |
| Complications of Prostatitis | Epididymitis and Cystitis. |
| Bacterial Prostatitis | Ascending lower urinary infection or bloodborne pathogen. |
| Manifestations of Bacterial Prostatitis | Firm,swollen, tender, mimics UTI symptoms, urethral discharge, Pain, urine retentions because of swelling, pain with ejaculation, pain during urination, and cloudy urine. |
| Epididymitis | Associated with chronic bacterial prostatitis. |
| Chronic Prostatitis Pelvic Pain Syndrome | Prostate and urinary pain, irritation or obstruction upon voiding, follows a viral illness, associated with STD, decreased libido, dull achey pain in the back, can produce stones in the prostate, negative culture WBCs in urine, perineal pain. |
| Asymptomatic prostatitis | Inflammatory process doing on but no signs and symptoms. |
| Management of Prostatitis | UA & Culture, you want to check for infection, CBC, DRE, PSA- The PSA is higher than normal start ruling out cancer and do more testing. |
| Treatments for Prostatitis | Antibiotics (bacterium, vancymyocin, NSAIDS)- inflammatory phase. Opiods- pain (Chronic antibiotics are used for longer periods of time, 16 weeks and the drug of choice is Flagel), Catheterization, high fluid intake (3L), Sitz baths- discomfort. |
| Benign Prostate Hyperplasia (BPH) | Occurs in 50% of men >50 yrs- this occurs due to decreased testosterone and the prostate enlarges. |
| Endocrine Changes with BPH | Dihydroxytestosterone (DHT)- testicular androgen converts in the prostate and estrogen synthesizes the DHT. Changes of less testosterone and high estrogen increases the growth becomes more sensitive and enlarges, estrogen, imbalanced hormonal changes. |
| Pathophysiology of BPH | Hyperplasia (increased cells), hypertrophy (gland enlargement), compression of urethra, Obstruction urine(bladder can lose compliance and renal insufficiency), urethral resistance, instability of the bladder, dialation of structures. |
| Clinical manifestations of BPH | Hesitancy, intermittency, weak stream, dribbling, irritation, urgency, frequency, nocturia, dysuria, bladder pain, hematuria, retention, destention, overflow incontinence, straining or inability to urinate, and infection. |
| Complications of BPH | Acute retention- diverticula, hydrureter, hydrnephrosis, and renal insufficiency. UTI and sepsis- Pyelonephritis and Bladder calculi. |
| Diagnostic studies for BPH | Hx, PE, acute symptoms, DRE, UA & culture, serum creatinine, PSA (rule out cancer), US(rule out cancer), IVP (to measure flow), uroflometry, and cystoscopy. |
| BPH Treatment Management | "watchful Waiting", drug therapy, alternative technologies, minimally invasive heat-based treatments, and surgery. |
| Non-surgical Drug Therapy for BPH | Antiandrogens, adrenergic blockers, herbal therapy, and alternative technologies. |
| Antiandrogens | You compete with the antigen and reduce the growth. Finasteride (Proscar), Dutasteride (Avodart), decreases size of the prostate, inhibits production of DHT, side effects- decreased libido, ED, Finasteride cannot be touched by pregnant women. |
| Adrenergic Blockers | Tamsulosin (Flomax), Doxazosin (Cardura), Terazosin (Hytrin), promotes smooth muscle relaxation of the prostate to prevent it from contracting. Side effects- orthostatic changes, dizziness/syncope. |
| Herbal Therapy | Saw Palmettto, Lycopene- patients on hypertensive's and adrenergic blockers can cause the effects to increase and can be dangerous. |
| Non-Surgical minimally invasive management | Transurethral microwave thermotherapy (TUMT), Transurethral needle ablation(TUNA), laser coagulation, and urethral stent. |
| Transurethral Microwave Thermotherapy (TUMT) | Microwave heat to destry the tissue, uses a catheter to create heat to destroy the prostate tissue and second probe in the rectum to control the heat, anesthesia, catheter for 2-7 days, irritation and some bleeding, and antibiotics profolacticly. |
| Transurethral Needle Ablation (TUNA) | A probe that goes in has two rabbit ear antennas where the waves go back and forth. The sounds waves destroy the tissue and gets sloughed off and they remove the tissue as the procedure goes on. Bleeding can occur. Does not cause impotency or incontence. |
| Laser Coagulation | Uses a probe to laser the tissue around the urethra. |
| Urethral Stent | A Balloon through the catheter and put into the urethra or stent placement to push out the prostate. These are only temporary and not long term. It is uncomfortable. This is only done of the patient is not a candidate for other treatments. |
| Preoperative Care | Coud`e catheter to drain bladder, antibiotics, assess patient's concerns, education- procedure, indwelling catheter, bladder irrigation, and sexual functioning (retro-grade ejaculation) |
| Transurethral Resection of Prostate (Turp) | Resection of the prostate by means of cystoscope passed through the urethra. The tissue of the capsule remains. Continuous bladder irrigation for 24 hrs. Watch for hypernatremia and fluid electrolyte imbalance. |
| Perineal Prostectomy | Is used for biopsy when early cancer is suspected or for the removal of calculi. |
| Suprapubic Prostatectomy | A large catheter is positioned into the bladder through the abdomen. |
| Postoperative care: Prostatectomy | Assessment: VS, hemorrhage, infection, DVT, urine output, surgical incision, CBI,electroylyte imbalance, patency of cathether tubes, and pain management. |
| When you remove the catheter they should: | Output of 150-200 mL Q 3-4 hrs, Dribbling, occasional bleeding, output should be greater than what is going in. |
| Bladder Irrigation System | 3-way catheter-3 lumen on for irrigation one for catheter drainage bag, and intermittent. Sterile NS, Y-Type tubing, IV pole, sterile procedure, monitor flow rate, record output. |
| Pathophysiology of Prostate Cancer | Androgen-dependent adenocarcinoma-originate in the posterior of the prostate. Spreads by three routes: Direct extension, Lymph system, and Blood stream. Predicatable metastasis pattern: lymph nodes, bones, visceral organs, major organs. |
| Diagnostic Studies of Prostate Cancer | Prostate-specific antigen (PSA), Digital rectal examination (DRE), Elevated levels of PAP (prostatic acid phosphatase), bone scan, CT, MRI (to determine the location and size of the cancer in nearby areas of the prostate). |
| TRUS Biopsy | Transurethral ultrasound-goes into the rectum to visualize what is going on and the probe can be used to gather tissue. |
| Treatment Management of Prostate Cancer | Conservative therapy- "watchful waiting", surgical- radical prostatectomy, TURP for symptom relief, chemo is not done not effective, Radiation, and hormone manipulation. |
| Surgical Management of Prostate Cancer | Radical prostatectomy- removes gland, seminal vesicles, and part of bladder neck, Common surgeries- retropubic, perineal resection, suprapubic, Orchiectomy- surgical removal of testes, reduces antigen that the testicles produce. |
| Postoperative Care of Prostate Cancer surgery | IV hydration, monitor for DVT, emboli, retention, wound and drains, analgesics, antibiotics, stool softeners, ambulation, indweeling urinary catheter (for 6 weeks), antispasmotics, and swelling (elevate, apply ice) |
| Complications of Prostate Cancer surgery | Incontinence and ED |
| Radiation: Brachytherapy | The probe goes into the rectum and has a template used to guide seed implantation, loaded seed needles and radiation seeds are implanted into the prostate. They can have swelling after treatments. |
| Hormone Manipulation | Depress the antigen that stimulates the growth. Adrogen suppression/deprivation: orchiectomy, hormone refractory-not going to upload the hormone, luteinizing hormone-releases hormone agonsists-LH and FSH,and antiandrogens. |
| Etiology and Pathology of Testicular Cancer | Family Hx, cryptorchidism, orchitis, HIV, Germ cell tumor- 90% of the cancer cells are produced in the germ cell(sperm)- Seminoma and nonseminoma (aggressive and very rare). |
| Clinical Manifestation of Testicular Cancer | A painless swelling of testicles, abdominal pain and groin/testicle, scrotum, heaviness in scrotum, breasts will be tender, and unexplained fatigue, |
| Diagnostic Studies of Testicular Cancer | Palpation, trasillumination-put a light through the scrotum to see the mass, US, X-ray, CT, blood serum- to check for tumor markers, and liver function may be elevated because of metastitisis. |
| Treatment Management of Testicular Cancer | Surgery- Orchiectomy and retroperitoneal lymph node resection, chemotherapy-advances stages, radiation-perineal area & lymph nodes, stem cell transplant- remove cells before chemo & radiation, after treatment transplant stem cells to regenerate sperm. |
| Epididymitis | Inflammation of the epididymus, 2nd to infection, trauma, reflux, complications of STDs. Treatment: antibiotic, analgesics, BR with elevate scrotum, ice pack, and epididymectomy. |
| Orchitis | Inflammation of infection of testes, mumps orchitis. Treatment: antibiotics, analgesics, BR with elevated scrotum, ice pack, emotional support- fear of being sterile. |
Created by:
tiniekittie12
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