[Exam 1] Chapter 59: Assessment and Management of Patients with Male Reproductive Disorders Flashcards
(136 cards)
1
Q
Cancer of Prostate: Most common cancer in men other than
A
nonmelanoma skin cancer
2
Q
Cancer of Prostate: Who has the highest risk of prostate cancer?
A
Blacks, and twice as likely to die.
3
Q
Cancer of Prostate: Risk factors for this?
A
Increasing age, and those who have father or brother previously diagnosed
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Q
Cancer of Prostate: Genes that may be associated with this?
A
HPC1 and BRCA1/BRCA2 mutations.
5
Q
Cancer of Prostate: What diet increases chances of this
A
those with excessive amounts of red meat or datiry products high in fat.
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Q
Cancer of Prostate, CMs: What signs may happen if cancer is large enough?
A
Signs of urinary obstruction may occur. Also may be blood in urine.semen and painful ejaculation. Hematuria may occur in urethra invaded.
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Q
Cancer of Prostate, CMs: What is common before diagnosis made?
A
Sexual dysfunction
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Q
Cancer of Prostate, CMs: This can spread where?
A
To lymph nodes and bone.
9
Q
Cancer of Prostate, CMs: Symptoms of metastases?
A
Backache, hip pain, perineal and rectal discomfort , anemia, weight loss, weakness, oliguria, and spontaneous pathologic fractures.
10
Q
Cancer of Prostate, Assess/Diagnostic: How can this be diagnosed?
A
Through an abnormal finding with DRE, Serum PSA< and Ultrasound-guided TRUS with biopsy.
11
Q
Cancer of Prostate, Assess/Diagnostic: Why is routine repeated DRE important?
A
Because early cancer may be detected as nodule within gland or as extensive hardening on posterior lobe.
12
Q
Cancer of Prostate, Assess/Diagnostic: Diagnosis of prostate cancer confirmed how
A
by histologic exam of tissue removed surgically by TURP, prostatectomy or ultrasound-guided transrectal needle biopsy.
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Q
Cancer of Prostate, Assess/Diagnostic: Why is fine-needle aspiration great?
A
Because it is quick, painless method of obtaining prostate cells.
14
Q
Cancer of Prostate, Assess/Diagnostic: When are most prostate cancers detected?
A
When man seeks medical attention for symptoms of urinary obstruction or found by routine DRE and PSA.
15
Q
Cancer of Prostate, Assess/Diagnostic: What levles of DRE and PSA may arise suspicion?
A
Abnormal DRE and elevated levels of PSA
16
Q
Cancer of Prostate, Assess/Diagnostic: What does TRUS help detect?
A
Nonpalpable prostate cancers and helps assist with staging localized prostate cancer. Needle biopsies of prostate guided by TRUS.
17
Q
Cancer of Prostate, Assess/Diagnostic: Most commonly used tumor grading system?
A
Gleason score. Scores it 1-5 for most predominant pattern of glands and secondary grae of 1-5 to the second most predominant pattern. Lower scores indicate well-differentiated and less aggressive tumor cells.
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Q
Cancer of Prostate, Assess/Diagnostic: Categorization of low, intermediate, and high risk prostate cancer determined by what
A
extent of cancer in prostate gland, whether it is localized , aggressiveness of cells, and spread to lymph nodes.
19
Q
Cancer of Prostate, Assess/Diagnostic: What may be used to identify metastatic bone disease?
A
Bone scans, skeletal x-rays, and MRI
20
Q
Cancer of Prostate, Assess/Diagnostic: What can be done to see if its spread to lymph nodes?
A
Pelvic computed tomography (CT) scan.
21
Q
Cancer of Prostate, Assess/Diagnostic: What antibody can eb used to detect either recurrent prostate cancer at low PSA levels or metastatic disease?
A
radiolabeled monoclonal antibody capromab pendetide with indium 111
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Q
Cancer of Prostate, Medical Mx: Treatment based on what?
A
Patients life expectancy, symptoms, risk of recurrent, size of tumor, and psa levels.
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Q
Cancer of Prostate, Medical Mx: What is done when a patient chooses a nonsurgical watchful waiting?
A
They actively monitor the course of disease and intervening only if cancer progresses. For those with less than 5 years to live.
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Q
Cancer of Prostate, Medical Mx: Advantage of nonsurgical watchful waiting?
A
Absence of SE, improved quality of life, and avoidance of unneccessary treatment.
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Cancer of Prostate, Medical Mx: What do therapeutic vaccines do?
Kill existing cancer cells and provide long-lasting immunity. Sipuleucel-T is used, a long with zbiraterone (zytiga) and cabaziaxel (jevtana)
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Cancer of Prostate, Medical Mx, Surgical Mx: What is the first line of treatment?
Radical prostatectomy, and when its confined to the prostate. This is the complete surgical removal of prostate, seminal vesicles, tips of vas deferns and surrounding fat.
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Cancer of Prostate, Medical Mx, Surgical Mx: Why is a laparoscopic radical prostatectomy preferred?
Results in low morbidity and more favorable postoperative outcomes, including less sexual dysfunction.
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Cancer of Prostate, Medical Mx, Radiation Therapy: What are the two types?
Teletherapy (external) and brachytherapy (internal)
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Cancer of Prostate, Medical Mx, Radiation Therapy: When is teletherapy prescribed?
For total dose over a certain time frame (28 tx over 5.5 weeks). For patients with low-risk prostate cancer.
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Cancer of Prostate, Medical Mx, Radiation Therapy: Patients with intermediate and high-risk cancers may be candiates for what?
pelvic lymph node irradiation anda ndrogen deprivation therapy that entails surgical or medical castration.
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Cancer of Prostate, Medical Mx, Radiation Therapy: What is intensity modulated radiation therapy (IMRT)?
Sets a dose for the target volume and restricts teh dose to surrounding tissue.
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Cancer of Prostate, Medical Mx, Radiation Therapy: What is Brachytherapy?
Implantation of interstitial radioactive seeds under anesthesia. 80-100 seeds planted, then returns home, should aovid pregnant women.
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Cancer of Prostate, Medical Mx, Radiation Therapy: Radiation safety guidelines for someone using brachytherapy?
Strainign urine for 2 weeks after implantation to catch seeds that pass.
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Cancer of Prostate, Medical Mx, Radiation Therapy: What effects may be experienced with brachytherapy?
Inflammation of rectum, bowel, bladder because of promixity of these structures to prostate.
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Cancer of Prostate, Medical Mx, Radiation Therapy: What can cause acute urinary dysfunction with brachytherapy?
inflammation and mucosal loss at the bladder neck, prostate, adn urethra.
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Cancer of Prostate, Medical Mx, Radiation Therapy: Late side effects of brachytherapy?
Rectal proctitis ,bleeding, rectal fistula, painless hematuria, and erectile dysfunction.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: What is ADT?
Commonly used to suppress androgenic stimuli to the prostate by decreasing circulating plasma testosterone or interrupting the conversion to or bidning of DHT. Prostatic epithelium then atrophies (decreases size)
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Cancer of Prostate, Medical Mx, Hormonal Strategies: How is the effect of prostatic epithelium atrophing accomplished?
Surgical castration (bilateral orchiectomy, removal of one or both testes), or medical castration through medsd.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: LHRH agonists include what?
Leuprolide and Goserelin.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: Why may additional hormonal manipulation be prescribed?
For patients who do not show adequate serum testosterone suppression with medical or surgical castration.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: What do LHRH and Antiandrogen receptor antagonsits do?
LHRH = Suppress testicular androgen
Antiandrogen receptor antagonists = cause adrenal androgen suppression.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: What happens when LHRH agonists are initiated?
Testosterone flare may occur, causing pain in bony metastatic disease. Antiandrogens given for first 7 days may reduce this uncomfortable symptom.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: Most common uses of LHRH?
1. In adjuvant and neoadjuvant setting
2. After radical prostatectomy
3. In treatmetn of recurrent indicated by elevation in PSA.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: Hypogonadism is responsible for adverse effects of ADT, which include what
vasomotor flushing, loss of libido, decreased boen density, anemia, fatigue, and increased fat mass.
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Cancer of Prostate, Medical Mx, Hormonal Strategies: Hypogonadism is associated with what
an increased risk of diabetes, resulting from insulin resistance, metabolic syndrome, and cardiovascular disease
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Cancer of Prostate, Chemotherapy: REcent studies have shwon benefits for survival with chemotherapy treatment that includes what
a docetaxel-based regimen for androgen-dependent prostate cancer
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Cancer of Prostate, Chemotherapy: Tumor angiogenesis is essential for what?
For tumor growth, so that is why antiangiogenic treatment play a role in treatment.
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Cancer of Prostate, Other Therapies: What is Cryosurgery?
Used to ablate prostate cancer in patients who cannot tolerate surgery and in those with recurrent prostate cancer. TRansperineal probes inserted into prostate under ultrasound to freeze tissue directly.
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Cancer of Prostate, Other Therapies: What can be done if there is bone pain from metastisis?
Opioid and nonopioid meds can be used, a long with EBRT that can be delivered to skeletal lesions.
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Cancer of Prostate, Other Therapies: Why may bisphosphonate therapy be given?
To reduce the risk of pathologic fracture.
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Patient Undergoing Prostate Surgery: Objectives before prostate surgery include
assess patient genral ehalth status and establish optimal kidney function.
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Patient Undergoing Prostate Surgery: What procedures can be done to remove the hypertrophies portion of prostate gland?
TURP, suprapubic prostatectomy, perineal prostatectomy, retropubic prostatectomy, TUIP, and laparoscopic radical prostatectomy.
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Patient Undergoing Prostate Surgery, TURP: How does this work?
Carried out through endoscopy. PRostate gland removed in small chips with electrical cutting loop.
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Patient Undergoing Prostate Surgery, TURP: What does this method eliminate?
transurethral resection syndrome (hyponatremmia and hypovolemia
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Patient Undergoing Prostate Surgery, TURP: Why may this trigger retrograde ejaculation?
Because removal of prostatic tissue at bladder neck can cause the seminal fluid to flow backward into bladder rather than foward through urethra during ejaculation
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Patient Undergoing Prostate Surgery, Suprapubic PRostatectomy: What is this?
Open surgical procedure
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Patient Undergoing Prostate Surgery, Suprapubic PRostatectomy: Disadvantes?
blood less, need for abdominal incision and risks associaed with any major abdominal surigical procedure.
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Patient Undergoing Prostate Surgery, Perineal Prostatectomy: When is this done?
When other approaches are not possible and useful for an open biopsy. Incontinence, sexual dysfunction and rectal injury more likely
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Patient Undergoing Prostate Surgery, Retropubic Prostatectomy: When is this siutable?
For large glands located high in pelvis
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Patient Undergoing Prostate Surgery, TUIP: What is this?
Transurethral incision of the prostate. When prostate gland is small and effective treatment for many cases of BPH.
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Patient Undergoing Prostate Surgery, Pelvic Lymph Node Dissection: When is this used?
For some patients to provide information for staging the tumor and to remove an area of microscoic metastasis.
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Patient Undergoing Prostate Surgery, Comps: This may include what
hemorrhage, clot formation, catheter obstruction, and sexual dysfunction
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Patient Undergoing Prostate Surgery, Comps: What is transurethral resection syndrome?
Signs caused by neurologic , cardiovascular, and electrolyte imabalnces associated with absorption of fsolution used to irrigate the surgical site during the surigcal procedure.
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Patient Undergoing Prostate Surgery, Comps: What to do is transurethral resection syndrome occurs?
Discontineu irrigation, administer diuretic agents, and monitor intake/output.
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Patient Undergoing Prostatectomy, Assess: What questions may be asked
Have activity tolerance changed?
DO they have a urinary problem?
Have they experienced decrease in flow of urine?
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Patient Undergoing Prostatectomy, Assess: What complciations may occur?
Hemorrhage, infection, VTE< catheter obsturction, urinary incontinence, and sexual dysfunction
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Patient Undergoing Prostatectomy, PreOp, Relieving Discomfort: What is done before surgery?
BEd rest prescribed, analgesic agents are given, and measures are initated to releive anxiety.
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Patient Undergoing Prostatectomy, PreOp, Relieving Discomfort: What is done if urinary retention continues?
Catheter inserted or if close monitoring needed of lab tests for azotemia (accumulation of nitrogenous waste products in the blood)
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Patient Undergoing Prostatectomy, PostOp, Maintaining Fluid Balance: What problem may occur because of the irrigation of the urinary cateheter to prevent its obsturction by blood?
Fluid may be absorbed through open surigcal site and retained, increasing risk for excessive fluid retention, imabalnce, and water intoxication.
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Patient Undergoing Prostatectomy, PostOp, Relieving Pain: How quickly do they move after surgery?
Day of: Dangle legs over bed.
Day after: Ambulate
If pain present, determine location
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Patient Undergoing Prostatectomy, PostOp, Relieving Pain: What does it mean if theres flank pain?
There may be a kidney problem caused by bladder spasms.
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Patient Undergoing Prostatectomy, PostOp, Relieving Pain: What meds can relax the smooth muscles to ease the spasms?
Flavoxate and oxybutynin. Warm compress to pubisor sitz baths may also help
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Patient Undergoing Prostatectomy, PostOp, Relieving Pain: How much fluid is line irrigated with
50 mL at a time. Make sure the same amount o fluid eventualy comes out.
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Patient Undergoing Prostatectomy, Potential Complications, Hemorrhage: Why is this a great risk?
Beaucase a hyperplastic prostate gland is very vascular. Bleeding can also result in formation of clots, when obstruct urine.
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Patient Undergoing Prostatectomy, Potential Complications, Hemorrhage: What may indicate arterial bleeding?
bright red bleeding with increased viscosity and numerous clots. Usually requires surgical intervention, while venous bleeding can be controlled by applying traction to catheter.
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Patient Undergoing Prostatectomy, Potential Complications, Infection: When are the dressings changeD?
Surgeon changes on first day postop, then up to nurse/home care
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Patient Undergoing Prostatectomy, Potential Complications, Infection: What is avoided due to risk of injury and bleeding in prostatic fossa?
Rectal thermomaters, rectal tubes, and enemas.
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Patient Undergoing Prostatectomy, Potential Complications, Infection: What are possible complications after porsttectomy?
UTIs and epidymitis
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Patient Undergoing Prostatectomy, Potential Catheter Problems: An obstructed catheter produces what
distention of prostatic capsule and resultant hemorrhage. Lasix may be prescribed to promote urination
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Patient Undergoing Prostatectomy, Potential Catheter Problems: What to tell patient after catheter is removed?
Urine may leak around wound for several days in patient who has gone through perineal, suprapubic or retropubic surgery
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Patient Undergoing Prostatectomy, Urinary Incontinence: How can this be reduced?
Through use of surgical technique called puboprostatic ligament-sparing or through the use of a male sling.
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Patient Undergoing Prostatectomy, Urinary Incontinence: Preventing incontinence involves what
increasing voiding frequency, avoiding positions that encourage the urge to void, and decreasing fluid.
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Patient Undergoing Prostatectomy, Urinary Incontinence: Promoting continence involves
Pelvic floor exercises, biofeedback, and electrical stimulation
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Patient Undergoing Prostatectomy, Urinary Incontinence: What are some options to restore erectile function?
Medications, surgically placed implants, or negative-pressure devices.
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Patient Undergoing Prostatectomy, Urinary Incontinence: What exercises may help regain bladder control?
Tensing perineal muscles by pressing the buttocks togheter and holding position.
Try to interrupt the urinary stream after starting to void
Continue to do these until you gain full urinary control
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Patient Undergoing Prostatectomy, Urinary Incontinence: What things should patient avoid?
Avoid activites that produce valsalva effects. Also avoid long motor trips, strenous exercise. And also avoid spicy foods and alcohol.
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Orchitis: What is this?
Rare, acute inflammatory response of one or both teestes as complication of systemic infection or as an extension of an associated epipidymitis caused by bacterial, viral, spirocheetal or parasitic organisms
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Orchitis: Microorganisms may reach testes through
blood, lymph system, or through urethra
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Orchitis: Signs of this include>
Fever, pain, tenderness in testes, bilateral testicular swelling, penile discahrge, blood in semen, and leukocytosis
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Orchitis: Treatment is based on what
whether the organism is bacterial or viral.
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Orchitis: Bacterial treated how
antibiotic agents and s upportive comfort measures.
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Orchitis: Viral treated how
using supporitve treatmetn of rest, elevation of scrotum, ice packs to reduce scrotum edema, analageic agents, and anti-inflammatory meds.
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Orchitis: Bilateral orchitis can cause what
sterility in some men
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Orchitis: Mumps vaccine recommended for who?
For postpubertal men who have not had mumps.
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Epididymitis: What is this
infection of the epididymis, which spreads from infected urethra, bladder or prostate.
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Epididymitis: Whos most likely to get this
Those 19-35 years old.
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Epididymitis: Risk factors?
Recent surgery or procedure involving urinary tract, participating in high-risk sex, personal history of sTI, past prostate infection, and lack of circumcision.
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Orchitis, Patho: What usually causes this?
E. Coli in oldermen, or can also be a result of obstruction.
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Orchitis, Patho: FOr those younger than 35, what is the cause of this
usually related to STIs. Infection moves in an upward direction, through urethra and ejaculatory duct then to epididymis.
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Orchitis, CMs: When does epididymitis develop?
Over 1-2 days, beginning with low-grade fever, chills, heaviness in affected testicle. It becomes tender to pressure and traction.
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Orchitis, CMs: What may th epatient report?
Unilateral pain, soreness in the inguinal canal along the course of the vans deferens, and pain and swelling in scrotum and groin.
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Orchitis, CMs: What may discharge look like?
From urethra , with blood in semen, pus, and bacteria in urine and pain during intercourse.
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Orchitis, Assess/Diagnostic: Lab assessment includes?
Urinalysis, CBC, Gram Stain, Urethral Culture or DNA probe, and referral for syphillis and HIV testing
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Orchitis, Medical Mx: What should be done if this is asosciated with STI?
If epididymitis associated with STI, partner of patient should also recieve antimicrobial therapy.
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Orchitis, Medical Mx: What may be done if seen within first 24 hours of onset of pain?
Spermatic cord may be infiltrated with a local anesthetic agent.
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Orchitis, Medical Mx: Supportive interventions for this?
reduction in physical activty, scrotal support, ,ice packs, and anti-inflammatory agents.
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Orchitis, Medical Mx: What is done with chronic epididymitis?
4-6 week course of antibiotic therapy for bacterial pathogens presceribed
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Orchitis, Medical Mx: When would a epididymectomy be perofmred?
For patients who have recurrent, refractory, incapactating episdoes of infection.
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Orchitis, Nursing Mx: What is usually prescribed?
Scrotum elevated, bed rest, and elevated to prevent traction on spermatic cord and to promtoe venous drainage.
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Orchitis, Nursing Mx: What should be avoided?
Straining, lifting, and sexual stimulation until infection is under control.
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Testicular Torsion: What is this?
Emergency requiring immediate diagnosis to avoid loss of testicle. Is rotation of testis, which twists blood vessels in spermatic cord and impedes arteriala nd venous supply to testicle.
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Testicular Torsion: How does patient present with pain?
Over 1-2 hours . Nausea, lightheadedness and swelling of scrotum may occur
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Testicular Torsion: Physical exam will reveal what
elevated testis, thickened spermatic cord and swollen scrotum.
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Testicular Torsion: What if it can be manually reduced?
Surgery needed to untwidt the spermati cord and anchor both testes in their correct position. Should occur within 6 hours.
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Testicular Cancer: Most common cancer for what age group?
Men between 15-35 years of age.
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Testicular Cancer, Germinal Tumor: What do these grow from?
Germ cells that produce spserm
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Testicular Cancer, Germinal Tumor: Divided into what two groups
seminomas and nonseminomas
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Testicular Cancer, Germinal Tumor: Seminomas are what
slow-growing forms of testicular cancer that are usually found in men in their 30-40s. Can spread to lymph nodes, but usually stay in testes.
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Testicular Cancer, Germinal Tumor: What are nonseminomas?
More common, grow quicker than seminomas. Made up of different cell types
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Testicular Cancer, Nongerminal Tumor: May develop where?
In supporitve and hormone-producing tissues or stroma of testicles.
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Testicular Cancer, Nongerminal Tumor: Two main types of stromal tumors?
Leydig tumors and Sertoli cell tumors. Small number can metastasize and tend to be resistant to chemotherapy and radiation therapy
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Testicular Cancer, Secondary Testicular Tumors: What are these?
That have metastasized to the testicle from other organs. Lymphoma is the most common cause. May spread to testicles from prostate gland, lung, and skin.
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Testicular Cancer, RFs: This includes what?
Cryptorchidism (undescended testicles), family history of testicular cancer, and personal history of testicular cancer.
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Testicular Cancer, RFs: Occupational hazards for getitng this include?
Exposure to chemicals encountered in mining, oil, and gas production and leather processing.
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Testicular Cancer, CMs: How do symptoms appear?
Gradually, with a mass or lump on the testicle and usually painmless enlargement of the testis. May report heaviness in scrotum or lower abdomen.
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Testicular Cancer, CMs: What may result from metastasis?
BAckache, abdominAL PAIN, WEIGHT loss, and general weakness.
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Testicular Cancer, Assesssment/Diagnostic: What is the key for early detection?
Educating young men about testicular cancer and the need for urgent evaluation of any mass.
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Testicular Cancer, Assesssment/Diagnostic: How often should TSE be performed?
Monthly, since these cancers tend to grow rapidly.
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Testicular Cancer, Assesssment/Diagnostic: What markers may be elevated here?
Alpha-Fetoprotein (AFP) and Beta-Human Chorionic Gonadotropin (Beta-hCG)
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Testicular Cancer, Assesssment/Diagnostic: What diagnostic may be performed?
Chest X-Ray to assess for metastasis in the lungs and a ranscrotal testicular ultrasound.
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Testicular Cancer, Assesssment/Diagnostic: What is teh only definitive way to determine if cancer present?
Microscopic analysis of tissue. But usually performed at time of surgery.
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Testicular Cancer, Medical Mx: Primary treatment includes what?
Removal of affected testis by orchiectomy thorugh an inguinal incision with a high ligation of the spermatic cord. Offered option of implantation fo testicular prosthesis during this.
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Testicular Cancer, Medical Mx: Why may retroperitoneal lymph node dissection be performed after orchiectomy?
To diagnose and prevent lymphatic spread of cancer.
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Testicular Cancer, Medical Mx: Is radiation therapy more effective with seminomas or nonseminoas?
Seminomas
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Testicular Cancer, Medical Mx: For nonsemeinomas, which is done after chemotherapy?
Aggressive surgical resection of all residual masses.
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Testicular Cancer, Medical Mx: Long-term side effected associated with treatment for testicular cancer include?
Renal insufficiency from kidney damage, hearing problems, gonadal damage, peripheral neuropathy, and seconadry cancers.
