Week 14- Genitourinary System 2

Question 1

The process of micturition (voiding or bladder-emptying) and continence involves a complex interplay of…

Answer 1

-Nerves (cortex of brain, brainstem, parasympathetic, and preganglionic sympathetic)
-Detrusor smooth muscle of the bladder
-Internal urethral sphincter (involuntary smooth muscle)
-External urethral sphincter, part of the pelvic floor muscles (voluntary skeletal muscle); innervated by the pudendal nerves

Question 2

The pelvic floor has ___ layers

Answer 2

3

Question 3

Complaint of involuntary urine loss

Answer 3

Urinary incontinence

Question 4

Only _____% of incontinent adults seek medical care

Answer 4

20-50

Question 5

Urinary incontinence is related to…

Answer 5

-Falls in older adults
-Pressure sores
-Skin breakdown
-UTIs
-Institutionalization
-Depression
-Isolation

Question 6

True or false: Many people have more than one type of incontinence

Answer 6

True

Question 7

Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing

Answer 7

Stress urinary incontinence (SUI)

Question 8

Stress urinary incontinence occurs during activities that increase _______________

Answer 8

Intraabdominal pressure

Question 9

Pathogenesis of SUI

Answer 9

-Weakness or loss of tone in PFM
-Internal urethral sphincter failure
-Hypermobility of the ureterovesical junction
-Damage to the pudendal nerve (e.g., infection, tumor, childbirth)

Question 10

Complaint of involuntary loss of urine associated with urgency

Answer 10

Urgency urinary incontinence (UUI)

Question 11

Urgency urinary incontinence I is related to…

Answer 11

Detrusor instability (the bladder contracts at small volumes)

Question 12

Urgency urinary incontinence (UUI) often happens in response to ____________

Answer 12

Triggers

Question 13

Inflammation of the prostate gland can be…

Answer 13

-Acute/chronic
-Bacterial/nonbacterial
-Symptomatic/asymptomatic

Question 14

True or false: All categories of prostatitis have inflammation

Answer 14

False

Question 15

Category ____ of prostatitis is more commonly seen in the PT clinic

Answer 15

III

Question 16

Bacterial infection of the prostate gland as a result of GU infection (bacteria or virus), sexually transmitted infections (STIs)

Answer 16

Acute bacterial prostatitis (category I)

Question 17

Acute bacterial prostatitis has ___________ voiding and __________ voiding

Answer 17

-Irritative
-Obstructive

Question 18

Type of pain associated with acute bacterial prostatitis

Answer 18

Suprapubic, rectal, sacral, low back, perineum

Question 19

Systemic symptoms associated with acute bacterial prostatitis

Answer 19

Fever, chills, nausea, emesis, arthralgia, myalgia, and malaise

Question 20

Recurrent infection of the prostate

Answer 20

Chronic bacterial prostatitis (category II)

Question 21

-Low-grade symptoms as for category I
-Flare-ups of pelvic pain
-Voiding problems
-Sexual dysfunction

Answer 21

Chronic bacterial prostatitis (category II)

Question 22

Pain and urinary dysfunction with inflammation but without infection

Answer 22

IIIA

Question 23

Pain and urinary dysfunction without inflammation or infection
Previously known as chronic nonbacterial prostatitis

Answer 23

IIIB

Question 24

-GU, lower abdominal/pelvic, and low back pain (worse by sitting, squatting, and bending)
-Irritative voiding and obstructive voiding
-Sexual dysfunction
-Disturbed quality of life

Answer 24

Chronic prostatitis/chronic pelvic pain syndrome

Question 25

-No symptoms -WBCs and inflammatory markers are found in semen or prostate tissue -Usually being diagnosed when looking for causes of infertility or when testing for prostate cancer

Answer 25

Asymptomatic inflammatory prostatitis (category IV)

Question 26

Non-malignant enlargement of the prostate gland

Answer 26

Benign prostatic hyperplasia (BPH)

Question 27

BPH has a prostate volume of _____ mL

Answer 27

> 30 mL

Question 28

BPH occurs with lower __________ symptoms and __________

Answer 28

-Urinary tract -Bladder outlet obstruction

Question 29

____% of men ≥ 50 y/o experienced BPH symptoms

Answer 29

70

Question 30

BPH risk factors

Answer 30

-Age over 40 -Family history of BPH -Diabetes -Heart disease with use of beta blockers -Obesity

Question 31

True or false: As men age, the ratio of new prostate cells to old prostate cells shifts in favor of lower cell death

Answer 31

True

Question 32

Pathogenesis of BPH

Answer 32

-The increased growth of new prostate cells (hyperplasia, not hypertrophy) occurs primarily inward, encroaching on the urethra (benign prostate obstruction) -As the prostate enlarges, the urethra becomes obstructed, interfering with the normal flow of urine, resulting in urine backing up the ureters and pooling in the kidney

Question 33

BPH symptoms

Answer 33

-Painful urination -Blood in the urine -Unexplained lower back, pelvis, hip, or upper thigh pain -Sexual dysfunction

Question 34

Common BPH assessments

Answer 34

-Digital rectal exam (DRE) -Prostate specific antigen (PSA) blood test

Question 35

PSA is secreted by ___________

Answer 35

Prostatic epithelia cells

Question 36

True or false: PSA rises slowly with aging

Answer 36

True

Question 37

PSA is strongly correlated to ____________

Answer 37

Prostate volume

Question 38

Norm for PSA blood test

Answer 38

< 4 ng/mL

Question 39

BPH PT implications

Answer 39

-Identify the presence of obstructed voiding (4 questions on next slide) -Medical referral may be required -Lifestyle education and pelvic physical therapy -Sides effects from the medications to treat BPH -Screening questions

Question 40

Side effects from the medications to BPH

Answer 40

-General muscle weakness, drowsiness, dizziness, tachycardia, and postural orthostatic hypotension -Erectile dysfunction (ED) and loss of libido -Gynecomastia (enlargement of a man's breasts) -Possibility of falls from dizziness and loss of balance

Question 41

The most common cancer in American men

Answer 41

Prostate cancer

Question 42

Prostate cancer is the ____ most common cause of male death from cancer

Answer 42

2nd

Question 43

___ in ___ American men will develop prostate cancer!!!

Answer 43

1 6

Question 44

______________ (glandular cells) accounts for 98% of primary prostatic tumors

Answer 44

Adenocarcinoma

Question 45

Prostate cancer usually starts in the outer portion of the prostate and spreads ____________

Answer 45

Inwardly

Question 46

True or false: The relationship between testosterone/androgens and prostate cancer fully understood

Answer 46

False

Question 46

True or false: We know the precise cause of prostate cancer

Answer 46

False

Question 46

______________ influences the normal growth and development of the prostate

Answer 46

Testosterone

Question 47

Most prostatic adenocarcinomas are characterized by small- to moderate-size disorganized glands that infiltrate the _________ of the prostate

Answer 47

Stroma

Question 48

True or false: Prostate cancer invades adjacent local structures and includes lymphatic metastasis

Answer 48

True

Question 49

Obstructive symptoms of prostate cancer

Answer 49

-Urinary urgency, frequency, hesitancy, dysuria, hematuria, difficulty initiating or continuing the urine stream, and decreased urine stream -Similar to BPH typically present in later stages

Question 50

True or false: Bony metastasis occurs more often to appendicular skeleton than to the axial skeleton

Answer 50

False (axial, appendicular)

Question 51

True or false: Bony metastasis may come in the form as sacral and lumbar pain

Answer 51

True

Question 52

Clinical manifestation of prostate cancer

Answer 52

A dull, vague ache may be noted in the rectal, sacral, or lumbar spine region, and the individual may have difficulty walking

Question 53

PT implications for prostate camcer

Answer 53

-Screening for referral -Complications of medical treatment -Pre-hab and rehab for prostate surgery