Week 6- Men’s Health Physiotherapy Flashcards
What is included in mens health Physiotherapy
- post surgical removal or reduction of prostate of the prostate gland
- incontenence issues, pelvic floor weakness, post-void dribble
- pelvic pain, sexual health issue (many will not present due to embarrassment)
What is the prostate gland
- Produces seminal fluid
- found at the base of the bladder
- what can go wrong? (Hyperplasia, cancer). Enlargement leads to hyperplasia. Inflammation leads to prostatits. Cancer
Prevalence of prostate cancer
1 in 11 Australian men, most common >65yrs
Risk factors for prostate cancer
- age
- obesity
- family history prostate or breast cancer
What are symptoms of prostate cancer
- difficulties with urination
- blood in urine or semen
- pain during sex/ orgasm
How is prostate cancer detected
- digital rectal exam
- biopsy
- PSA testing
What are the management approaches to prostate cancer
- watchful waiting (some are slow growing and if older man, likely something else will kill them before the prostate cancer will and therefore surgery isn’t worth it)
- active surveillance
- surgical approaches (TURP, removal of prostate gland (open vs lap))
- radiotherapy
- hormone therapy
Surgical approach for prostate cancer
- radical prostatectomy for stage 1-2 cancers
- removal of entire prostate gland, surrounding tissues, seminal vessels
- open removal
- laparoscopic
What are the 2 open surgical approaches
-Radical Retropubic
• Lower abdo incision under GA/spinal
• Lymph node resection if local spread
-Radical Perineal
• Surgical incision between anus and perineum
• Less common due to↑risk side effects
• Unable to access LNs
• Shorter op, less pain -?easier recovery
What are the advantages to laparoscopic over open surgery
- Small incisions
- ↓ blood loss
- ↓ post-op pain
- Faster recovery
- ↓ length of stay
Note:
• Still requires catheterisation
• Similar rates of ED & UI for open prostatectomy
What are surgical risks
- Standard risks for surgery
- Highly vascularised area
- Near abdominal structures
- Development of a Lymphocele
What are surgical side effects
*Urinary incontinence
- Stress incontinence (SUI) – most common
• Problems with urethral sphincter control
- Urge incontinence (UUI)
• Oversensitivity of bladder stretch as it fills
- Overflow incontinence/urinary obstruction – rare
• Trouble fully emptying
• Prolonged urination
• Narrowing of bladder outlet
*Impotency (erectile dysfunction)
• Under60=1in4
• Over70=3in4
• Lower rates with nerve sparing approach
• Ability to obtain erection normally returns slowly
• Try to regain early post-op
- Loss of fertility
- Lymphoedema
- Decrease in length
- Inguinal hernia
What does TURP stand for?
Trans-urethral resection of prostate
What is TURP used for
Used to treat non-cancerous prostate enlargement —> Benign Prostatic Hyperplasia
Not used for curative management of prostate Ca, but may be used for advanced Ca
Explain TURP
- Removal of inner part of gland that surrounds urethra – quick, 1-2 day admission
- Nil surgical incision, scope is passed through urethra – cauterisation of tissue
- Under GA or spinal – catheterisation
Post op management- mobility
