Porth's Patho Chapter 43
Diagnosis of BPH
- Rectal examination - PSA to rule out malignancy - US of prostate to rule out malignancy -blood and urine analyses
penile cancer
-This is a RARE cancer in men. Mostly in uncircumcised & not very hygienic male, smoking, HPV, phimosis -Bacteria harbors in prepuse & are irritants causing carcigenic cancer. -Presents with no pain, fatigue & nodular growths. -Surgery is usually a penectomy and client with have a urethrostomy in place after surgery.
priapism
-a painful erection that lasts 4 hours or more but is not accompanied by sexual excitement -
clinical manifestations and complications of cryptorchidism
-absence of one or both testes from the scrotum -testis either is not palpable or can be felt external to the inguinal ring
manifestations of benign prostatic hyperplasia
-diminished force of the urinary stream -hesitancy in initiating voiding -nocturia -urinary retention -frequency, urgency
Paraphimosis
-foreskin is so tight and constricted that it cannot over the glans -tight foreskin can constrict the blood supply to the glans and lead to ischemia and necrosis -results from the foreskin being retracted for an extended period, as in case of catheterized uncircumcised males -can present as a swollen tender penis with multiple skin folds just under the glans
Peyronie disease (connective tissue disorder)
-localized and progressive fibrosis of unknown origin that affects the tunica albuginea -characterized initially by an inflammatory process that results in dense fibrous plaque formation prevents lengthening of the involved area during erection usually occurs in males older than 40
Extravaginal torsion
-occurs exclusively in neonates
manifestations of Peyronie disease
-painful erection -bent erection -presence of a hard mass at the site of fibrosis
Epididymitis treatment
-treatment focuses on treating the cause of the infection -antibiotics, scrotal elevation, scrotal ice packs, bed rest, nsaids -can result in sterility if treatment is delayed
Fournier gangrene
A condition that results from bacteria entering a laceration to the scrotum or perineum, causing infection and subsequent necrosis of the subcutaneal tissue and muscle in the scrotum. presents subtly with malaise and scrotal discomfort that transitions to pain with progressing discoloration of the scrotal or perineal skin these regions eventually turn black as tissue becomes necrotic can be a mixed infection with aerobic/anaerobic bacteria resulting from a variety of potential sources including a perirectal abscess, trauma, circumcision and insect bite requires immediate referral to a urologist and/or surgeon for debridement of the wound along with antibiotic therapy
Treatment of orchitis
Antibiotics, anti-inflammatory drugs, bed rest, scrotal support, and ice to the area.
Extravaginal torsion Manifestations
At birth or shortly there after, a firm, smooth, painless scrotal mass is identified. The scrotal skin appears red, and some edema is present.
A client asks the nurse what can cause or contributes to the development of BPH. The best response would be
Dihydrotestosterone (DHT) proliferates the growth of prostatic stroll cells, leading to a reduction in the death of the epithelial cells
After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which of the patient's following statements indicates the need for further teaching?
I can't shake this feeling like Ive received a death sentence explanation: testicular cancer has the potential for metastasis, but outcomes are positive for most clients and survival rates are high.
Balanoposthitis
Inflammation and/or infection of the glans penis and prepuce. may be characterized by erythema of the glans and prepuce, itching, soreness, blisters, ulcers and painful urination foul smelling discharge may also be present
BPH etiology
age: >40 years family history obesity CVD DM 2 anatomic location of the prostate at the bladder neck contributes to the pathophysiology and symptomatology of BPH
complications of balanoposthitis
Phimosis, Paraphimosis, Cancer, Meatal stenosis
A 52-year-old male diagnosed with erectile dysfunction (ED) asks the nurse what will be implemented as a first option for treatment. The best response would be
Psychosexual counseling and PDE-5 inhibitor medications
Treatment of erectile dysfunction
Sildenafil, tadalafil, vardenafil -intracavernosal injection -surgical treatment reserved for patients in whom conservative therapy has failed
treatment for varicocele
Surgery to block varicose veins and redirect blood through good veins disappears in the lying position because of venous decompression into the renal vein valsalva maneuver can accentuate small varicosities
True or False Balanophosthitis is uncommon in circumcised males
True
Benign Hyperstatic Hyperplasia
a condition which prostate gland is enlarged but not cancerous formation of large, discrete lesions in periurethral region of the prostate rather than the peripheral zones
The nurse is reviewing the laboratory results of a client who has noninflammatory prostatitis. The nurse would expect the results to include:
a normal leukocyte count explanation: men with noninflammatory prostatitis have symptoms resembling those of nonbacterial prostatitis but have negative urine culture results and no evidence of prostatitis inflammation. A normal leukocyte count indicates no evidence of prostatic inflammation and is a key factor o consider when making a. noninflammatory prostatitis diagnosis.
spermatocele
a painless cyst that develops in the epididymis and is filled with a milky fluid containing sperm
testicular torsion
a sharp pain in the scrotum caused by twisting of the vas deferens and blood vessels leading into the testicle
Manifestations of intravaginal torsion
affected testis is large and tender pain radiates to inguinal area true surgical emergency
Hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
Acute bacterial prostatitis
acute infection of the prostate gland that results in pelvic pain and urinary tract symptoms dysuria, urinary frequency, urinary retention--> may lead to systemic symptoms such as fevers, chills, nausea, emesis and malaise caused by ascending urethral infection or intraprostatic reflex facilitated by numerous risk factors including BPH, genitourinary infections, history of STD's and being immunocompromised direct or lymphatic spread from the rectum, or hematogenous spread via bacterial sepsis --E. coli --P. aeruginosa --Klebsiella --Enterococcus --Enterobacter --Proteus --Serratia
orchitis
acute inflammation of testis secondary to infection associated with viral mumps infection primary infection can be in genitourinary tract (cystitis, urethritis, prostatitis) and then travel to the epidermis and testis through the vas deferens can develop as a complication of a systematic infection such as mumps, scarlet fever or pneumonia
an adolescent male comes to the urgent care clinic. Upon assessment, the following is noted:history of circumcision, erythema of the glans, and prepuce with a malodorous discharge. Based on symptoms, the probable diagnosis would be
acute superficial balanoposthitis
Hypospadias and Epispadias
congenital defect where the urinary meatus is below/above its normal location
ischemic priapism
associated with progressive fibrosis of the cavernosal tissues and ED
Treatment of BPH
based symptoms severity, impact on daily life, and personal preferences 1. Alpha-1 antagonist to relax smooth muscle (2 types) -Terazosin is not specific, so relaxes smooth muscle and lowers BP -Tamsulosin is selective for alpha1a antagonism, so only relaxes smooth muscle and does not affect BP (used in normotensive) 2. 5-alpha reductase inhibitor - block conversion of T to DHT (takes months for results and can cause gynecomastia and sexual dysfunction); also used for male pattern baldness
Hematocele
blood located between the visceral and parietal layers of the tunica vaginalis
prostate cancer
cancer of the prostate gland, usually occurring in men middle-aged and older
testicular cancer
cancer of the testicle, usually occurring in men 15 to 35 years of age
Which is the most common cause of recurrent urinary tract infections in males
chronic bacterial prostatitis explanation: chronic bacterial prostatitis is the most common cause of relapsing urinary tract infections in males.
epispadias
congenital defect in which the urinary meatus is located on the upper surface of the penis
acute bacterial prostatitis treatment
depends on severity of symptoms antibiotics, bed rest, adequate hydration, antipyretics, analgesics to relieve pain abx therapy is usually continued for at least 4 weeks
clinical manifestations of orchitis
enlarged testis, tenderness, scrotal skin erythema, edema of the scrotum and induration of the testes if these signs and symptoms are accompanied by an enlarged epididymis, this is concern for epididymo-orchitis usually resolve spontaneously in approximately 3-10 days, whereas epididymitis will usually resolve in same time frame after initiation of abx
testicular cancer etiology
genetic link and geographic risk risk factors include cryptorchidism, genetic factors and disorders of testicular development cryptorchid testis 90% of malignant tumors arising in the testis are germ cell tumors, classified as seminomas and nonseminomas
Causes of hypospadias
genetic: family history maternal: older maternal age, multiple pregnancies, high body mass index, hypertension, preeclampsia
Epididymitis manifestations
gradual onset of posterior testicular pain (unilateral), occasionally radiates to lower abdomen acute involves pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks chronic- characterized >/6 weeks discharge, dysuria, frequency, urgency, erythema of the scrotal skin, fever may be present must be differentiated with testicular torsion, Fournier gangrene
The community health nurse is providing men's health education on prostate cancer. What risk factors for prostate cancer should the nurse include in the discussion
high fat diet from processed meat consuming high fate dairy items
a factor that would increase a male's risk for the development of testicular cancer
history of cryptorchidism
intravaginal torsion
if the attachment of the tunica vaginalis to the testicle is too high, the spermatic cord can rotate within it referred to as the bell clapper deformity most commonly occurs in adolescents more common than extravaginal torsion
erectile dysfunction
inability of an adult male to achieve an erection; impotence
epididymitis
inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder
Posthitis
inflammation of the prepuce
prostatitis
inflammation of the prostate gland
A client is concerned about having mumps orchitis and asks the nurse about the symptoms. The nurse best response is
painful enlargement of the testes with fever 3 days after infection
a nurse is providing teaching to the parents of a chid who has undergone corrective surgery for cryptorchidism. the most important information for the nurse to provide is
parents should be taught that their child needs frequent follow-up visits
Causes of cryptorchidism
prematurity maternal smoking small birth weight family history
Types of cryptorchidism
primary: testis failed to complete its migration from its pararenal embryologic origin to the scrotum -may be located in a nonpalpable intra-abdominal, suprascrotal position or may be palpable in an intracanalicular position, suprascrotal position, or an ectopic position secondary: a testis that had previously been in a scrotal position can be pulled into a suprascrotal position as a result of scarring, often after surgical repair of an inguinal hernia
noninflammatory prostatitis
prostatodynia have sx resembling those of nonbacterial prostatitis but have negative urine cx results and no evidence of prostatic inflammation extraprostatic sources: apparent functional obstruction of the bladder neck near the external urethral sphincter
Acute bacterial prostatitis manifestations
rapid onset of irritative or obstructive voiding symptoms irritative sx: dysuria, urinary frequency and urinary urgency obstructive sx: hesitancy, incomplete voiding, straining to urinate and weak stream suprpubic recta or perineal pain painful ejaculation hematospermia painful defecation systemic symptoms such as fever, chills, nausea, emesis, malaise cloudy, malodorous urine prostatic massage produces a thick discharge with white blood cells prostate with often be tender, enlarged or boggy
Hydrocele
scrotal swelling caused by a collection of fluid without presence of inguinal hernia -caused by a patent processes vaginalis
Prostate Cancer etiology
several risk factors: age, race, heredity and environmental influences male hormones: androgens
clinical manifestations and diagnosis of testicular cancer
slight enlargement of the testicle that may be accompanied by some degree of discomfort (ache in abdomen or groin or a sensation of dragging or heaviness in the scrotum) signs of metastatic spread include swelling of lower extremities, back pain, neck mass, cough, hemoptysis, or dizziness
Chronic bacterial prostatitis
subtle disorder that is difficult to treat most often caused by E. coli present with hx of relapsing UTI's other irritative or obstructive urologic sx ua to confirm the diagnosis
cryptorchidism
undescended testes
varicocele
varicosities of the pampiniform plexus left side more commonly affected because the left internal spermatic vein inserts into the left renal vein at a right angle
what complications of a transurethral prostatectomy will the nurse address with the patient as part of discharge teaching
incontinence explanation: late complications of a TURP include erectile or sexual dysfunction, incontinence and bladder neck constriction. Immediate complications of TURP include the inability to urinate, postoperative hemorrhage or clot retention and urinary tract infection
balanitis
inflammation of the skin covering the glans penis
Which disorder of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment
intravaginal testicular torsion
Scrotal cancer
linked to exposure to tar, soot and oils most squamous cell cancers are linked to poor hygiene and chronic inflammation exposure to photchemotherapy or HPV may appear as a small tumor or warlike growth that eventually ulcerates
cause of epididymitis
multiple infectious -- mycobacterium tuberculosis --E. Coli --pseudomonas aeruginosa --klebsiella pneumoniae --Haemophilus influenzae --Proteus mirabilis --ureaplasma urealyticum --m. genitalium viral (enterovirus and adenovirus) infections most common in children noninfectious: trauma, postprostatic biopsy, and postvasectomy epididymal inflammation, sarcoidosis, Behçet disease, vasculitis associated with Henoch-Schönlein purpura and medications (amiodarone) post infectious microbial sources
Phimosis
narrowing of the opening of the prepuce over the glans penis
organic causes of erectile dysfunction
neurogenic, hormonal, vascular, drug-induced, penile-related etiologies -most common in older men is vascular and involves the penile arteries, veins or both -arterial issues usually caused by atherosclerosis -Parkinsons, disease, multiple sclerosis, heavy metal poisoning, stroke, cerebral trauma -metabolic syndrome
Erection
neurovascular process involving the autonomic nervous system, neurotransmitters, and endothelial relaxing factors
Inflammatory Prostatitis
no bacteria in urinary system but have pain along penis, testicles and scrotum painful ejaculation low back pain rectal pain along the inner thighs urinary symptoms decreased libido ED elevated leukocyte count and abnormal inflammatory cells in prostatic secretions
Treatment of testicular cancer
orchiectomy, which is done at the time of diagnostic exploration surgical therapy enables precise staging of disease
Diagnosis and Treatment of cryptorchidism
to be differentiated from retractable testes that retract into the inguinal canal in response to an exaggerated cremasteric muscle reflex only definitive management is surgical intervention parents need to be aware potential issues off infertility and increased risk of testicular cancer
cryptorchidism (undescended testes)
when one or both of testicles fail to move down into the scrotal sac -most common congenital disorder affecting male infants