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