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Mens Health Concerns
Transcript of Mens Health Concerns
Kidney cancer Bladder Cancer Erectile dysfunction (ED) From cancer or surgery Benign prostatic hypertrophy (BPH) Introduction
Benign Prostatic Hypertrophy (BPH)
Testicular Cancer Disorders of Urinary and Renal Function in Men Disorders of the male reproductive system include a wide variety of conditions that usually affect both the urinary and reproductive systems.
Because these disorders focus on the genitalia, and some instances sexuality, the patient may experience anxiety and embarrassment.
A comprehensive health history and assessment is key when caring for a patient with any one of these disorders. Health History and Assessment As men age:
Prostate gland enlarges (BPH)
Increase incidence of prostate, kidney and bladder cancers in men older than 50 years of age.
Decrease in sexual function (vascular problems, diabetes, hypertension and decrease in testosterone).
Urinary incontinence (may be related to certain medications).
Gerontologic Considerations Structures of Male Reproductive System
Bladder cancer, combined with prostatic cancer is the most common urologic cancer.
More than 70,980 newly diagnosed cases in the United States each year and 14,330 deaths.
Men get bladder cancer 4 times as often as women. Bladder Cancer Smoking-tobacco use is the leading risk factor for all urinary tract cancers. People who smoke get bladder cancer twice as often as those who do not smoke.
Work exposure-some chemicals used in making dye have been linked to bladder cancer.
Race-whites are twice as likely to get bladder cancer than are African Americans and Hispanics.
Age-cancer of the urinary bladder is more common in people between the ages of 50 to 70 years. This is a cancer of older people. Bladder Cancer Risk Factors Hematuria is the most common presenting symptom and sign of bladder cancer.
Hematuria is a common symptom that has many causes that can range in clinical importance:
Microscopic hematuria Signs and Symptoms of Bladder Cancer
Bladder tumor markers and antigens are blood test that are being looked at and studied to support the early detection and diagnosis of bladder cancers. Bladder Cancer Screening and Diagnosis Treatment of bladder cancer depends on the grade, the stage of tumor growth and the presence or absence of spread of the tumor (metastasis).
Localized tumor without muscle involvement chemotherapy, using BCG is infused directly into the bladder. Bacillus Calmette-Guerin (BCG)
inactivated form of the bacterium Mycobacterium tuberculosis
Not yet totally understood why BCG and other immunotherapies work against cancer, they are thought to elicit an immune response.
Cystectomy-removal of bladder, with surrounding tissue and lymph node dissection is often the treatment modality of choice if there is bladder muscle involvement.
Treatment of Bladder Cancer
Continent Diversions-no drainage bag
Indiana Pouch-a segment of the ileum and cecum is used to create a reservoir for urine. A stoma is formed flush with the skin and this pouch is sewn to the anterior abdominal wall creating a continent pouch that the patient can self-catheterize.
Urostomy -is another term for urinary diversion Urinary Diversions Bladder Biopsy
Providing stoma and skin care
Testing urine and caring for the ostomy
Encouraging fluids and relieving anxiety
Selecting the proper ostomy appliance Nursing Management Of Urinary Diversions Diagnosis is typically an incidental finding usually by radiographic imaging(CT scan, Ultrasound or MRI) ordered for reasons other than kidney cancer.
Kidney cancer usually has no symptoms until it is advanced, patient sometimes presents with painless hematuria.
57,760 new cases diagnosed annually in the United States
12,980 deaths Kidney Cancer Obesity is the #1 risk factor for the development of kidney cancer.
Genetics-(Von Hippel-Lindau disease) very rare.
Men are at a higher risk than women (it is not clear why).
Most people with this cancer are older, overall lifetime risk is about 1 in 75. Risk Factors of Kidney Cancer Radiographic imaging is so precise today biopsies are typically never done.
The tumor is best characterized on a CT scan.
9 times out of 10 if a biopsy was done it would be inconclusive and show necrotic or dead tissue.
If a biopsy was needed it would be done in Interventional Radiology and guided by CT scan. Diagnosis of Kidney Cancer The goal of management is to eradicate the tumor before metastasis occurs.
A radical nephrectomy is the preferred treatment if the tumor can be removed and is 2cm or less. This includes removal of the kidney, adrenal gland and surrounding lymph nodes.
Laparoscopic (robotic) nephrectomy is preferred, there is less recover time with this technique.
Open incision is used for bigger tumors or awkwardly located tumors. Treatment of Kidney Cancer Catheter and drain management
Accurate measurement of urine output
Turning and deep breathing ( location of incision makes this very difficult and uncomfortable). Post Operative Management after Nephrectomy Undescended testicles (cryptorchidism)
Family history of testicular cancer.
Cancer of one testicle increases the risk in the other testicle.
Caucasian American men have a five times greater risk than that of African American man and more than double the risk of Asian American men.
Occupational hazards including exposure to certain chemicals. Risk Factors of Testicular Cancer Testicular cancer is the most common cancer in men between the ages of 15 and 40 years, although it can occur in males of any age. The testicles are the organ where testosterone is produced.
Testicular cancer is cancer in one or both testicles and is a type of cancer that can be treated and very often cured.
An estimated 9000 new cases diagnosed annually in the United States
400 deaths annually Testicular Cancer Symptoms appear gradually with a mass or lump on the testicle and usually with a painless enlargement of the testis.
Men of all ages should perform monthly testicular exams (TSE) which is important for early intervention and treatment of this cancer.
Biopsies are not done anymore, ultrasound is precise enough to go right to surgery. Diagnosis of Testicular Cancer Testis is removed by orchiectomy through an inguinal incision, often done laparoscopically.
Testicular cancer often affects man at an age when they are trying to have children. These men may wish to talk to their doctors about nerve-sparing surgery.
They may also want to talk about storing frozen sperm cells before treatment (sperm banking).
Patients may need chemotherapy and radiation therapy. Treatment of Testicular Cancer Patients may have difficulty coping with his condition, issues related to body image and sexuality need to be addressed.
A gel filled prosthesis can be implanted to restore a more natural appearance to the scrotum.
The nurse reminds the patient of the importance of performing TSE and keeping follow-up appointments with the physician. Nursing Management of Patient with Testicular Cancer Testicular cancer Urinary Diversion procedures are performed to divert urine from the bladder to a new exit site, two types of diversions exist, these include:
Cutaneous Diversions- drainage bag required
Ileal-Conduit-the urine is diverted by implanting the ureter into a loop of the ilieum that is led out through the abdominal wall. (the colon can also be used-colon conduit)
Cutaneous Ureterostomy-the detached ureter is brought trough the abdominal wall and attaches to an opening in the skin.
Nephrostomy-a tube is placed directly into the renal pelvis via a flank incision, or by a percutaneous catheter placement into the kidney. Urinary Diversions Erectile Dysfunction-also know as impotence
Incidence ranges from 25% to 50% in men older than 65 years of age.
This is a result of the removal and interruption of nerves on each side of the prostate glad(if cancer has invaded theses nerves they are much harder to detach from the prostate leading to removal of a few nerves or bundles of nerves). Side Effects of Radical Prostatectomy
Phosphodiesterase-5 (PDE-5) inhibitors are oral medications that act as a smooth muscle relaxant causing blood flow into the penis.
These medications can cause headache, flushing and should be used with caution for men taking nitrate medications, together these meds can cause severe hypotension. Medication Management of Erectile Dysfunction
Implants Management of Erectile Dysfunction Is about the size of a walnut and is located just below the neck of the bladder-the urethra runs directly through the prostate gland.
Responsible for the production of prostatic-specific antigen (PSA).
Prostate Gland Annual screening should start at age 50 except for African Americans and men with a family history of prostate cancer they should start screening at age 40.
Screening consists of:
PSA-is a substance made by the prostate gland mostly found in semen but is also found in the blood.
Prostate Screening Noncancerous enlargement or hypertrophy of the prostate gland.
Prostate gland begins to extend upward into the bladder obstructing the outflow of urine.
>50% after age 60
>90% after age 70 Benign Prostatic Hypertrophy (BPH) Increased urinary frequency
Nocturia (getting up in the middle of night to urinate)
Abdominal straining with urination
Decrease in the volume and force of urinary stream
Recurrent urinary tract infections
A sensation that the bladder has not been fully emptied Clinical Symptoms of BPH Urinary catheterization to relieve urinary obstruction
5 Alpha-Reductase Inhibitors-these meds are anitandrogen agents and are responsible for hormone manipulation
Alpha-Adrenergic Blockers-relax the smooth muscle of the bladder neck and prostate
Tamsulosin (Flomax) Treatment of BPH Transurethral Resection of the Prostate (TURP)-surgical resection of prostate tissue through endoscopy; surgical instruments are introduced directly through the urethra to the prostate glad.
TURP and Related Nursing Care
Continuous bladder irrigation
Intake and output
Coughing and deep breathing (bed rest)
Treatment of BPH Age: risk increases with age, although 25% of diagnoses are made before age 65
Race: African Americans have a rate of incidence double that of Caucasian men (remember the Vit D theory)
Family History: there is definite genetic component to the development of prostate cancer (BRCA 1 mutation-see this in men who develop prostate cancer in their 40’s)
Diet-a diet high in saturated animal fat has been linked to an increase risk in the development of prostate cancer Prostate Cancer-Risk Factors
TRUST biopsy-(Trans Rectal Ultrasound Guided Biopsy)-this is standard of care and is done in the urologists office.
Probe (size of large finger) with ultrasound on tip of probe is inserted into the rectum; needle goes into probe and into the an out pouching and then into the prostate.
6 samples are taken on the right side of the prostate and 6 samples on the left for adequate tissue evaluation. Prostate Biopsy
Treatment is determined by the:
Stage of the Cancer
Prostate Specific Antigen (PSA) level
The higher the Gleason score the worse the prognosis and the higher chance of a recurrence of the cancer. Treatment of Prostate Cancer
Radical Prostatectomy-95% of these procedures that are done in the United States are being done robotically (The da Vinci Prostatectomy).
4-6 incisions made in the abdomen where scopes are placed
Surgeon maneuvers scopes with hands and feet
Those procedures that can not be done robotically are done with an open-midline incision. Treatment of Prostate Cancer Incontinence
Common after surgery and is usually temporary lasting 7-30 days.
Part of the urethra is removed and the remaining portion is reattached.
Foley catheter placed after surgery and stays in for 10 days.
Kegel exercises should start before surgery to help train the bladder. Side Effects of Radical Prostatectomy Testicular Cancer Cystoscopy- is where the urologist looks inside the bladder at the bladder mucosa.
If an abnormality is seen during cystoscopy a biopsy is performed by way of a Trans Urethral Resection of Bladder Tumor (TURBT)-the urologist tries to get a piece of the bladder muscle when obtaining the biopsy.
PSA is a protein and its main function is to stop semen from clumping so we are capable of reproducing. Digital rectal exam (DRE) –prostate should feel smooth not lumpy or hard
PSA can be elevated with BPH, prostatitis and prostate cancer Normal PSA-most think is <4ng/ml (newer thinking is < 2ng/ml) Questions Education is not the filling of a pail,
but the lighting of a fire.
Wiliam Butler Yeats