Common Disorders of Male & Female Reproductive Systems N109 MATERNAL and CHILD HEALTH NURSING MICHELLE E. FLORES, MAN, RNCommon Disorders of Male & Female Reproductive Systems TOPICS: MALE: 1. Benign Prostatic Hyperplasia 2. Prostatic Cancer 3. Hydrocele 4. Varicocele Female: 1. Ovarian Cancer 2. Breast Cancer 3. Cystocele 4. RectoceleBenign Prostatic Hyperplasia Benign prostatic hyperplasia (BPH) is the enlargement, or hypertrophy, of the prostate gland. «It is one of the most common diseases in aging men. The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine. Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs). . The cause is not well understood, but evidence suggests hormonal involvement. BPH is common in men older than 40 years. . [Itcan cause bothersome lower urinary tract symptoms that affect the quality of life by interfering with daily normal activities and sleep patterns.Benign Prostatic Hyperplasia Pathophysiology Resistance. BPH is a result of complex interactions involving resistance in the prostatic urethra to mechanical and spastic effects. Obstruction. The hypertrophied lobes of the prostate may obstruct the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention. Dilation. Gradual dilation of the ureters and kidneys can occur.Benign Prostatic Hyperplasia Statistics and Epidemiology BPH typically occurs in men older than 40 years of age. By the time they reach 60 years ot age, 50% of men have BPH. BPH affects as many as 90% of men by 85 years of age. BPH is the second most common cause of surgical intervention in men older than 60 years of age.Benign Prostatic Hyperplasia Causes: Cause of BPH is not well understood, but testicular androgens have been implicated. Elevated estrogen levels. BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive. Smoking. Smoking increases the risk of acquiring BPH. Reduced activity level. A sedentary lifestyle could also lead to the development of BPH. Western diet. A diet high in animal fat and protein and refined carbohydrates while low in fiber predisposes a man to BPH.Benign Prostatic Hyperplasia Clinical Manifestations: BPH may or may not lead to lower urinary tract symptoms; if symptoms occur, they may range from mild to severe. Urinary frequency. Frequent trips to the bathroom to urinate may be an early sign of a developing BPH. Urinary urgency. This is the sudden and immediate urge to urinate. Nocturia. Urinating frequently at night is called nocturia. Weak urinary stream. The decreased and intermittent force of stream is a sign of BPH. Dribbling urine. Urine dribbles out after urination. Straining. There is presence of abdominal straining upon urination.Benign Prostatic Hyperplasia Assessment & Diagnostics Digital Rectal Examination Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and nontender pros tate gland.Benign Prostatic Hyperplasia Assessment & Diagnostics Urinalysis. A urinalysis to screen for hematuria and UTI is recommended. Prostate specific antigen levels. A PSA level is obtained if the paver has at least a 10-year life expectancy and for whom nowledge of the presence of prostate cancer would change management. Urinalysis: Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection); bacteria, WBCs, RBCs may be present microscopically. Urine culture: May reveal Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas, or Escherichia coli. Urine cytology: To rule out bladder cancer. BUN/Creatinine: Elevated if renal function is compromised.Benign Prostatic Hyperplasia Assessment & Diagnostics Prostate-specific antigen (PSA): Glycoprotein contained in the even een of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research Suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition. WBC: Maybe more than 11,000/mm3, indicating infection if patient is not immunosuppressed. Uroflowmetry: Assesses the degree of bladder obstruction. IVP with post voiding film: Shows delayed emptying of the bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticula, and abnormal thickening of the bladder muscle.Benign Prostatic Hyperplasia Pathophysiology Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes. . Cystometrogram: Measures pressure and volume in foe atcer to identify bladder dysfunction unrelated to hs . Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum). . Cystometry: Evaluates detrusor muscle function and tone. Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.Benign Prostatic Hyperplasia Medical Management Goals of medical management of BPH are to improve the quality of life and treatment depends on the severity of symptoms. Catheterization. If a patient is admitted on an emergency basis because he is unable to void, he is immediately catheterized. Cystostomy. An incision into the bladder may be needed to provide urinary drainage.Benign Prostatic Hyperplasia Medical Management Pharmacologic: Alpha-adrenergic blockers (eg, alfuzosin, terazosin), which relax the smooth muscle of the bladder neck and prostate, and 5alpha reductase inhibitors. Hormonal manipulation with antiandrogen agents (finasteride [Proscar]) decreases the size of the prostate and prevents the conversion of testosterone to dihydrotestosterone (DHT). Use of phytotherapeutic agents and other dietary supplements (Serenoa repens [saw palmetto berry] and Pygeum africanum [African plum]) are not recommended, although they are commonly used. One herbal medication effective against BPH is Saw Palmetto.Benign Prostatic Hyperplasia Surgical Management The treatment options include minimally invasive procedures and resection of the prostate gland. Transurethral microwave heat treatment. This therapy involves the application of heat to prostatic tissue. Transurethral needle ablation (TUNA). TUNA uses low- level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues. Transurethral resection of the prostate (TURP). TURP involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra. Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a Sonre PUR retropubic, or perineal approach for large prostate glands.Benign Prostatic Hyperplasia Nursing Assessment & Diagnosis Health history. The health history focuses on the urinary tract, previous surgical procedures, general health issues, family history of prostate diseases, and fitness for possible surgery. Physical assessment. Physical assessment includes digital rectal examination. Urinary retention related to obstruction in the bladder neck or urethra. Acute pain related to bladder distention. Anxiety related to the surgical procedure.Benign Prostatic Hyperplasia Nursing Interventions Reduce anxiety. The nurse should familiarize the patient with the preoperative and postoperative routines and initiate measures to reduce anxiety. Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort. Provide instruction. Before the surgery, the nurse reviews with the patient the anatomy of the affected structures and their function in relation to the urinary and reproductive systems. Maintain fluid balance. Fluid balance should be restored to normal.Benign Prostatic Hyperplasia Nursing Evaluation: Reduced anxiety. Reduced level of pain. Maintained fluid volume balance postoperatively. Absence of complications.Benign Prostatic Hyperplasia Discharge Instructions: Instructions. The nurse provides written and oral instructions about the need to monitor urinary output and strategies to prevent complications. Urinary control. The nurse should teach the patient exercises to regain urinary control. Avoid Valsalva maneuver. The patient should avoid activities that produce Valsalva maneuver like straining and heavy lifting. Avoid bladder discomfort. The patient should be taught to avoid spicy foods, alcohol, and coffee. Increase fluids. The nurse should instruct the patient to drink enough fluids.Benign Prostatic Hyperplasia Surgical Management The treatment options include minimally invasive procedures and resection of the prostate gland. Transurethral microwave heat treatment. This therapy involves the application of heat to prostatic tissue. Transurethral needle ablation (TUNA). TUNA uses low- level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues. Transurethral resection of the prostate (TURP). TURP involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra. Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a SunrePuRD retropubic, or perineal approach for large prostate glands.Benign Prostatic Hyperplasia (BPH) THE ABNORMAL PROSTATE "MeN PRosranicHrPERPLASIA ‘PROSTATE CANCER PROSTANITS MOST COMMON _OasrRUCTIVE OB Y = =a BENGNTUNOR —_IBRITATIVE VOIOING 2 PROSTATIC INDURATION SYMPTOMS (XQ) OW DRE OR ELEVATION OF Psa ‘www aiDcowe com 20% 0RGE MONEPearse 1.Displeasurefiom esidvaluine 2, Weakurine 3. Urgent Urine ) Hyperplasia Symptoms HIFUN Hesitancy Intermittence, Incontinence Frequency, Fullness Urgency NocturiaTransurethral Resection of Prostate (TURP)Prostate Cancer Malignant tumour of prostate gland Occurs in 1:11 Most common cancer amongst men Third leading cause of cancer death in NZ Incidence in less in Maori Large increase in incidence of newly diagnosed cases attributed to widespread use of PSA as a screening procedure Incidence likely to continue increasing because of population ageingProstate Cancer e Usually asymptomatic in early stages e Patient may have symptoms similar to BPH -dysuria, hesitancy, dribbling, frequency, urgency, haematuria, nocturia, retention, interruption of urinary stream & inability to urinate e Pain in lumbosacral area that radiates down to hips or legs may indicate metastasesDiagnostic Studies e Blood test may show elevated Prostate- specific antigen (PSA) e Normal PSA is 0-4.0mg/ml e Rectal examination may reveal hard prostate with asymmetric enlargement with areas of induration or nodulesPROSTATE CANCER © Slow-growing, most common neoplasm in men older than age 50 © Commonly forms as adrenocarcinoma Per ier-lWmela(e arelcss) in posterior ae PCCM eli ‘ A Paaate Cancer ProstateProstate Cancer Etiology ects ema) eects Pen aeu eet) Seat et eae SA at PATHOPHYSIOLOGY © Difficulty initiating urinary stream, Cem een ae Ra OTR Reis aR a iC Nas Pes SE eT On ome Tee ee ore erste Sen See cr cin eee ee aay Se een we Cu Ce Sag cca Oe a ces rr So cc ere) SnProstate Cancer Medical and Surgical Intervention: ives Ue Ua I eet : re i Ste Pra epee ett ea eee See CURE UE CCCI CM Maier ies rina Been Sena eo ‘malignant tissue-growth of tissue interferes Preventive: ey Day wre ECW Cy eae) NURSITOM Ieee Ce gland and tumor CUS Scone eomsn Le) Soe ae] Sec ea resection indweling catheter and underying | examinations -Orchiectomy to decrease androgen productio| malignancy) Dee Cece cena Complications al Pon eereeeeny Eee Ce coe era roySymptom or Sign (Changein bowel or badder hais Aisore that does nat eal U rusia len or discharge inst U rusial ble n between prods Thickeringorampin the beasties, esenhere (ndigeston or dif swallowing (0 bviaus change nthe size of mol, or mou sore Nagging ough orhoarseness Action to be taken EARLY WARNING SIGNS OF CANCER Uvasononcy and endsopy : : CAUTION UP Biopsy and oral and skin cata HANGE IN BOWEL OR BLADDER Rectal exam and colonoscopy LESION THAT DOES NOT HEAL ‘Gynec examination for envi and NUSUAL BLEEDING OR DISCHARGE im. HICKENING OR LUMP (ou ores. testi ete) Vrnoaerbt nd RS NDIGESTION OR DIFFICULTY SWALLOWING abnormal BVIOUS CHANGES IN WART OR MOLE Endoscopy AGGING COUGH OR PERSISTENT HOARSENESS Biopsy ENT examination and ray chest E A u T I ° N ra LP |HYDROCELE Collection of fluid between the visceral and parietal layers of the tunica vaginalis of the testicles or along the spermatic cord. Most common form of scrotal swellingatolls AOU een EL Deere enc Deere ee oir L ey Ree td Non-Communicating Hydrocele (Adults) ere Rec nn co cleric) Meu co) Boy A) a Al Etiology NaC) TUES » Infection ofthe testes CSOHYDROCELE Nee eee | High risk for dysfunction relate to excision of tunica fee ener termes et Diagnostics I, Pain related to swelling, — pain that is experienced by er etn a light through the scrotum for the purpose fy. High risk for infection related to fluid accumulation. ~ Cae iia ates et cee or Na ee eee * Ultrasonography — determine whether the test and procedure. - patient may feel very anxious mass is solid or cystic and whether the pe eet tt ats Ce Complications Etiology ee eee ae ad there is inflammation of the epididymis (a curved ete en en SRN Ae had Ree eR in the spermatic veins » Testicular Atrophy - is a medical condition in Which the male reproductive organs (the testes, Pen eek) Ce eu Ly PecemicTos Seem tee Rue vena cava (unilateral [left-sided] Nei}Medical and Surgical Int Ces Ul Ue LC ee RC LOMO Sy SC U SONY ta Surgical ESV OR EWM cna Sec OND accor Reo) tense hydrocele that impedes blood Ce ge ISa MO ae|( Oo SOM) as thorough physical examination annually Rehabilitative apply ice packsVARICOCELE - amass of dilated and tortuous varicose veins in the seallllld cord. Classically | described as a ‘Bag of worms”Ovarian Cancer le Malignancy arising from the ovary le Rapidly progressing (Tne U1 as) difficult to diagnoseEtiology Oirete me Saad Sue uma Seco Se Sec arene ec SUOMI URC retake’ Ovarian cancer Pathophysiology Ree ee ene Re ene Aa cus as See i EW meee ie through the lymphatict and the Peseta CRC nu ea Wee ue Ory Deas eu emu aS Diagnostics Scena iy Cee Eee cag eee ea RCE Ne Prem EaOVARIAN CANCER Melee en RM elec cue oi eed Sau Loar Ce kee oe aay ne) Seat eee as ee em) ert ees sn Sati Oeter Be eee oon) ne errr Corer terse SE eee Ter nconry areca Ores ae eee ad Nursing Diagnosis none ese Oui y Cea O MUL SMa © High risk for ineffective breathing pattern (risk factor: presence of ascites) © High risk for altered nutrition (Risk factor: cancer, poor appetite secondary to disease, side effects of therapies) '* High risk for Impaired home management (risk SECO MEW IE ny nog a TS SOC UCC MCCCnCn Ny SOW Ne NA RayPre-operatively Nursing care management Rerum e Rk ete econ ne Ce eee aN peer ea Rec ce Ra) nC Rr eee Post-operatively nursing care management Benn ren ume gs eae et aR Sree eel Suelo Mol cre rege nee Rue sd Ree ne tne aon Cee tec aera Re Rica) erence RMR LCRCuiCmcl itnmusic) Bese uel enmcn ner cue eens os ghemotherapy toxicity; such as impaired cardiac, pulmonary Tieton Bere CIRC Reg RUC) aie ge eae eat te tect gry TT UCN eM eRe ue cee or on ere aceLevels of Care eee Involves measures to avoid or reduce exposure to carcinogens Screening programs help to identify high risk populations and individuals Early detection involves finding a precancerous lesion or a cancer at its earliest most treatable stage ¢ Rehabilitation Consist of limitation of disability and rehabilitation An important opportunity for rehabilitation may be an exercise program to help a client counteract chemotherapy related fatigueBREAST CANCER SYMPTOMS Early diagnosis of cancer generally increases the chances for successful treatment. Nipples Bloody changes discharge Changein _Pitting of the breast color breast skin 3) World Heath Organization Lump in the breast Breast or ripple pain #Cancer i Ura oa Ra baring A GENeny i M astass rears Metastassto ie Cora Prima Distant Greer tu shinor chest ei Exo eniyt Ns= — By location: @ upper outer quocromt (50%) — Genetic Chomges ge (230) central (207) ver of see, history, uctal carcineme in sity (DCIS) Eralent preg ene Mean ae Fae Sot detected om BRCAL2, P53 - ii @ Poget disease of nipple —Rowliotion, (Tor hackkires |ymphome) @ Lensls fo invasive duct corcinoma- Other: Smoking. ,olcchol, TBM! = Lobdar carcinamo. in. situ (LCIS) high fat ofits HRT @ Downs Germ esis @ Incident porehvem Glen: Sot ee Protecive factors — Breastfeeding, Investigations: — Pority — Exercise @Mlomnrno grophy Management options: — 4 Estrogen exposure @ Fine-needle aspiration (eytolow”) — Surgical ‘ @Core biopsy (Histology) Slympecony se cssnta nf ets oc ae —Pain — Visi oo ae Adjuvant redie/chemo — Nipple rebracton ~The most Comman sit for beast gm estranens —Peass of rome (oronge ped-like texture) Greer metodois (s amas Shree Tihs —Redlness — Discharge —Monocdenal ab i HERQ —Skin dimeling &. erate atPOST MASTECTOMY SING CARE / 7 (CARE OF CLIENT ‘AFTER MASTECTOMY Bonotonafoct side Reach fr Recovery oeCystocele and Rectocele Normal Fendi Avatony ——_CstvelePrupe « Cystocele occas when support : between the vagina and bladder is be weakened. = The pelvic organs are held in place by me muscles and tissues that can sd sometimes weaken and stretch. Ui Vain CystCystocele and Rectocele oral e Rectocele results from weakening Female ebic Amony Rca Pole : between the vagina and rectum e Woman may not be able to empty bladder or bowel Recacele