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Genitourinary 2

Prostate cancer
1. Definition: malignant neoplasm, usually adenocarcinoma, of prostate gland
2. Etiology
  1. more prevalent in African American men
  2. most appear on the peripheral zone of the gland
  3. most are palpable on rectal examination
  4. spreads via lymphatics, bloodstream or by local extension
  5. specific etiology unknown; familial history increases risk
3. Findings
  1. usually asymptomatic in early stages
  2. obstruction of urinary flow
  3. pain represents location of metastases
    1. lumbosacral
    2. hips
    3. lower legs
  4. rectal discomfort
  5. weight loss
  6. anemia
  7. edema of lower extremities
1. Diagnostics
  1. digital rectal examination
  2. needle biopsy
  3. transrectal ultrasonography
  4. serologic markers
    1. PSA
    2. prostatic acid phosphatase
    3. descending urography
  5. metastatic evaluation:
    1. chest x-ray
    2. IVP
    3. CT scan
    4. MRI
1. Management
  1. conservative approach
    1. usually no treatment for men over 70 due to slow progression
    2. analgesics and narcotics to manage pain
    3. short course of radiotherapy (site-specific)
    4. IV administration of strontium chloride 89 (beta emitter agent)
    5. TURP in cases of bladder obstruction
    6. placement of suprapubic catheter
  2. surgical approach
    1. radical prostatectomy
    2. laparoscopic dissectionof pelvic lymph node
    3. cryosurgery
  3. curative approach
    1. external beam radiation
    2. interstitial radiation
  4. palliative approach
    1. hormone manipulation
      - estrogen therapy diethylstilbestrol (DES)
      - luteinizing hormone-releasing hormone (LHRH)
    2. bilateral orchiectomy (removal of the testes)
    3. use of anti-androgen drugs
      - megestrol acetate (Megace) - antineoplastic decreases the growth of prostate carcinoma, an androgen-sensitive tumor
      - flutamide (Eulexin)
      - drugs are often used in combination therapy
1. Complications
  1. bone metastases
  2. complications of hormone manipulation
    1. nausea and vomiting
    2. gynecomastia
    3. sexual dysfunction
    4. hot flashes
2. Nursing interventions
  1. assessment
    1. history of current symptoms
    2. examine abdomen for palpable nodes
    3. flank pain
    4. bladder distention
  2. control pain
  3. reduce anxiety
  4. discuss potential changes re: sexual functioning
Female Reproductive Disorders
Cystocele
1. Definition - bladder herniates into vagina
1. Etiology
  1. associated with obstetrical trauma
  2. may be due to a congenital defect
  3. findings may appear after hysterectomy
  4. may appear as genitalia atrophy with age
2. Findings
  1. in early stages, asymptomatic
  2. pelvic pressure
  3. changes in micturition
1. Diagnostics
  1. pelvic examination
  2. urinalysis and culture
2. Management
  1. in postmenopausal client, estrogen therapy
  2. insertion of vaginal pessaryto support pelvic organs
  3. surgical Intervention (if indicated)
    1. to restore bladder function
    2. repair of anterior vaginal wall
3. Complications
  1. infection
  2. urinary incontinence
4. Nursing interventions
  1. assessment
    1. history of obstetrical trauma, abdominal surgery, menopause, and estrogen therapy
    2. changes in micturition
    3. pain level
    4. bulge from vagina while standing upright
    5. bulge from perineumwhen patient bears down (illustration)
  2. provide pain management as ordered
  3. control incontinence
  4. prevent urinary retention
Pelvic inflammatory disease (PID)
1. Definition - infection of the cervix ascending to the fallopian tubes and broad ligaments
2. Etiology
  1. increased incidence due to reinfection
  2. causative agents:
    1. neisseria gonorrhoeae
    2. C. trachomatis
    3. mycoplasma hominis
  3. history of multiple sexual partners
  4. use of IUD's (intrauterine device)
  5. history of therapeutic abortion
  6. history of caesarean section(s)
3. Findings
  1. pelvic pain
  2. fever, cervical discharge
  3. cervical motion tenderness
  4. irregular bleeding
  5. nausea, vomiting, acute abdomen
  6. dysuria, frequency
  7. chlamydia(see STDs on page 30 of this lesson)
1. Diagnostics
  1. endocervical culture
  2. CBC
  3. laparoscopyto view fallopian tubes
2. Management
  1. medications (may be used in combination therapy)
    1. tetracyclines
    2. penicillins
    3. quinolones
    4. cephalosporins
  2. potential surgical intervention to drain abscess
1. Complications
  1. rupture of abscess
  2. sepsis
  3. infertility
  4. ectopic pregnancy(illustration)
2. Nursing interventions
  1. assess
    1. history of menses, contraceptive use, sexual habits
    2. level of pain
    3. vital signs for hypotension, hypovolemia, and fever
    4. how an STD will impact client socially
  2. manage pain
  3. restore fluid balance
  4. client teaching
Endometriosis (illustration)

Definition - endometriumtissue grows in cysts at various sites throughout the pelvis and/or abdominal wall
Etiology
1. occurs at any age; most commonly 25 to 45
2. higher incidence in white women than in African American women
3. responds to ovarian hormonal stimulation
  1. progestins decrease it
  2. estrogens increase it
Findings
1. may be asymptomatic
2. may be present with pelvic pain
3. dyspareunia
4. painful defecation
5. abnormal uterine bleeding
6. persistent infertility
7. hematuria, dysuriaand flank pain if bladder is involved
Diagnostics

pelvic examination
rectal examination
laparoscopy
ultrasound, CT scan, barium studies

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