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care of children with Epispadias,hypospadias,ectopia vescica



Group 5

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Group 5

  1. 1. Male and Female Reproductive Disorders
  2. 2. Male Reproductive Organ
  3. 3. Anatomy and Physiology <ul><li>bulbourethral glands – secretes a fluid component of the seminal fluid </li></ul><ul><li>epididymis – provides the a temporary storage site for the immature sperm that enter it from the testis. </li></ul><ul><li>penis </li></ul><ul><ul><li>Foreskin - the skin covering the penis </li></ul></ul><ul><ul><li>glans penis – the conical tip of the penis that covers the end of the corpora cavernosa penis and the corpus spongiosom like a cup </li></ul></ul><ul><li>prostate – secrete a milky fluid that plays a role in activating sperm </li></ul><ul><li>scrotum – the divided sac of skin that hangs outside the abdominal cavity between the legs and at the root of the penis. </li></ul><ul><li>seminal vesicles – produce about 60% of the fluid volume of semen </li></ul><ul><li>testicles – one of the pair of male gonads that produce semen. </li></ul>
  4. 4. Male reproductive disorders: Phimosis <ul><li>Constriction of the male foreskin so that it cannot be pull back over the glans of the penis. </li></ul><ul><li>Can be congenital or a result of inflammation, infection or local trauma. </li></ul>
  5. 5. phimosis <ul><li>Signs and symptoms: </li></ul><ul><li>pain </li></ul><ul><li>Penile swelling </li></ul><ul><li>Penile inflammation </li></ul><ul><li>Penile discharge </li></ul><ul><li>Penile bleeding </li></ul><ul><li>Swelling of penis on urination </li></ul><ul><li>Urination difficulties </li></ul><ul><li>Pain on urination </li></ul>Classic phimosis Para phimosis
  6. 6. phimosis <ul><li>Causes: </li></ul><ul><ul><li>Balanitis xerotica obliterans </li></ul></ul><ul><ul><li>Poor hygiene </li></ul></ul><ul><ul><li>Forceful retraction of congenital phimosis </li></ul></ul>
  7. 7. <ul><li>Pathophysiology: </li></ul><ul><li>Acquired phimosis is usually the result of poor hygiene or chronic balanoposthitis, which eventually leads to the formation of a fibrotic ring of tissue close to the opening of the prepuce. Repetitive forceful retraction of a congenital phimosis by parents attempting to clean the underlying glans may lead to an acquired phimosis because of scar formation and a resultant fibrotic ring of tissue at the prepuce. </li></ul>phimosis
  8. 8. phimosis <ul><li>Assessment: </li></ul><ul><li>Congenital and acquired phimosis: </li></ul><ul><ul><li>Foreskin cannot be retracted proximally over the glans penis. </li></ul></ul><ul><li>Paraphimosis </li></ul><ul><ul><li>Edema, tenderness, and erythema of the glans </li></ul></ul><ul><ul><li>Edema of the distal foreskin </li></ul></ul><ul><ul><li>Flaccidity of the penile shaft proximal to the area of paraphimosis (unless there is accompanying balanoposthitis or infection of the penis) </li></ul></ul><ul><ul><li>Ensure the absence of an encircling foreign body, such as hair, clothing, metallic objects, or rubber bands. </li></ul></ul>
  9. 9. <ul><li>Diagnostic Tests </li></ul><ul><li>CT Scan </li></ul><ul><li>Physical examination </li></ul><ul><li>Cystoscopy </li></ul><ul><li>Intravenous Pyelogram </li></ul><ul><li>MRI </li></ul><ul><li>Renal Ultrasound </li></ul><ul><li>Urodynamics </li></ul><ul><li>Complication: </li></ul><ul><li>Difficulty urinating </li></ul><ul><li>Balanitis </li></ul><ul><li>Painful erections </li></ul><ul><li>Paraphimosis </li></ul>phimosis
  10. 10. <ul><li>Nursing diagnosis: </li></ul><ul><li>Discomfort/Pain </li></ul><ul><li>Alternation in self esteem </li></ul><ul><li>Knowledge deficit r/t self care, fertility, infertility </li></ul><ul><li>High risk for transmission or infection r/t STD </li></ul>phimosis
  11. 11. <ul><li>Intervention: </li></ul><ul><li>Operative: </li></ul><ul><li>routine circumcision, </li></ul><ul><li>sutureless circumcision </li></ul><ul><li>modifications of preputial-plasty </li></ul><ul><li>dilation with a balloon or artery forceps </li></ul><ul><li>forced retraction with a local, general or no anaesthetic </li></ul><ul><li>note: Unfortunately, none of these studies have been prospective randomized trials. </li></ul>Phimosis
  12. 12. <ul><li>Non-operative </li></ul><ul><li>Steroid cream is a painless, less complicated and more economical alternative to circumcision for the treatment of phimosis. </li></ul><ul><li>betamethasoneKikiros </li></ul><ul><li>18 of 21 boys (86%) with hydrocortisone, but they considered that the betamethasone worked more quickly. </li></ul><ul><li>Another steroid cream, 0.05% clobetasol propionate, has also been used successfully by (70%, 54 boys ) </li></ul>phimosis
  13. 13. HYPOSPADIA <ul><li>is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (opening). Instead of opening at the tip of the glans of the penis , a hypospadic urethra opens anywhere along a line (the urethral groove ) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum . </li></ul>
  14. 14. HYPOSPADIA <ul><li>Signs and syptoms: </li></ul><ul><li>Opening of the urethra below the tip on the bottom side of the penis </li></ul><ul><li>Abnormal appearance of the glans penis (the tip) </li></ul><ul><li>Incomplete foreskin in which the foreskin extends only around the top of the penis </li></ul><ul><li>Curvature of the penis during an erection (called chordee) </li></ul><ul><li>Buried penis </li></ul><ul><li>Abnormal position of scrotum with respect to penis </li></ul>
  15. 15. HYPOSPADIA <ul><li>KINDS Of HYPOSPADIA: </li></ul><ul><li>ANTERIOR HYPOSPADIA (70% of the cases) the meatus is located near the apex of the penis. </li></ul><ul><li>MEDIUM HYPOSPADIA (10% of the cases) the meatus is located on the medium part of the penis, which often has a slight curvature. </li></ul><ul><li>POSTERIOR HYPOSPADIA (20% of the cases) these are the most severe types : the meatus is located at the base of the penis or in the scrotum of in the perineal scrotum. The penile curvature is considerable . </li></ul>
  16. 16. HYPOSPADIA <ul><li>Causes: </li></ul><ul><li>sporadic, without inheritance or family recurrence however, it can result from genetics (a pericentric inversion of chromosome 16). </li></ul><ul><li>genetic </li></ul><ul><li>endocrine </li></ul><ul><li>environmental factors </li></ul>
  17. 17. HYPOSPADIA <ul><li>Pathophysiology: </li></ul><ul><li>Hypospadias is a congenital defect that is thought to occur embryologically during urethral development, from 8-20 weeks' gestation. The external genital structures are identical in males and females until 8 weeks' gestation; the genitals develop a masculine phenotype in males primarily under the influence of testosterone. As the phallus grows, the open urethral groove extends from its base to the level of the corona. The classic theory is that the urethral folds coalesce in the midline from base to tip, forming a tubularized penile urethra and median scrotal raphe. This accounts for the posterior and middle urethra. The anterior or glanular urethra is thought to develop in a proximal direction, with an ectodermal core forming at the tip of the glans penis, which canalizes to join with the more proximal urethra at the level of the corona. The higher incidence of subcoronal hypospadias supports the vulnerable final step in this theory of development. </li></ul>
  18. 18. HYPOSPADIA <ul><li>Assessment: </li></ul><ul><li>Upon examination, the foreskin is usually incomplete and the misplaced urethral opening is located. </li></ul><ul><li>Complications: </li></ul><ul><li>undescended testicles and inguinal hernias (i.e., located in the groin). </li></ul><ul><li>Other complications include upper urinary tract anomalies and backflow of urine from the ureter to the bladder (vesicoureteral reflux). </li></ul>
  19. 19. HYPOSPADIA <ul><li>Diagnostic test: </li></ul><ul><li>prenatal ultrasound, but it usually occurs in males at birth. </li></ul><ul><li>Mild hypospadias may not be diagnosed unless removal of the foreskin (circumcision) is performed. Diagnosis of hypospadias in females requires thorough physical examination. </li></ul>
  20. 20. HYPOSPADIA <ul><li>Nursing diagnosis: </li></ul><ul><li>Discomfort/Pain </li></ul><ul><li>Alternation in self esteem </li></ul><ul><li>Knowledge deficit r/t self care, fertility, infertility </li></ul><ul><li>High risk for transmission or infection r/t STD </li></ul>
  21. 21. HYPOSPADIA <ul><li>Surgical techniques: </li></ul><ul><li>Mathieu's technique </li></ul><ul><li>Duckett's technique </li></ul><ul><li>Snodgrass's technique </li></ul><ul><li>Bracka's two-stage technique </li></ul><ul><li>Intervention: </li></ul><ul><li>Medical Treatment </li></ul><ul><li>Medications – </li></ul><ul><li>Hormone therapy </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Diet/Fluids </li></ul><ul><li>Radiation therapy </li></ul>
  22. 22. HYPOSPADIA <ul><li>Nursing Interventions: </li></ul><ul><li>Monitor </li></ul><ul><li>Vital signs </li></ul><ul><li>Fluid balance </li></ul><ul><li>Elimination </li></ul><ul><li>Laboratory results </li></ul><ul><li>Emotional status </li></ul><ul><li>Postoperative care : </li></ul><ul><li>incisions, dressings </li></ul><ul><li>Bladder irrigation </li></ul><ul><li>Pain management </li></ul><ul><li>Nutritional & fluid intake </li></ul><ul><li>Activity & Rest </li></ul><ul><li>Psychological support </li></ul>
  23. 23. epispadia <ul><li>is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. </li></ul>
  24. 24. epispadia <ul><li>Causes: </li></ul><ul><li>is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis. </li></ul>
  25. 25. epispadia <ul><li>Signs and symptoms: </li></ul><ul><li>Bladder extrosphy </li></ul><ul><li>Widened penis </li></ul><ul><li>Enlarged pubic bone </li></ul><ul><li>Urinary incontinence </li></ul><ul><li>Urinary tract infections </li></ul><ul><li>Reflux nephropath </li></ul><ul><li>Surgical treatment: </li></ul><ul><li>Surgical repair: Repair of a damaged body structure by surgical measures. </li></ul><ul><li>Plastic surgery: An operation that restores or improves the appearance of body structures. Source: National Institute of Health </li></ul>
  26. 26. cryptorchidism <ul><li>Absence of 1 or both testis from the scrotum. </li></ul><ul><li>Failure of the testis to move or descend during fetal development from an abdominal position through the inguinal; canal into the epsilateral scrotum. </li></ul><ul><li>Common birth defects of male genetalia </li></ul>
  27. 27. cryptorchidism <ul><li>Syptoms: </li></ul><ul><li>Misplaced testes hidden in the abdomen </li></ul><ul><li>Missing testicle in male newborn </li></ul><ul><li>undescended testicle </li></ul>
  28. 28. cryptochidism <ul><li>Pathophysiology: </li></ul><ul><li>The embryology of testis development is critical to understanding the most common theories that explain cryptorchidism. </li></ul><ul><li>Shortly after 6 weeks' gestation, the testis-determining SRY gene on chromosome Y directly affects the differentiation of the indifferent gonad into a testis. Around 6-7 weeks' gestation, Sertoli cells develop and secrete Müllerian inhibitory substance (MIS), which leads to the regression of the female genital organs. Around the 9 weeks' gestation, Leydig cells start producing testosterone, which promotes development of the wolffian duct into portions of the male genital tract. Because of the differential growth of the fetus, the testicles move into the pelvis, close to the internal ring. </li></ul><ul><li>The testis remains in an retroperitoneal position until 28 weeks' gestation, at which time inguinal descent of the testicle begins. Most testes have completed their descent into the scrotum by the 40 weeks' gestation. </li></ul>
  29. 29. cryptochidism <ul><li>Causes: </li></ul><ul><li>Prematurity </li></ul><ul><li>Androgen insensitivity syndrome </li></ul><ul><li>Unexplained birth defect </li></ul><ul><li>inguinal hernias are common </li></ul><ul><li>Hormaonal abnormalities </li></ul><ul><li>Contributing environmental chemicals </li></ul><ul><li>Heredofamilial defect </li></ul><ul><li>Assessment: </li></ul><ul><li>Physical examination discloses absence of one or both testis within the scrotum. </li></ul><ul><li>Diagnostic test: </li></ul><ul><li>Cremasteric reflex </li></ul><ul><li>Pelvic ultrasound or MRI </li></ul>
  30. 30. cryptochidism <ul><li>Complications: </li></ul><ul><li>Testicular cancer. Testicular cancer usually begins in the cells in the testicle that produce immature sperm. </li></ul><ul><li>Fertility problems. Low sperm counts, poor sperm quality and impaired fertility are more likely to occur among men who have had an undescended testicle. </li></ul><ul><li>Testicular torsion. Testicular torsion is the twisting of the spermatic cord, which contains blood vessels, nerves and the tube that carries semen from the testicle to the penis. </li></ul><ul><li>Trauma. If a testicle is located in the groin, it may be damaged from pressure against the pubic bone. </li></ul><ul><li>Inguinal hernia. An undescended testicle may be associated with an inguinal hernia. </li></ul>
  31. 31. cryptochidism <ul><li>Diagnostic test </li></ul><ul><li>Ultrasonography </li></ul><ul><li>CT scanning </li></ul><ul><li>MRI </li></ul><ul><li>angiography </li></ul><ul><li>Diagnostic laparoscopy </li></ul><ul><li>Nursing diagnosis </li></ul><ul><li>Disturbed body image </li></ul><ul><li>Fatigue </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Acute pain </li></ul>
  32. 32. MANAGEMENT
  33. 33. HYDROCELE <ul><li>A hydrocele is an accumulation of fluid in any sac-like cavity or duct - specifically in the tunica vaginalis testis or along the spermatic cord. The condition is caused by inflammation of the epididymis or testis or by lymphatic or venous obstruction of the cord. </li></ul>
  34. 34. HYDROCELE <ul><li>Signs and symptoms </li></ul><ul><li>frequency, urgency, and dysuria associated with bacteriuria </li></ul><ul><li>painful scrotal swelling suggests an inflammatory cause. </li></ul><ul><li>There may also be pain in the groin or testicle. </li></ul><ul><li>presence of erythema and edema </li></ul><ul><li>loss of the normal scrotal rugae </li></ul><ul><li>Pain is aggravated by standing and should be relieved when the testicle is elevated (Prehn's sign). </li></ul>
  35. 35. HYDROCELE <ul><li>Causes: </li></ul><ul><li>Testes inflammation </li></ul><ul><li>Lymphatic obstruction </li></ul><ul><li>Congenital DEFECTS </li></ul><ul><li>failed closure of the processus vaginalis at the internal ring. </li></ul><ul><li>pathologic closure of the processus vaginalis and trapping of peritoneal fluid. </li></ul><ul><li>Adult-onset hydrocele may be secondary to orchitis or epididymitis. </li></ul><ul><li>can be caused by tuberculosis and by tropical infections such as filariasis. </li></ul><ul><li>Tumor, especially germ cell tumors or tumors of the testicular adnexa </li></ul><ul><li>Traumatic (ie, hemorrhagic) hydroceles are common. </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Exstrophy of the bladder </li></ul><ul><li>may arise from Ehlers-Danlos syndrome. </li></ul><ul><li>change in the type or volume of peritoneal fluid , </li></ul>
  36. 36. HYDROCELE <ul><li>Pathophysiology </li></ul><ul><li>Embryologically, the processus vaginalis is a diverticulum of the peritoneal cavity. It descends with the testes into the scrotum via the inguinal canal around the 28th gestational week with gradual closure through infancy and childhood. </li></ul><ul><li>Structurally, hydroceles are classified into 3 principal types. </li></ul><ul><li>In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele. </li></ul><ul><li>In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs. </li></ul><ul><li>In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele. </li></ul><ul><li>Adult hydroceles are usually late-onset (secondary). Late-onset hydroceles may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result from chronic infection after surgical repair. Hydrocele can adversely affect fertility. </li></ul>
  37. 37. HYDROCELE <ul><li>Assessment: </li></ul><ul><li>An accurate diagnosis can usually be made solely on the basis of physical findings. </li></ul><ul><li>A complete examination of the scrotum - consisting of inspection, palpation, and transillumination - is made in every case. </li></ul><ul><li>Diagnostic test: </li></ul><ul><li>Scrotal Ultrasound </li></ul><ul><li>Urinalysis </li></ul><ul><li>Complication: </li></ul><ul><li>Infection or tumor. Either may impair sperm production or function. </li></ul><ul><li>Inguinal hernia. A loop of intestine could become trapped in the weak point in the abdominal wall (strangulated), a life-threatening condition. </li></ul><ul><li>Nursing diagnosis </li></ul><ul><li>Discomfort/Pain </li></ul><ul><li>Alternation in self esteem </li></ul><ul><li>Knowledge deficit r/t self care, fertility, infertility </li></ul><ul><li>High risk for transmission or infection r/t STD </li></ul>
  38. 38. HYDROCELE <ul><li>Medical Treatment : </li></ul><ul><li>Medications – </li></ul><ul><li>Hormone therapy </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Diet/Fluids </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Surgical Intervention – </li></ul><ul><li>Surgical excision (hydrocelectomy).. </li></ul><ul><li>Needle aspiration . </li></ul><ul><li>Postoperative care : </li></ul><ul><li>incisions, dressings </li></ul><ul><li>Bladder irrigation </li></ul><ul><li>Pain management </li></ul><ul><li>Nutritional & fluid intake </li></ul><ul><li>Activity & Rest </li></ul><ul><li>Psychological support </li></ul><ul><li>Nursing Interventions : </li></ul><ul><li>Monitor – </li></ul><ul><li>Vital signs </li></ul><ul><li>Fluid balance </li></ul><ul><li>Elimination </li></ul><ul><li>Laboratory results </li></ul><ul><li>Emotional status </li></ul>
  39. 39. VARICOCELE <ul><li>is an abnormal enlargement of the veins in the scrotum draining the testicles . </li></ul>
  40. 40. VARICOCELE <ul><li>Symptom: </li></ul><ul><li>Dragging-like or aching pain within scrotum . </li></ul><ul><li>Feeling of heaviness in the testicle(s) </li></ul><ul><li>Infertility </li></ul><ul><li>Atrophy (shrinking) of the testicle(s) </li></ul><ul><li>Visible or palpable (able to be felt) enlarged vein </li></ul><ul><li>Causes: </li></ul><ul><li>A varicocele develops when the valve that regulates bloodflow from the vein into the main circulatory system becomes damaged or defective. Inefficient blood flow causes enlargement (dilation) of the vein. </li></ul>
  41. 41. VARICOCELE <ul><li>Pathophysiology: </li></ul><ul><li>The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis . Up-ward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the veins near the testis, leading to the formation of a varicocele. </li></ul>
  42. 42. VARICOCELE <ul><li>Assessment: </li></ul><ul><li>age-appropriate development of male secondary sex characteristics, gynecomastia, or hirsutism </li></ul><ul><li>evaluated for lesions or scarring to the abdomen or groin </li></ul><ul><li>discoloration to the scrotum, </li></ul><ul><li>asymmetry of the testicles </li></ul><ul><li>location and size of the opening of the penile meatus </li></ul><ul><li>Masses may arise from the surface of the testicle, adjacent to or separate from the testes. </li></ul><ul><li>epididymal induration </li></ul><ul><li>scrotal swelling </li></ul><ul><li>bluish discoloration beneath the scrotal skin </li></ul><ul><li>visible during inspection (&quot;bag of worms&quot;). </li></ul>
  43. 43. VARICOCELE <ul><li>Diagnostic test: </li></ul><ul><li>scrotal ultrasound </li></ul><ul><li>hormonal studies, of serum FSH, LH, and testosterone, may be performed to assess testicular function </li></ul><ul><li>venography </li></ul><ul><li>Complication: </li></ul><ul><li>shrinkage of the affected testicle (atrophy).. </li></ul><ul><li>Infertility.). </li></ul><ul><li>Nursing diagnosis: </li></ul><ul><li>Discomfort/Pain </li></ul><ul><li>Alternation in self esteem </li></ul><ul><li>Knowledge deficit r/t self care, fertility, infertility </li></ul><ul><li>High risk for transmission or infection r/t STD </li></ul>
  44. 44. VARICOCELE <ul><li>Intervention: </li></ul><ul><li>Medical Treatment : </li></ul><ul><li>Medications – </li></ul><ul><li>Hormone therapy </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Diet/Fluids </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Surgical Intervention – </li></ul><ul><li>A sub-inguinal, microsurgical varicocelectomy </li></ul><ul><li>Nursing Interventions : </li></ul><ul><li>Monitor – </li></ul><ul><li>Vital signs </li></ul><ul><li>Fluid balance </li></ul><ul><li>Elimination </li></ul><ul><li>Laboratory results </li></ul><ul><li>Emotional status </li></ul>
  45. 45. VARICOCELE <ul><li>Postoperative care: </li></ul><ul><li>incisions, dressings </li></ul><ul><li>Bladder irrigation </li></ul><ul><li>Pain management </li></ul><ul><li>Nutritional & fluid intake </li></ul><ul><li>Activity & Rest </li></ul><ul><li>Psychological support </li></ul><ul><li>Self-monitoring of status: </li></ul><ul><li>Medications </li></ul><ul><li>Incision/Skin care </li></ul><ul><li>Activity </li></ul><ul><li>Medical follow-up </li></ul>
  46. 46. PROSTATE CANCER <ul><li>one of the most common cancers in American men.  There are no warning signs of symptoms of early prostate cancer.  Once a malignant tumor causes the prostate gland to swell significantly, or once cancer spreads beyond the prostate, </li></ul>
  47. 47. PROSTATE CANCER <ul><li>SYMPTOMS: </li></ul><ul><li>A frequent need to urinate, especially at night </li></ul><ul><li>Difficulty starting or stopping the urinary stream </li></ul><ul><li>A weak or interrupted urinary stream </li></ul><ul><li>A painful or burning sensation during urination or ejaculation </li></ul><ul><li>Blood in urine or semen </li></ul><ul><li>Loss of weight and appetite </li></ul><ul><li>Fatigue </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Dull, incessant deep pain or stiffness in the pelvis, lower back, ribs or upper thighs; arthritic pain in the bones of those areas </li></ul>
  48. 48. PROSTATE CANCER <ul><li>4 stages of Prostate Cancer: </li></ul><ul><li>T1 - Tumor is microscopic and confined to prostate but is undetectable by a digital rectal exam (DRE) or by ultrasound.  Usually discovered by PSA tests or biopsies. </li></ul><ul><li>T2 - Tumor is confined to prostate and can be detected by DRE or ultrasound. </li></ul><ul><li>T3 / T4 - In stage T3, the cancer has spread to tissue adjacent to the prostate or to the seminal vesicles.  In stage T4, tumors have spread to organs near the prostate, such as the bladder. </li></ul><ul><li>N+ / M+ - Cancer has spread to pelvic lymph nodes (N+) or to lymph nodes, organs, or bones distant from the prostate (M+). </li></ul>
  49. 49. PROSTATE CANCER <ul><li>Causes: </li></ul><ul><ul><li>age , </li></ul></ul><ul><ul><li>genetics , </li></ul></ul><ul><ul><li>race , </li></ul></ul><ul><ul><li>diet , </li></ul></ul><ul><ul><li>lifestyle , </li></ul></ul><ul><ul><li>medications </li></ul></ul><ul><li>Diagnostic tools: </li></ul><ul><li>PCA3 </li></ul><ul><li>Prostate mapping </li></ul><ul><li>MRI </li></ul><ul><li>X ray </li></ul><ul><li>CT scan </li></ul>
  50. 50. PROSTATE CANCER <ul><li>Pathophysiology: </li></ul><ul><li>Prostate cancer is classified as an adenocarcinoma , or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma ) forming a tumor . Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum , or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system . Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called metastasis . Prostate cancer most commonly metastasizes to the bones , lymph nodes , rectum, and bladder. </li></ul>
  51. 51. PROSTATE CANCER <ul><li>Assessment: </li></ul><ul><li>Hisitancy </li></ul><ul><li>Hematuria </li></ul><ul><li>Urinary retention </li></ul><ul><li>Stool changes </li></ul><ul><li>Pain radiating down hips and legs </li></ul><ul><li>Cystitis </li></ul><ul><li>Dribbling </li></ul><ul><li>Nocturia </li></ul><ul><li>hard enlarge prostate </li></ul><ul><li>Complication: </li></ul><ul><li>Spread of cancer. </li></ul><ul><li>Pain. </li></ul><ul><li>Difficulty urinating (urinary incontinence). </li></ul><ul><li>Erectile dysfunction (ED) or impotence. </li></ul><ul><li>Depression. </li></ul>
  52. 52. PROSTATE CANCER <ul><li>Nursing Diagnosis: </li></ul><ul><li>Discomfort/Pain </li></ul><ul><li>Alternation in self esteem </li></ul><ul><li>Knowledge deficit r/t self care, fertility, infertility </li></ul><ul><li>High risk for transmission or infection r/t STD </li></ul>
  53. 53. PROSTATE CANCER <ul><li>Intervention: </li></ul><ul><li>Early detection of tumor </li></ul><ul><li>Ultrasound </li></ul><ul><li>Radiation therapy </li></ul><ul><li>Surgery: Prostatectomy </li></ul><ul><li>Nursing Interventions : </li></ul><ul><li>Monitor – </li></ul><ul><li>Vital signs </li></ul><ul><li>Fluid balance </li></ul><ul><li>Elimination </li></ul><ul><li>Laboratory results </li></ul><ul><li>Emotional status </li></ul><ul><li>Postoperative care: </li></ul><ul><li>incisions, dressings </li></ul><ul><li>Bladder irrigation </li></ul><ul><li>Pain management </li></ul><ul><li>Nutritional & fluid intake </li></ul><ul><li>Activity & Rest </li></ul><ul><li>Psychological support </li></ul>
  54. 54. Female Reproductive System
  55. 55. Anatomy and physiology <ul><li>Fallopian tube- pair of tubes that carry the eggs form the ovary to the uterus </li></ul><ul><li>Ovary- organs that produce eggs and female sex hormones </li></ul><ul><li>Uterus- womb </li></ul><ul><li>Cervix- narrow inferior portion of the uterus that opens into the vagina. </li></ul><ul><li>Vagina- the opening into the female reproductive system that leads to the uterus. </li></ul><ul><li>Endometrium-innermost layer of the uterine wall . </li></ul>
  56. 56. OVARIAN CANCER <ul><li>Ovarian cancer is a cancerous growth arising from an ovary. </li></ul><ul><li>Ovarian cancer most commonly forms in the lining of the ovary or in the egg cells (resulting in a germ cell tumor). </li></ul>
  57. 57. OVARIAN CANCER <ul><li>Symptoms: </li></ul><ul><li>Bloating </li></ul><ul><li>Pelvic or abdominal pain </li></ul><ul><li>Difficulty eating or feeling full quickly </li></ul><ul><li>Urinary symptoms (urgency or frequency) </li></ul><ul><li>Pain during sex </li></ul><ul><li>back pain </li></ul><ul><li>urinary urgency </li></ul><ul><li>constipation </li></ul><ul><li>tiredness </li></ul><ul><li>abnormal vaginal bleeding </li></ul><ul><li>involuntary weight loss </li></ul>
  58. 58. OVARIAN CANCER <ul><li>Causes: </li></ul><ul><li>Lynch II syndrome </li></ul><ul><li>Hereditary breast-ovarian cancer syndrome </li></ul><ul><li>Hereditary ovarian cancer syndrome </li></ul><ul><li>Complication: </li></ul><ul><li>Ovarian cysts </li></ul><ul><li>Stomach cancer </li></ul><ul><li>Diagnostic test: </li></ul><ul><li>Physical exam </li></ul><ul><li>Pelvic exam </li></ul><ul><li>Ultrasound </li></ul><ul><li>Lower GI series </li></ul><ul><li>CT scan </li></ul><ul><li>CA-125 assay blood test - a tumor marker </li></ul><ul><li>Transvaginal ultrasound - a test under research. </li></ul><ul><li>Biopsy </li></ul><ul><li>Laparotomy </li></ul>
  60. 60. OVARIAN CANCER <ul><li>Nursing diagnosis: </li></ul><ul><li>Anxiety </li></ul><ul><li>Ineffective coping </li></ul><ul><li>Imbalance nutrition: less than body requirements </li></ul><ul><li>Acute pain </li></ul><ul><li>Surgical Intervention: </li></ul><ul><li>Total Hysterectomy and Bilateral Salpingo-Oophorectomy </li></ul><ul><li>Debulking </li></ul><ul><li>Intervention: </li></ul><ul><li>Early detection of tumor </li></ul><ul><li>Ultrasound </li></ul><ul><li>Radiation therapy </li></ul>
  61. 61. UTERINE MYOMA <ul><li>A benign growth of smooth muscle in the wall of the uterus. </li></ul><ul><li>solid tumor made of fibrous tissue </li></ul><ul><li>may grow as a single nodule or in clusters and may range in size from 1 mm to more than 20 cm in diameter. </li></ul>
  62. 62. UTERINE MYOMA <ul><li>Symptoms with fibroids: </li></ul><ul><ul><li>Menorrhagia </li></ul></ul><ul><ul><li>Pelvic pressure or Pain Sensation Pelvic discomfort </li></ul></ul><ul><ul><ul><li>Urine symptoms </li></ul></ul></ul><ul><ul><ul><li>Constipation </li></ul></ul></ul><ul><ul><li>Infertility </li></ul></ul><ul><ul><li>Pregnancy complications </li></ul></ul><ul><ul><ul><li>Recurrent Miscarriage </li></ul></ul></ul><ul><ul><ul><li>Premature labor </li></ul></ul></ul><ul><ul><ul><li>Fetal Malpresentation </li></ul></ul></ul><ul><ul><ul><li>Labor complications </li></ul></ul></ul><ul><ul><ul><li>Placental Abruption </li></ul></ul></ul>
  63. 63. UTERINE MYOMA <ul><li>Causes: </li></ul><ul><li>develop in women during their reproductive years. </li></ul><ul><li>estrogen dominance. </li></ul><ul><li>Synthetic chemicals </li></ul><ul><li>Risk factors: Positive (increased risk of fibroids) </li></ul><ul><li>Overweight women </li></ul><ul><li>Advancing age </li></ul><ul><ul><li>Age 20-30 years: 4% fibroid Incidence </li></ul></ul><ul><ul><li>Age 30-40 years: Up to 18% fibroid Incidence </li></ul></ul><ul><ul><li>Age 40-60 years: 33% fibroid Incidence </li></ul></ul><ul><li>Hyperestrogenic states or Estrogen agonist use </li></ul><ul><ul><li>Enlarge in pregnancy (and regress after Menopause) </li></ul></ul><ul><li>Black women with higher Incidence </li></ul><ul><ul><li>Larger fibroids </li></ul></ul><ul><ul><li>More symptomatic fibroids </li></ul></ul><ul><li>Comorbid Hypertension </li></ul><ul><li>Family Historyof uterine fibroids </li></ul><ul><li>Nulliparity </li></ul>
  64. 64. UTERINE MYOMA <ul><li>Pathophysiology : </li></ul><ul><li>Benign tumors arising from myometrial smooth muscle </li></ul><ul><ul><li>Malignant leiomyosarcoma is uncommon (0.23%) </li></ul></ul><ul><li>Hormonally mediated </li></ul><ul><ul><li>Enlarge with Estrogen and Growth Hormone </li></ul></ul><ul><ul><li>Regress with Progesterone </li></ul></ul>
  65. 65. UTERINE MYOMA <ul><li>Diagnostics: </li></ul><ul><li>Transvaginal Ultrasound </li></ul><ul><ul><li>Best initial test due to cost efficacy </li></ul></ul><ul><ul><li>Least Test Sensitivity and Specificity </li></ul></ul><ul><li>Pelvic MRI </li></ul><ul><ul><li>Best for fibroid mapping preoperatively </li></ul></ul><ul><ul><li>Expensive </li></ul></ul><ul><li>Sonohysterography or hysteroscopy </li></ul><ul><ul><li>Good Test Sensitivity and Specificity, but invasive </li></ul></ul><ul><li>Complications: </li></ul><ul><li>Infertility </li></ul><ul><li>premature delivery </li></ul><ul><li>Severe pain or excessively heavy bleeding </li></ul><ul><li>Nursing diagnosis: </li></ul><ul><li>Fear </li></ul><ul><li>Risk for injury </li></ul><ul><li>Acute pain </li></ul>
  66. 66. UTERINE MYOMA <ul><li>Management: Surgery </li></ul><ul><li>Hysterectomy </li></ul><ul><ul><li>Fibroids account for 30% of hysterectomies </li></ul></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><ul><li>Postmenopausal women with enlarging fibroids </li></ul></ul></ul><ul><ul><ul><li>Peristent Abnormal Uterine Bleeding </li></ul></ul></ul><ul><ul><ul><li>Symptomatic fibroids refractory to other measures </li></ul></ul></ul><ul><li>Myomectomy </li></ul><ul><ul><li>Excision of fibroids with preservation of uterus </li></ul></ul><ul><ul><li>High risk of recurrence (15-30% in 5 years) </li></ul></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><ul><li>Fibroids in women who want to preserve fertility </li></ul></ul></ul><ul><li>Uterine Fibroid Embolization </li></ul><ul><ul><li>Recurrence rate not yet established </li></ul></ul><ul><ul><li>McLucas (2001) J Am Coll Surg 192:100 </li></ul></ul><ul><li>Myolysis </li></ul><ul><li>Fibroid destruction by Nd-YAG laser or bipolar needle </li></ul><ul><ul><li>Often combined with endometrial ablation </li></ul></ul><ul><ul><li>Uterine arteries occluded with polyvinyl Alcohol foam </li></ul></ul><ul><ul><ul><li>Incomplete embolization used now to reduce pain </li></ul></ul></ul><ul><ul><ul><li>Intervention radiology procedure under IV Sedation </li></ul></ul></ul><ul><ul><ul><li>Well tolerated </li></ul></ul></ul><ul><ul><li>Recurrence rate not yet established </li></ul></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><ul><li>Fibroids in women who want to preserve fertility </li></ul></ul></ul>
  67. 67. UTERINE MYOMA <ul><li>Management: Medical </li></ul><ul><li>Observation (preferred for asymptomatic cases) </li></ul><ul><li>GnRH agonists (induce hypoestrogenism) </li></ul><ul><ul><li>Results in Amenorrhea and fibroid mass reduction </li></ul></ul><ul><ul><li>Fibroids recur when medication stopped </li></ul></ul><ul><ul><li>Hypoestrogenic side effects (Hot Flushes, BMD risk) </li></ul></ul><ul><ul><li>Used in combination with Progesterone </li></ul></ul><ul><ul><ul><li>Reduces Hot Flushes (vasomotor symptoms) </li></ul></ul></ul><ul><li>Progesteronereceptor-binder (Mifepristone) </li></ul><ul><ul><li>Mifepristone 5 mg daily </li></ul></ul><ul><ul><ul><li>Eisinger (2003) Obstet Gynecol 101:243 </li></ul></ul></ul><ul><ul><ul><li>Fiscella (2006) Obstet Gynecol 108:1381 </li></ul></ul></ul><ul><li>Other investigational measures </li></ul><ul><ul><li>ExAblate 2000 </li></ul></ul><ul><ul><ul><li>Uses combination of ultrasound and MRI </li></ul></ul></ul><ul><ul><ul><li>Focused coagulation necrosis of fibroids </li></ul></ul></ul><ul><ul><li>Raloxifene (Evista) </li></ul></ul><ul><li>Unproven or ineffective therapies </li></ul><ul><ul><li>Androgenic agents (e.g. Danazol) </li></ul></ul><ul><ul><li>Progestins (e.g. Depo Provera) </li></ul></ul><ul><ul><li>Oral Contraceptive cycling (not effective) </li></ul></ul>
  68. 68. -THE END- <ul><li>THANK YOU FOR LISTENING & FOR YOUR COOPERATION </li></ul><ul><li>PREPARED BY: </li></ul><ul><li>ABALAJON, VINCENT </li></ul><ul><li>BERGANTINOS, KARLA KAYE </li></ul><ul><li>DELFIN, SANALE JEAN </li></ul><ul><li>LOZADA, CHERRY ROSE </li></ul><ul><li>MAGDALUYO, RICHELLE </li></ul><ul><li>ROBLES, APRIL DANILYN </li></ul>
  69. 69. <ul><li>References: </li></ul><ul><li> /wiki/ Phimosis </li></ul><ul><li>www. /library/treatment/ phimosis </li></ul><ul><li> /wiki/ Hypospadia s </li></ul><ul><li>www. /sr_ hypospadia .html </li></ul><ul><li> </li></ul><ul><li>www. /c/ cryptorchidism </li></ul><ul><li>www. /health/undescended-testicle/DS00845 </li></ul><ul><li> /surgery/ Hydrocele -repair-series.htm </li></ul><ul><li>www. /nonsurgical_ varicocele .pdf </li></ul><ul><li> /wiki/ Prostate _ cancer </li></ul><ul><li>www. / ovarian - cancer /default.htm </li></ul><ul><li>www. / myoma .html - </li></ul>
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