2. MENOPAUSE:
Menopause is the permanent physiologic cessation of menses associated with
declining ovarian function; during this time, reproductive function diminishes
and ends.
Postmenopause is the period beginning from about 1 year after menses cease.
Menopause is associated with some atrophy of breast tissue and genital
organs, loss in bone density, and vascular changes.
Menopause starts gradually and is usually signaled by changes in
menstruation. The monthly flow may increase, decrease, become irregular,
and finally cease. Often, the interval between periods is longer
Changes signaling menopause begin to occur as early as the late 30s, when
ovulation occurs less frequently, estrogen levels fluctuate, and FSH levels rise
in an attempt to stimulate estrogen production.
3. Clinical Manifestations:
Because of these hormonal changes, some women notice irregular menses, breast
tenderness, and mood changes long before menopause occurs. The hot or warm
flashes and night sweats reported by some women profuse sweating, causing
discomfort, sleep disturbances and subsequent fatigue, and embarrassment
Other physical changes may include atrophic changes and osteoporosis (decreased
bone density), resulting in decreased stature and bone fractures.
Vaginal secretions decrease, and the woman may report dyspareunia (discomfort
during intercourse). The vaginal pH rises during menopause, predisposing the
woman to bacterial infections (atrophic vaginitis). Discharge, itching, and vulvar
burning may result.
Some women report fatigue, dizziness, forgetfulness, weight gain, irritability,
trouble sleeping, feeling “blue,” and feelings of panic. Menopausal complaints need
to be evaluated carefully as they may indicate other disorders
5. Nursing Management:
Measures should be taken to promote general health. The nurse can
explain to the patient that cessation of menses is a physiologic function
that is rarely accompanied by nervous symptoms or illness.
The individual woman’s evaluation of herself and her worth, now and in
the future, is likely to affect her emotional reaction to menopause.
Patient teaching and counseling regarding healthy lifestyles, health
promotion, and health screening are of paramount importance.
6. PREMENSTRUAL SYNDROME:
Premenstrual syndrome (PMS) is a combination of symptoms that
occur before the menses and subside with the onset of menstrual flow
(Chart 46-10). The cause is unknown, but serotonin regulation is
currently the most plausible theory. Other hormones may also be
involved. Dietary factors may play a role because carbohydrates may
affect serotonin. Severe symptoms have been labeled as premenstrual
dysphoric disorder (DiCarlo, Palomba, Tommaselli et al., 2001; Morse,
1999). This severe form of PMS, which interferes with the woman’s
schoolwork, job, or social or family life, is uncommon.
7. Clinical Manifestations:
Major symptoms of PMS include headache, fatigue, low back pain,
painful breasts, and a feeling of abdominal fullness.
General irritability, mood swings, fear of losing control, binge eating,
and crying spells may also occur.
Symptoms vary widely from one woman to another and from one cycle
to the next in the same person. Great variability is found in the degree of
symptoms.
Many women are affected to some degree, but few are severely affected.
Many women are not bothered at all, whereas some experience severe
and disabling symptoms
8. Medical Management:
Because there is no single treatment or known cure for PMS, the woman
should chart her symptoms so she can possibly anticipate and therefore
cope with them.
Exercise is encouraged for all patients as no controlled studies have
shown a benefit. Many practitioners advise women to avoid caffeine,
high-fat foods, and refined sugars, but there is little research to
demonstrate the efficacy of dietary changes.
Alternative therapies that women have used include vitamins B and E,
magnesium, and oil of evening primrose capsules. No studies have
evaluated the effectiveness of these therapies.
9. Nursing Management:
The nurse should establish rapport with the patient and obtain a health
history, noting the time when symptoms began and their nature and
intensity. The nurse then determines whether the onset of symptoms
occurs before or shortly after the menstrual flow begins. Additionally,
the nurse can show the patient how to develop a chart to record the
timing and intensity of symptoms. A nutritional history is also elicited to
determine if the diet is high in salt, caffeine, or alcohol or low in
essential nutrients The patient’s goals may include reduction of anxiety
(mood swings, crying, binge eating, fear of losing control), ability to
cope with day-to-day stressors and relationships with family and
coworkers, and increased knowledge about PMS with improved use of
control measures.
10. DYSMENORRHEA /AMENORRHEA
Primary dysmenorrhea is painful menstruation, with no identifiable pelvic
pathology. It occurs at the time of menarche or shortly thereafter. It is
characterized by crampy pain that begins before or shortly after the onset of
menstrual flow and continues for 48 to 72 hours. Pelvic examination findings
are normal. Dysmenorrhea is thought to result from excessive production of
prostaglandins, which causes painful contraction of the uterus and arteriolar
vasospasm.
Amenorrhea (absence of menstrual flow) is a symptom of a variety of
disorders and dysfunctions. Primary amenorrhea (delayed menarche) refers to
the situation in which a young woman older than 16 has not begun to
menstruate but otherwise shows evidence of sexual maturation, or when a
young woman has not begun to menstruate and has not begun to show
development of secondary sex characteristics by 14 years of age.
11. Menorrhagia / Metrorrhagia:
Menorrhagia is defined as prolonged or excessive bleeding at the time of the
regular menstrual flow. In early life the cause is usually related to endocrine
disturbance, whereas in later life it usually results from inflammatory
disturbances, tumors of the uterus, or hormonal imbalance. Emotional
disturbances may also affect bleeding.
Metrorrhagia (vaginal bleeding between regular menstrual periods) is
probably the most significant form of menstrual dysfunction because it may
signal cancer, benign tumors of the uterus, or other gynecologic problems.
This condition warrants early diagnosis and treatment. Although bleeding
between menstrual periods by a woman taking oral contraceptives is usually
not serious, irregular bleeding by a woman taking HRT should be evaluated.
Menometrorrhagia is heavy vaginal bleeding between and during periods and
requires evaluation.
12. ABORTION:
Interruption of pregnancy or expulsion of the product of conception
before the fetus is viable is called abortion. The fetus is generally
considered to be viable any time after the fifth to sixth month of
gestation. The term “premature labor” is used when a woman
experiences labor after this point in the pregnancy.
13. Spontaneous Abortion:
It is estimated that 1 of every 5 to 10 conceptions results in spontaneous
abortion. Most of these occur because an abnormality in the fetus makes
survival impossible. Other causes may include systemic diseases,
hormonal imbalance, or anatomic abnormalities. If a pregnant woman
experiences bleeding and cramping, a threatened abortion is diagnosed
because an actual abortion is usually imminent. Spontaneous abortion
occurs most commonly in the second or third month of gestation
14. Cont….
There are various kinds of spontaneous abortion, depending on the
nature of the process (threatened, inevitable, incomplete, or complete).
In a threatened abortion, the cervix does not dilate. With bed rest and
conservative treatment, the abortion may be prevented. If it cannot, an
abortion is imminent.
If only some of the tissue is passed, the abortion is referred to as
incomplete.
If the fetus and all related tissue are spontaneously evacuated, the
abortion is complete.
15. HABITUAL ABORTION:
Habitual or recurrent abortion is defined as successive, repeated,
spontaneous abortions of unknown cause. As many as 60% of abortions
may result from chromosomal anomalies. After two consecutive
abortions, patients are referred for genetic counseling and testing, and
other possible causes are explored. If bleeding occurs in these patients,
conservative measures, such as bed rest and administering progesterone
to support the endometrium, are tried in an attempt to save the
pregnancy. Supportive counseling is crucial in this stressful condition.
Bed rest, sexual abstinence, a light diet, and no straining on defecation
are recommended in an effort to prevent spontaneous abortion. If
infection is suspected, antibiotics may be prescribed.
16. MEDICAL MANAGEMENT:
After a spontaneous abortion, all tissue passed vaginally is saved for
examination. The patient and all personnel caring for her are alerted to
save any discharged material. In the rare case of heavy bleeding, the
patient may require blood component transfusions and fluid
replacement. An estimate of the bleeding volume can be determined by
recording the number of perineal pads and the degree of saturation over
24 hours. When an incomplete abortion occurs, oxytocin may be
prescribed to cause uterine contractions before dilation and evacuation
(D & E) or uterine suctioning.
17. NURSING MANAGEMENT:
Because patients experience loss and anxiety, emotional support and
understanding are important aspects of nursing care. The response of the
woman who desperately wants a baby is very different from that of the
woman who does not want to be pregnant but may be frightened by the
possible consequences of an abortion
Providing opportunities for the patient to talk and express her emotions helps
and also provides clues for the nurse in planning more specific care. Those
closest to the woman are encouraged to give emotional support and to allow
her to talk and freely express her grief. Unresolved grief may manifest itself
in persistent vivid memories of the events surrounding the loss, persistent
sadness or anger, and episodes of overwhelming emotion when recalling the
loss. Dysfunctional grief may require the assistance of a skilled therapist.
18. Elective Abortion:
A voluntary induced termination of pregnancy is called an elective
abortion and is usually performed by skilled health care providers.
19. Infertility:
Infertility is defined as a couple’s inability to achieve pregnancy after 1
year of unprotected intercourse. Primary infertility refers to a couple
who has never had a child. Secondary infertility means that at least one
conception has occurred, but currently the couple cannot achieve a
pregnancy. In the United States, infertility is a major medical and social
problem, affecting 10% to 15% of the reproductive-age population. In
20%, the infertility is unexplained.
20. Factors considered basic to infertility:
Five factors are considered basic to infertility: ovarian, tubal, cervical,
uterine, and semen conditions.
OVARIAN FACTORS
Studies performed to determine if there is regular ovulation and if
progestational endometrium is adequate for implantation may include a
basal body temperature chart for at least four cycles, an endometrial
biopsy, serum progesterone level, and ovulation index. The ovulation
index involves a urine-stick test that determines if the surge in LH that
precedes follicular rupture has occurred.
21. TUBAL FACTORS:
Hysterosalpingography is used to rule out uterine or tubal abnormalities.
Laparoscopy permits direct visualization of the tubes and other pelvic structures and
can assist in identifying conditions that may interfere with fertility (eg,
endometriosis).
CERVICAL FACTORS:
The cervical mucus can be examined at ovulation and after intercourse to determine
whether proper changes occur that promote sperm penetration and survival. A
postcoital cervical mucus test (Sims-Huhner test) is performed 2 to 8 hours after
intercourse. Cervical mucus is aspirated with a medicine dropper–like instrument.
Aspirated material is placed on a slide and examined under the microscope for the
presence and viability of sperm cells. The woman is instructed not to bathe or
douche between coitus and the examination
22. UTERINE FACTORS:
Fibroids, polyps, and congenital malformations are possible conditions
in this category. Their presence may be determined by pelvic
examination, hysteroscopy, saline sonogram (a variation of a sonogram),
and hysterosalpingography.
SEMEN FACTORS:
After 2 to 3 days of sexual abstinence, a specimen of ejaculate is
collected in a clean container, kept warm, and examined within 1 hour
for the number of sperm (density), percentage of moving forms, quality
of forward movement (forward progression), and morphology (shape
and form)
23. • Volume: more than 1 mL
• Concentration: more than 20 million/mL
• Motility: more than 50% of the forms should be moving
• Morphology: more than 60% of sperm should have normal forms
• No sperm clumping, significant red or white blood cells, or thickening of
seminal fluid (hyperviscosity)
MISCELLANEOUS FACTORS:
Men may also be affected by varicoceles, varicose veins around the testicle,
which decrease semen quality by increasing testicular temperature.
Retrograde ejaculation or ejaculation into the bladder is assessed by urinalysis
after ejaculation.
24. Medical Management:
Infertility is often difficult to treat because it frequently results from a
combination of factors. Couples undergoing an infertility evaluation
may conceive without the cause of infertility ever identified. Likewise,
although some couples undergo all tests, the cause of the problem may
remain undiscovered and infertility persists. Between these extremes,
many problems, both simple and complex, can be discovered and
corrected. Patients may need assisted reproductive technology to
conceive; the methods are described below. Therapy may require
surgery to correct a malfunction or anomaly, hormonal supplements,
attention to proper timing, and recognition and correction of
psychological or emotional factors.
25. Nursing Management:
Nursing interventions appropriate when working with couples during infertility
evaluations include the following: assist in reducing stress in the relationship,
encourage cooperation, protect privacy, foster understanding, and refer the couple to
appropriate resources when necessary. Because infertility workups are expensive,
time-consuming, invasive, stressful, and not always successful, couples need
support in working together to deal with this endeavor.
Resolve, Inc., a nonprofit self-help group that provides information and support for
infertile patients, was founded by a nurse who experienced difficulty conceiving.
The literature on infertility that is produced by this group is an important resource
for patients and professionals. Most areas across the country have local support
groups
Smoking is strongly discouraged because it has an adverse effect on the success of
assisted reproduction. Diet, exercise, stress reduction techniques, health
maintenance, and disease prevention are being emphasized in many infertility
programs.
26. PELVIC ORGAN PROLAPSE: CYSTOCELE,
RECTOCELE, ENTEROCELE
Cystocele is a downward displacement of the bladder toward the vaginal
orifice resulting from damage to the anterior vaginal support structures. It
usually results from injury and strain during childbirth.
Rectocele and perineal lacerations may affect the muscles and tissues of the
pelvic floor and may occur during childbirth. Because of muscle tears below
the vagina, the rectum may pouch upward, thereby pushing the posterior wall
of the vagina forward. This structural abnormality is called a rectocele.
An enterocele is a protrusion of the intestinal wall into the vagina. Prolapse
(if complete prolapse occurs, it may also be referred to as procidentia) results
from a weakening of the support structures of the uterus itself; the cervix
drops and may protrude from the vagina
27. Clinical Manifestations:
Because a cystocele causes the anterior vaginal wall to bulge downward,
the patient may report a sense of pelvic pressure, fatigue, and urinary
problems such as incontinence, frequency, and urgency. Back pain
and pelvic pain may occur as well. The symptoms of rectocele resemble
those of cystocele, with one exception: instead of urinary symptoms,
the patient may experience rectal pressure. Constipation,
uncontrollable gas, and fecal incontinence may occur in patients with
complete tears. Prolapse can result in feelings of pressure and
ulcerations and bleeding.
Dyspareunia may occur with these disorders.
28. Medical/ Surgical Management:
Kegel exercises are easy to do and are recommended for all women,
including those with strong pelvic floor muscles.
Pessaries can be used to avoid surgery. This device is inserted into the
vagina and positioned to keep an organ, such as the bladder, uterus, or
intestine, properly aligned when a cystocele, rectocele, or prolapse has
occurred.
The procedure to repair the anterior vaginal wall is called anterior
colporrhaphy, repair of a rectocele is called a posterior colporrhaphy,
and repair of perineal lacerations is called a perineorrhaph
29. UTERINE PROLAPSE:
If the structures that support the uterus weaken (typically from
childbirth), the uterus may work its way down the vaginal canal
(prolapse) and even appear outside the vaginal orifice. As the uterus
descends, it may pull the vaginal walls and even the bladder and rectum
with it.
Symptoms include pressure and urinary problems (incontinence or
retention) from displacement of the bladder. The problems are
aggravated when the woman coughs, lifts a heavy object, or stands for a
long time. Normal activities, even walking up stairs, may aggravate the
problem.
30. Medical Management:
Pessaries and surgery are two options for treatment. If surgery is the
method of treatment used, the uterus is sutured back into place and
repaired to strengthen and tighten the muscle bands. In postmenopausal
women, the uterus may be removed (hysterectomy).
32. Breast Cancer:
There is no single, specific cause of breast cancer; rather, a combination
of hormonal, genetic, and possibly environmental events may contribute
to its development.
Etiology:
Hormones produced by the ovaries have an important role in breast
cancer. Two key ovarian hormones, estradiol and progesterone, are
altered in the cellular environment by a variety of factors, and these may
affect growth factors for breast cancer.
33. Risk Factors:
BRCA-1 or BRCA-2 genetic mutation
Increasing age
Personal or family history of breast cancer
Early menarche
Late menopause
History of benign proliferative breast disease
Obesity
Hormone replacement therapy
Alcohol intake
34. Clinical Manifestations:
Breast cancers occur anywhere in the breast, but most are found in the upper
outer quadrant, where most breast tissue is located. Generally, the lesions are
non-tender rather than painful, fixed rather than mobile, and hard with
irregular borders rather than encapsulated and smooth.
Complaints of diffuse breast pain and tenderness with menstruation are
usually associated with benign breast disease. Marked pain at presentation,
however, may be associated with breast cancer in the later stages
Nipple retraction and lesions fixed to the chest wall may also be evident.
Involvement of the skin is manifested by ulcerating and fungating lesions.
These classic signs and symptoms characterize breast cancer in the late
stages. A high index of suspicion should be maintained with any breast
abnormality, and abnormalities should be promptly evaluated.
35. Assessment and Diagnostic Findings:
Techniques to determine the histology and tissue diagnosis of breast cancer
include FNA, excisional (or open) biopsy, incisional biopsy, needle
localization, core biopsy, and stereotactic biopsy
Breast Cancer Staging:
Several diagnostic tests and procedures are performed in the staging of the
disease. These may include chest x-rays, bone scans, and liver function tests.
Clinical staging involves the physician’s estimate of the size of the breast
tumor and the extent of axillary node involvement by physical examination
(palpable nodes may indicate progression of the disease) and mammography.
After the diagnostic workup and the definitive surgical treatment, the breast
cancer is staged according to the TNM system which evaluates the size of the
tumor, number of nodes involved, and evidence of distant metastasis.
38. Nursing management:
Nausea and vomiting: Administer antiemetic's as prescribed; monitor fluid intake and
output
Anorexia: Assist patient and family to identify appetizing foods; provide frequent small
meals if better tolerated than three regular meals; refer to dietitian for assistance in planning
palatable, nutritious meals
Stomatitis: Avoid commercial mouth washes; use baking soda, salt and water rinses, or oral
anesthetic agents Hair loss: Avoid brushing, blow drying, frequent shampooing; encourage
use of turbans and scarves; encourage patient to obtain wig before hair loss occurs
CNS changes: Monitor for weakness, malaise, fatigue, seizures, change in cognitive status;
assist with activities of daily living if fatigue and malaise occur Neurotoxicity:
Monitor deep tendon reflexes, assess gait and muscle strength, monitor for changes in
sensory function Fluid retention:
Monitor weight, fluid intake and output, skin turgor Cardiac changes: Monitor ECG, cardiac
rate and rhythm; notify physician of dysrhythmias
39. Cont….
Hypercalcemia: Monitor serum calcium levels, monitor cardiac rate and
rhythm
Constipation: Monitor bowel function; consider that constipation may be
indicative of neurotoxicity; administer stool softeners, laxatives as prescribed;
encourage adequate intake of fluids and fiber
Anxiety: Administer tranquilizers as prescribed; encourage use of strategies to
minimize anxiety (imagery, relaxation)
Hormonal instability: Observe for changes (hot flashes, vaginal bleeding,
flare); facial hirsutism, deepening of voice; fluid retention, Cushing’s
syndrome (fullness of face, lower extremity edema, weight gain); increased
blood pressure; assess for thrombophlebitis; monitor serum calcium levels;
educate patient on symptom management of hot flashes and assure patient
that most changes are temporary.
40. PELVIC INFECTION (PELVIC
INFLAMMATORY DISEASE):
Pelvic inflammatory disease (PID) is an inflammatory condition of the
pelvic cavity that may begin with cervicitis and may involve the uterus
(endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic
peritoneum, or pelvic vascular system.
Infection, which may be acute, subacute, recurrent, or chronic and
localized or widespread, is usually caused by bacteria but may be
attributed to a virus, fungus, or parasite.
41. Clinical Manifestations:
Symptoms of pelvic infection usually begin with vaginal discharge,
dyspareunia, lower abdominal pelvic pain, and tenderness that occurs
after menses.
Pain may increase while voiding or with defecation. Other symptoms
include fever, general malaise, anorexia, nausea, headache, and possibly
vomiting.
On pelvic examination, intense tenderness may be noted on palpation of
the uterus or movement of the cervix (cervical motion tenderness).
Symptoms may be acute and severe or low-grade and subtle
42. Complications:
Pelvic or generalized peritonitis, abscesses, strictures, and fallopian tube
obstruction may develop.
Obstruction may cause an ectopic pregnancy in the future if a fertilized
egg cannot pass a tubal stricture, or scar tissue may occlude the tubes,
resulting in sterility.
Adhesions are common and often result in chronic pelvic pain; they
eventually may require removal of the uterus, fallopian tubes, and
ovaries. Other complications include bacteremia with septic shock and
thrombophlebitis with possible embolization.
43. Medical Management:
Broad-spectrum antibiotic therapy is prescribed. Women with mild
infections may be treated as outpatients but hospitalization may be
necessary.
Intensive therapy includes bed rest, intravenous fluids, and intravenous
antibiotic therapy. If the patient has abdominal distention or ileus,
nasogastric intubation and suction are initiated.
Carefully monitoring vital signs and symptoms assists in evaluating the
status of the infection. Treating sexual partners is necessary to prevent
reinfection.
44. Nursing Management:
Infection takes a toll, both physically and emotionally. The patient may feel
well one day and experience vague symptoms and discomfort the next. She
may also suffer from constipation and menstrual difficulties.
The hospitalized patient is maintained on bed rest and is usually placed in the
semi-Fowler’s position to facilitate dependent drainage. Accurate recording of
vital signs and the characteristics and amount of vaginal discharge is
necessary as a guide to therapy.
The nurse administers analgesic agents as prescribed for pain relief. Heat
applied safely to the abdomen may also provide some pain relief and comfort.
The nurse minimizes the transmission of infection to others by carefully
handling perineal pads with gloves, discarding the soiled pad according to
hospital guidelines for disposal of biohazardous material, and performing
meticulous hand hygiene
45. ERECTILE DYSFUNCTION:
Erectile dysfunction, also called impotence, is the inability to achieve or
maintain an erection sufficient to accomplish intercourse. The man may
report decreased frequency of erections, inability to achieve a firm
erection, or rapid detumescence (subsiding of erection). Incidence
ranges from 25% to 50% in men older than 65 years of age.
The physiology of erection and ejaculation is complex and involves
sympathetic and parasympathetic components. At the time of erection,
pelvic nerves carry parasympathetic impulses that dilate the smaller
blood vessels of the region and increase blood flow to the penis,
expanding the corpora cavernosa.
46. Causes:
Erectile dysfunction has both psychogenic and organic causes.
Psychogenic causes include anxiety, fatigue, depression, and pressure
to perform sexually. Organic impotence, however, may account for
more impotence than previously realized.
Organic causes include occlusive vascular disease, endocrine disease
(diabetes, pituitary tumors, hypogonadism with testosterone deficiency,
hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure,
genitourinary conditions (radical pelvic surgery), hematologic
conditions (Hodgkin’s disease, leukemia), neurologic disorders
(neuropathies, parkinsonism, spinal cord injury, multiple sclerosis),
trauma to the pelvic or genital area, alcohol, medications and drug
abuse.
47. Assessment and Diagnostic Findings:
The diagnosis of erectile dysfunction requires a sexual and medical
history; an analysis of presenting symptoms; a physical examination,
including a neurologic examination; a detailed assessment of all
medications, alcohol, and drugs used; and various laboratory studies.
48. Medical Management:
Treatment, which depends on the cause, can be medical, surgical, or
both. Nonsurgical therapy includes treating associated conditions, such
as alcoholism, and readjusting hypertensive agents or other medications.
Endocrine therapy may be instituted for erectile dysfunction secondary
to hypothalamic pituitary-gonadal dysfunction and may reverse the
condition. Insufficient penile blood flow may be treated with vascular
surgery. Patients with erectile dysfunction from psychogenic causes are
referred to a health care provider or therapist specializing in sexual
dysfunction. Patients with erectile dysfunction secondary to organic
causes may be candidates for penile implants.
49. Nursing Management:
Personal satisfaction and the ability to sexually satisfy a partner are
common concerns of patients.
Men with illnesses and disabilities may need the assistance of a sex
therapist to find, implement, and integrate their sexual beliefs and
behaviors into a healthy and satisfying lifestyle.
50. BENIGN PROSTATIC HYPERPLASIA
(ENLARGED PROSTATE):
In many patients older than 50 years, the prostate gland enlarges,
extending upward into the bladder and obstructing the outflow of urine
by encroaching on the vesical orifice. This condition is known as benign
prostatic hyperplasia (BPH), the enlargement, or hypertrophy, of the
prostate. BPH is one of the most common pathologic conditions in older
men.
51. Clinical Manifestations:
Examination reveals a prostate gland that is large, rubbery, and non-
tender. The cause is uncertain, but evidence suggests that hormones
initiate hyperplasia of the supporting stromal tissue and the glandular
elements in the prostate.
The hypertrophied lobes may obstruct the vesical neck or prostatic
urethra, causing incomplete emptying of the bladder and urinary
retention. As a result, a gradual dilation of the ureters (hydroureter) and
kidneys (hydronephrosis) can occur. Urinary tract infections may result
from urinary stasis, because some urine remains in the urinary tract and
serves as a medium for infective organisms.
52. Assessment and Diagnostic Findings:
The obstructive and irritative symptom complex (referred to as prostatism)
includes increased frequency of urination, nocturia, urgency, hesitancy in
starting urination, abdominal straining with urination, a decrease in the
volume and force of the urinary stream, interruption of the urinary stream,
dribbling (urine dribbles out after urination), a sensation that the bladder has
not been completely emptied, acute urinary retention (when more than 60 mL
of urine remains in the bladder after urination), and recurrent urinary tract
infections.
Ultimately, azotemia (accumulation of nitrogenous waste products) and renal
failure can occur with chronic urinary retention and large residual volumes.
Generalized symptoms may also be noted, including fatigue, anorexia,
nausea, vomiting, and epigastric discomfort.
53. Medical Management:
The treatment plan depends on the cause of BPH, the severity of the
obstruction, and the patient’s condition. If the patient is admitted on an
emergency basis because he cannot void, he is immediately catheterized.
The ordinary catheter may be too soft and pliable to advance through
the urethra into the bladder.
In such cases, a thin wire called a stylet is introduced (by a urologist)
into the catheter to prevent the catheter from collapsing when it
encounters resistance. In severe cases, metal catheters with a
pronounced prostatic curve may be used. Sometimes an incision is made
into the bladder (a suprapubic cystostomy) to provide drainage.
54. HYDROCELE VARICOCELE
VASECTOMY:
A hydrocele is a collection of fluid, generally in the tunica vaginalis of
the testis, although it may also collect within the spermatic cord.
A varicocele is an abnormal dilation of the veins of the pampiniform
venous plexus in the scrotum (the network of veins from the testis and
the epididymis that constitute part of the spermatic cord).
Vasectomy, or male sterilization, is the ligation and transection of part
of the vas deferens, with or without removal of a segment of the vas
deferens.
