Male Reproductive Changes.pdf

Male Reproductive Changes  Testicular Torsion  Testicular Cancer  Prostatitis  Benign Prostatic Hyperplasia  Prostate Cancer Conditions Testicular Torsion -An emergency condition due its tendency to interrupt blood supply to the testis  Anomalous development of the tunica vaginalis a...

Male Reproductive Changes  Testicular Torsion  Testicular Cancer  Prostatitis  Benign Prostatic Hyperplasia  Prostate Cancer Conditions Testicular Torsion -An emergency condition due its tendency to interrupt blood supply to the testis  Anomalous development of the tunica vaginalis and spermatic cord  Found in 12 % of males  Testis is not well attached to the scrotum  Predisposes the testicle to twisting on its cord spontaneously or following trauma  Usually occurs between the ages of 12 -18 Testicular Torsion  Acute scrotal pain  Nausea/vomiting  Scrotal oedema and induration  Testis is tender to palpate  Testis is elevated and often lying horizontally  Cremasteric reflex is absent on the involved side  Urinary frequency  Fever Signs & Symptoms  Diagnosis is based on clinical/physical examination findings  Confirmed by a Doppler ultrasound Imaging Modality  Immediate manual detorsion  More than 1 rotation may be needed  Procedure is guided by pain levels  Immediate surgery if detorsion fails  80 -100% of testicular function can be saved if the condition is fixed within 6 -8 hours!  After 12 hours there is no hope of saving the testis  Bilateral testicular fixation is done electively after manual detorsion Medical Treatment  Recognise the need for emergency medical referral  Check and adjust to patient tolerance when back under your care  Post -operative consideration Chiropractic Management Testicular Cancer -Begins as a scrotal mass that may or may not be painful  The most common solid cancer in males aged 15 -35  Cryptorchidism increases the risk 2.5 -20 x  Cause is unknown  ~150 men are diagnosed and 7 -10 men die each year Testicular Cancer  Scrotal mass that is painless OR has a dull aching pain  Haemorrhage into the tumour may cause acute local pain Signs & Symptoms  Ultrasound will confirm the mass is testicular in origin as opposed to scrotal  Blood tests for alpha -fetoprotein and beta -human chorionic gonadotropin ( hCG )  Histopathologic examination  Abdominal, pelvic and chest CT for staging Diagnosis  Depends on histology and extent of the tumour  Good overall  5 year survival rate for a tumour that is localised to the testis is over 95%  5 year survival rate for a tumour with extensive retroperitoneal metastasis varies from 48 – 80% Prognosis  Radical inguinal orchiectomy  Cosmetic testicular prosthesis  Lymph node dissection  Radiation therapy  Chemotherapy  Sperm banking Medical Treatment  Check and adjust to patient tolerance  Post -operative precautions  Patient awareness & education  Monthly self -examination should be encouraged among young men Chiropractic Management Prostatitis -A group of disorders that cause irritative or obstructive urinary symptoms and perineal pain  Urinary irritation or obstruction  Increased frequency  Increased urgency  Sensation of incomplete emptying  Nocturia  Pain on urination  Painful ejaculation  Fever, chills, malaise and myalgia if bacterial  Painful perineum to palpation Signs & Symptoms  Signs of generalized sepsis:  Tachycardia  Tachypnea  Hypotension  2 urine samples are collected  One mid -stream collection  Patient then undergoes digital prostate massage then voids immediately  The first 10 ml of urine is the second sample  Diagnosis then depends on infection and inflammation markers Diagnosis  Antibiotics  Bed rest  Hydration  Pain management  Stool softeners Medical Treatment Benign Prostatic Hyperplasia  Non -malignant adenomatous overgrowth  Incidence increases with age  Histologic evidence of BPH in 50% at age 60 and 90% at age 80  Unknown etiology  Probably due to hormonal changes associated with aging Benign Prostatic Hyperplasia (BPH)  Older male  Bladder outlet obstruction:  Weak/decreased force of urine stream  Urinary frequency & urgency  Nocturia  Hesitancy  Dribbling/overflow  Sense of incomplete bladder emptying  Complete urinary retention History  Due to progressive obstruction of urine outflow  Bladder diverticula  Urine stasis  Calculus formation  Infection  Hydronephrosis & compromised renal function  Straining to void  Venous rupture – haematuria  Inguinal hernia  Haemorrhoids Complications  Abdominal discomfort  Bladder distention  Palpable or percussible bladder  Infection or hydronephrosis – Murphy’s punch Abdominal Exam  Cystoscopy  Trans -rectal ultrasonography  Urodynamics/uroflowmetry  Severe or prolonged obstructive symptoms  Ultrasound  Intravenous pyelogram (IVP)  CT Imaging Modalities  To rule out other causes of symptoms  Urinalysis & culture  UTI: haematuria  Serum creatinine: involvement of upper urinary tract  Prostate -specific antigen (PSA)  Unspecific  High PSA value or abnormal DRE will lead to a trans -rectal biopsy Laboratory Tests  Digital prostate examination for BPH:  Enlarged  Non -tender  Rubbery consistency  Infection (tender to palpate)  BPH and prostate cancer may co -exist  Digital rectal exam findings for BPH & cancer often overlap Referral  5 -alpha -reductase inhibitors – Finasteride (Proscar)  Block hormonal influence on prostate growth  Alpha -adrenergic blockers – Terazosin (Hytrin), Doxazosin (Cardura)  Reduce smooth muscle tone  Antibiotics if infection is present  Catheterisation (for urinary retention) Medical Treatment  Surgical options are reserved for those unresponsive to conservative treatment or with serious complications  Trans -urethral resection of the prostate  Open prostatectomy  Intra -urethral stent  Microwave therapy Medical Treatment  Check and adjust to patient tolerance  Active Surveillance – lab tests  Decreasing sympathetic stimulation  Stress  Caffeine  Reduce smoking  Physically active males have a lower frequency of symptoms Chiropractic Management Prostate Cancer  Prostate cancer is the most common cancer in men in NZ  ~3100 men per year  Incidence increases with age  75% of males over the age of 65 have some prostate cancer  Most prostate cancers do not progress to metastasis and death Prostate Cancer  Risk factors: African American and family history of prostate cancer  Older males  Asymptomatic during early stages as symptoms don’t appear until advanced stage  Local growth causes urethral obstruction:  Decreased force of urine stream  Hesitancy  Dribbling  Sense of incomplete bladder emptying  Haematuria History  Blastic Metastasis:  Bone pain  Pathologic fractures  Spinal cord compression  Cachexia  Common areas – pelvis, ribs and vertebral bodies  High risk individuals  Annual DRE & PSA screen from age 40  Men not at high risk  Annual DRE & PSA screen from age 50 Screening  Digital rectal exam  Stony  Hard  Nodular  Irregular enlargement  Or more often normal Referral  Elevated PSA and abnormal DRE  Trans -rectal ultrasound -guided prostate biopsy  Gleason system  Grading system based on microscopic appearance  Predicts prognosis  Helps guide therapy  Higher score = more aggressive & poorer prognosis Confirmation  Screening by digital rectal exam and/or PSA  Assessment of abnormalities by biopsy  Grading by histology  Staging by CT & bone scanning Flow of Diagnosis  Acid phosphatase – disruption of the capsule  Alkaline phosphatase – blastic metastasis Other Labs  Depends on tumour’s grade and stage  Prognosis is very good for most cases, especially when it is localised or regional  Long -term local control or cure is possible  High -grade, poorly differentiated cancer have a poor prognosis  Poor response to conventional therapies for cell types other than adenocarcinoma  Blastic metastasis - median life expectancy is 1 -3 years Prognosis  For patients with low -risk cancer, over 70 year of age or have less than 10 years’ life expectancy  Active surveillance  Localised cancer within the prostate  Prostatectomy  Radiation therapy  Brachytherapy  Cryotherapy Medical Treatment  Cancers outside of the prostate:  Palliative  Hormonal therapy  Radiation therapy  Chemotherapy  Check and adjust to patient tolerance  Palliative care  Metastasis  Risk of fatal prostate cancer increases with:  Smoking  High calcium intake  Lack of physical activity  Taller height  Higher BMI  Support groups & counselling Chiropractic Management  Complications from conventional treatment:  Osteoporosis  Immunocompromised  Anaemia  Erectile dysfunction  Incontinence