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Chapter 18

Urology and male reproductive procedures and exams

QuestionAnswer
anuria No urine is being formed by the kidneys
Benign prostatic hypertrophy means a benign (noncancerous)
hypertrophy: increase in organ size from an increase in the size of the cells
Nocturia The need to urinate frequently at the time of sleep The need to urinate frequently at the time of sleep
Oliguria Scanty urination
Incontinence An inability to retain urine
extracorporeal shock wave lithotripsy (ESWL): shock waves that break kidney stones down into small particles so that they can pass through the urinary tract with more ease
catheterization . This process involves the insertion of a sterile tube directly into the bladder through the urethra using a strict sterile technique.
Foley catheters have a balloon that inflates to keep the catheter in place in the bladder for an extended period of time. These catheters are also used short-term for patients during and following surgery
digital rectal exam (DRE) procedure in which the provider inserts his or her gloved finger into the patient’s rectum to check the size of the prostate
urology requires an understanding of the structure, physiology, and diseases of the urinary system and the male reproductive system
The male reproductive system is responsible for spermatogenesis (production of sperm) and producing male hormones in the body.
The testes are responsible for the production of the male gamete, spermatozoa, and the production of testosterone
Each testis contains twisted convoluted tubules referred to as the seminiferous tubules in which the sperm is made
These tubules will eventually unite to form the epididymis, which connects the testes to the vas deferens. The sperm continues to develop and is stored here until needed
Testosterone is a natural steroid in the body and is found in males and in lesser amounts in females
Testosterone is responsible for the secondary sex characteristics such as the development of a deeper voice, muscle mass, facial hair, and the development of male genitalia during puberty. Testosterone also increases sex drive in both males and females.
The scrotum is one of two external structures of the male reproductive system. . This is the external sac that encases each testis
The vas deferens is a continuation of the epididymis. Each duct runs up through the inguinal canal and down and around the side of the urinary bladder. Eventually the vas deferens joins the ejaculatory duct and descends through the prostate gland where it joins the urethra.
seminal vesicles are two tiny glands located behind the prostate These glands add a large volume of liquid to the ejaculate, which aids in nourishing the sperm.
The prostate gland is around the size of a walnut and located in front of the rectum between the bladder and the penis
The prostate contracts during ejaculation releasing a fluid, , which also helps to nourish the sperm and aids in the expulsion of semen outside the body.
The urethra is the structure that carries the sperm and seminal fluid to the to the urethral meatus during ejaculation. Also transports urine
The two Cowper’s glands are located on each side of the urethra below the prostate glands These glands secrete a fluid upon sexual arousal, which aids in lubrication during sexual intercourse and in making the semen less acidic.
The penis is the second external structure of the male reproductive system
Upon sexual stimulation, the brain sends chemical messages to the penile vessels, causing them to relax. This allows blood to flow freely into the penis where it gets trapped. The high pressure in chambers of the penis causes it to expand, resulting in an erection
The skin around the tip of the penis is called the prepuce can be removed through circumcision.
Pyelonephritis is an infection of the renal pelvis and kidney
Cystitis is an infection in the bladder
Urethritis is an infection in the urethra
Prostatitis is an infection in the prostate
If chronic UTIs occur, a prophylactic (preventive) antibiotic may be ordered by the provider to reduce the risk of infection.
Erectile dysfunction (ED), also called impotence , is defined as the inability to keep an erection long enough to complete intercourse
Renal calculi are small, hard deposits that form inside the kidney pelvis The stones are made of mineral and acid salts, but most commonly are composed of calcium. The size of the calculi range from tiny to a stag-horn (a calculi that fills the kidney pelvis).
When the stone starts to pass down the ureter , there may be a sudden, severe pain that radiates into the abdomen, flank, or groin. This pain is often intermittent and recurs with the natural peristalsis or gentle contractions of the ureter.
ED Sexual arousal in the male is a very complex process that involves the brain, emotions, and hormones as well as nerves and blood vessels. ED can develop if there are any problems in any of these areas. Typically, the cause of ED is physical, such as heart disease, hypertension, diabetes, obesity, or low testosterone. Some prescription medications, alcoholism, depression, injuries, or surgeries affecting the pelvic area or spinal cord can also contribute to ED symptoms.
Tests for ED include blood tests, urine tests, ultrasound, overnight erection test, and a psychological exam.
Medications for ED include sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra/Staxyn).
Although rare, testicular cancer can occur at any age, even in infants. . Early detection of testicular cancer involves knowing the signs of cancer and understanding the methods for performing testicular self-examination (TSE).
testicular self-examination (TSE) procedure in which the patient examines his testicles monthly for any changes such as lumps or enlargement
Prostate cancer is a malignancy of the prostate gland and is common in males over the age of 65.
The five-year survival rate is 98.9%, with a lifetime risk of developing prostate cancer at 14%. . Prostate cancer is slow-growing and highly curable when detected early. Current recommendations discourage routine screening for prostate cancer.
Certain risk factors for the development of prostate cancer are unknown but it appears that advancing age, family history, race (African-Americans are more prone to prostate cancer than Caucasians), and a high-fat diet are associated with the development of prostate cancer.
cancer of the prostate does not usually cause symptoms in the early stages, the first sign the patient may notice is problems with urination . Other symptoms may include difficulty starting the urine stream; weaker than normal stream; not being able to urinate at all; frequency; retention; nocturia; dysuria; hematuria; pain deep in the lower back, abdomen, hips, or pelvis.
the provider will order a blood test to measure prostate-specific antigen (PSA), . , which usually increases in patients with this type of cancer. However, the only definitive diagnosis of prostate cancer is made through a biopsy.
factors that decrease the risk of prostate cancer including drinking six or more cups of coffee daily, avoiding tobacco, avoiding obesity and diabetes, regular exercise, and nonsteroidal anti-inflammatory drug (NSAID) and aspirin use
risks that increase prostate cancer, zinc, folic acid, selenium, vitamin E, dairy sources of vitamin D, and calcium ,. Prostatitis, agent orange, insecticides, bisphenol A (BPA), UV light exposure, and radiation exposure also increase the rate of prostate cancer.
Treatments of prostate cancer involves surgery and/or radiation to remove or destroy the cancer, which unfortunately can leave the patient impotent.
tray setup for a DRE includes 4 × 4s, water-soluble lubricant, and possible occult blood test supplies under special conditions. During this part of the exam, the provider will insert a gloved finger into the rectum and feel the prostrate for enlargement, lumps, or any other abnormalities. Patients may be especially anxious regarding this part of the exa
Two common types of catheters are used to perform catheterizations straight catheters and Foley catheters Straight catheters are used for obtaining a single specimen and then discarded.
Foley catheters have a balloon that inflates to keep the catheter in place in the bladder for an extended period of time. These catheters are also used short-term for patients during and following surgery.
URS Ureterorenoscopy
GN Glomerulonephritis
When giving a patient information about a cystoscopy, first ask the following Are there any allergies, including those to anesthetic agents? (Local, spinal, or general anesthesia may be used.) Are there any bleeding problems or are any anticoagulant medications being taken?
An intravenous pyelogram (IVP) is an X-ray examination of kidney, ureters, and bladder urethra by injecting a contrast dye
Transrectal ultrasound (TRUS) uses reflected sound waves to produce pictures of internal body parts
During TRUS, an ultrasound probe is inserted into the rectum to produce images to examine the prostrate in men suspected to have BPH (enlargement of the prostate)
TRUS guides the location of the needle for the biopsy. Other indications for ordering a TRUS Estimate prostate size Evaluate lumps that are detected with a physical exam Evaluate the vas deferens Evaluate the seminal vesicles Evaluate the ejaculatory duct
Over 50% of testicular cancers occurs in males between the ages of 20 and 34
Testicular Cancer. Symptoms may include any of the following: : hard lumps or nodules in the testicle region, scrotal swelling or pain or enlarged breasts caused by hormonal activity from the tumor.
reasons for ordering an IVP include blood (An intravenous pyeogram) to determine the location of a kidney stone, or to evaluate an injury to the urinary tract. The patient must be NPO 8–12 hours prior to the procedure. Before the procedure ask if there are any allergies to iodine or seafood.
Other indications for ordering a TRUS are to: Estimate prostate size Evaluate lumps that are detected with a physical exam Evaluate the vas deferens Evaluate the seminal vesicles Evaluate the ejaculatory duct
Vasectomy is a surgical procedure in which the vas deferens is cut, clamped, or sealed to prevent the sperm from entering the ejaculate and should be considered to be a permanent form of birth control.
transurethral resection of the prostate (TURP) is a procedure performed on males who have BHP . In this procedure, the surgeon cuts away overgrown tissue of the prostate to facilitate urination
Created by: Tbella