This chapter focuses on the complications associated with definitive treatment of prostate cancer with surgery or radiation therapy (RT). Prostate cancer treatment can have significant effects on urinary continence and erectile function. Urinary incontinence can be seen after both prostatectomy and RT. Both surgery and RT can alter detrusor muscle function and lead to or unmask irritative voiding symptoms, such as urinary urgency and frequency. The irritative symptoms can often be managed with dietary and lifestyle modifications, followed by medical therapy such as anticholinergic agents. Stress incontinence can be mitigated with Kegel exercises and pelvic floor therapy. In the case of posttherapy urethral stricture disease that affects a patient’s emptying, surgical options include urethral dilation, endoscopic visual urethrotomy, or urethroplasty reconstructive surgery. Management of erectile dysfunction proceeds stepwise from oral medication (PDE-5 inhibitors), to intra-urethral medication and intra-cavernosal injections, and finally to penile prosthesis placement.
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Urinary tract issues are common in the hospitalized patient-common, but they should not become a normal event for the patient. Focused nursing assessments and interventions can assist the patient in preventing infection. Health care-associated urinary tract infections (UTIs) can be deadly to the hospitalized patient, so every effort must be taken to prevent this complication. The chapter lists the symptoms of a UTI, and describes how to prevent a catheter-associated UTI (CAUTI). It also explores risk factors for a urinary tract disorder and factors to prevent transient incontinence in the hospitalized patient. Prior medical conditions can place a patient at risk of developing renal and urologic disorders. Some of the most common genitourinary issues that develop on a medical-surgical unit include: UTI, CAUTI, and urinary incontinence. In the elderly, symptoms of a UTI may include altered mentation, lethargy, new-onset incontinence, or lowgrade fever without any signs of UTI.
Women may seek care for a range of common gynecologic concerns, including menstrual disorders, sexually transmitted infections, vaginosis and vaginitis, sexual dysfunction, contraception, preconception, perimenopause and menopause, and breast or cervical abnormalities. This chapter discusses pelvic floor dysfunction. Pelvic floor dysfunction is common among women, affecting approximately 25% of all women. Pelvic floor dysfunction disorders include urinary incontinence (
UI), overactive bladder, pelvic organ prolapse, anal incontinence, and chronic pelvic pain. A careful history, physical exam, and laboratory testing are crucial for diagnosis and treatment. Although not life-threatening, pelvic floor dysfunction can impair the physical, psychological, and quality of life of the affected woman. This chapter discusses etiology, history, physical examination, differential diagnosis, laboratory testing, treatment and intervention, complications, consultation/referral, and follow-up for pelvic floor dysfunction.