Nontreponemal or regain tests, such as the

SYPHILIS o
Venereal Disreagin Research Laboratory
(VDRL) or the Rapid Plasma Regain Circle
Test (RPR-CT)
• Acute and chronic infectious disease caused by the ▪ Generally used for screening and
spirochete Treponema pallidum diagnosis
• Acquired through sexual contact or may be ▪ After adequate therapy, the test
congenital in origin result is expected to decrease
• Stages of Syphilis quantitively until it is read as
o These stages reflect the time from infection negative, usually about 2 years
and the clinical manifestations observed in after therapy is completed
that period and are the basis for treatment o Treponemal tests, such as Fluorescent
conditions Treponemal Antibody Absorption (FTA-
o Primary syphilis ABS) test and the microhemagglutination
▪ Occurs 2 to 3 weeks after initial test for Treponema pallidum (MHA-TP)
inoculation with the organism ▪ Used to verify that the screening
▪ Painless lesions at the site of test did not represent a false-
infection, called “chancres” positive result
• Usually resolve ▪ Positive results usually are positive
spontaneously within 3 to for life and therefore are not
12 weeks, with or without appropriate to determine
treatment therapeutic effectiveness
o Secondary syphilis
▪ Occurs by hematogenous spread Medical Management
leading to generalized infection
▪ The rash of secondary syphilis • Treatment of all stages of syphilis is administration
occurs from 1 week to 6 months of antibiotic medication
after the chancre • Penicillin G benzathine is the medication of choice
▪ Transmission can occur through for early syphilis or early latent syphilis of less than 1
contact with these lesions year’s duration
▪ Generalized signs of infection may o Given by intramuscular injection at a single
include lymphadenopathy, arthritis, session
meningitis, hair loss, fever, o Usually monitored for 30 minutes after the
malaise, and weight loss injection to observed for a possible allergic
▪ After the secondary stage, there is a reaction
period of latency • Pt with late latent or latent syphilis of unknown
• When the person who is duration should receive three injections at 1-week
infected has no signs or intervals
symptoms of syphilis. • Pts who are allergic to penicillin are usually treated
Latency can be interrupted with doxycycline
by a recurrence of
secondary syphilis Nursing Management
symptoms
o Tertiary syphilis • In any health care facility, a mechanism must be in
▪ Final stage in the natural history of place to ensure that all Pts who are diagnosed are
the disease reported to the state of local public health department
▪ Estimated that between 20% to to ensure community follow-p
40% of those infected do not • The public health department is responsible for
exhibit signs and symptoms of this identification of sexual contacts, contact information,
final stage and contact screening
▪ May present as a slowly • Lesions of primary and secondary syphilis may be
progressive inflammatory disease highly infective, gloves are worn when direct contact
with the potential to affect multiple with lesions is likely, and hand hygiene is performed
organs after gloves are removed
▪ Most common manifestations at • Isolation in a private room is not required
this level are aortitis and
neurosyphilis, as evidenced by
dementia, psychosis, paresis,
stroke, or meningitis

Assessment and Diagnostic Findings

• Because it shares symptoms with many diseases,

clinical history and laboratory evaluation are
important
• Conclusive diagnosis can be made by direct
identification of the spirochete obtained from the
chancre lesions of primary syphilis
• Serologic tests used in the diagnosis of secondary and
tertiary syphilis require clinical correlation in
interpretation
 •
CHLAMYDIA Specimens for culture must be delivered to the
laboratory immediately after they are obtained

TRACHOMATIS & o Because N. gonorrhoeae organisms are

susceptible to environmental changes
•
NEISSERIA Because as many as 70% of chlamydial infections are
asymptomatic
GONORRHOEAE o CDC recommends Chlamydia testing for all
women who are pregnant
o Annual testing is also recommended for
women younger than 25 years who are
• Most commonly reported infectious diseases in the sexually active, and for women over 25
United States years who have a new sexual partner or
• Coinfection with C. trachomatis often occurs in Pts multiple partners
infected with N. gonorrhoeae
• The greatest risk of N. trachomatis infection occurs Medical Management
in young women between 15 and 24 years of age
• Because Pts are often coinfected with both gonorrhea
Clinical Manifestations and chlamydia, dual therapy is recommended, even if
only gonorrhea have been laboratory proven
• Both C. trachomatis and N. gonorrhoeae do not • The CDC updates STI therapy recommendations
cause symptoms in women regularly because of growing challenges with
o When symptoms are present, mucopurulent bacterial antibiotic resistance patterns and drug
cervicitis with exudates in the endocervical shortages
canal is the most frequent findings • Although the number of resistance strains of
o Can also present with symptoms of UTI or gonorrhea has increased, that is not the reason for the
vaginitis used of combination antibiotic therapy
• Although men are more likely than women to have o Such therapy is prescribed in order to treat
symptoms when infected, infection with N. both gonorrhea and chlamydia, because
gonorrhoeae or C. trachomatis can be asymptomatic many Pts with gonorrhea have a coexisting
o When symptoms are present, they may chlamydial infection
include burning during urination and penile • Pts with uncomplicated gonorrhea who are treated
discharge with CDC-recommended therapy do not routinely
o Pts with N. gonorrhoeae infection may also need to return for a proof-of-cure visit
report painful, swollen testicles o If the Pt reports a new episode of symptoms
or tests are positive for gonorrhea again, the
Complications most likely explanation is reinfection rather
than treatment failure
• In women • Serological testing for syphilis and HIV should be
o Pelvic inflammatory disease (PID), ectopic offered to Pts with gonorrhea or chlamydia, because
pregnancy, endometritis, and infertility are any STI increases the risk of other STIs
possible complications of either N.
gonorrhoeae or C. trachomatis infection Nursing Management
• In men
o Epididymitis, a painful disease that may • Gonorrhea and chlamydia are reported
lead to infertility, may result from infection communicable diseases
with either bacterium • In any health care facility, a mechanism should be in
• In both men and women place to ensure that all Pts who are diagnosed are
o Arthritis or bloodstream infection may be reported to the local public health department to
caused by N. gonorrhoeae ensure follow-up of the Pt
o The public health department also is
Assessment and Diagnostic Findings responsible for interviewing the Pt to
identify sexual contacts so that contact
• Pt is assessed for fever, discharge (urethral, vaginal, notification and screening can be initiated
or rectal, and signs of arthritis • The target group for preventive Pt education about
• Diagnostic methods used in N. gonorrhoeae infection gonorrhea and chlamydia is the adolescent and young
include adult population
o Gram stain (appropriate only for male • Along with reinforcing the importance of abstinent,
urethral samples) when appropriate, education should address
▪ Gram stain and the direct postponing the age of initial sexual exposure, limiting
fluorescent antibody test can be the number of sexual partners, and using condoms for
used in chlamydia barrier protection
o Culture • Young women and those who are pregnant should
o Nucleic acid amplification tests (NAATs) also be instructed about the importance of routine
▪ Also available for C. trachomatis screening for chlamydia
• In female Pt
o Samples are obtained from the endocervix,
anal canal, and pharynx
• In male Pt
o Specimens are obtained from the urethra,
anal canal, and pharynx
 Nursing Management
CHLAMYDIA AND
•
GONORRHEA All women who are sexually active may be at risk for
chlamydia, gonorrhea, and other STIs, including HIV
• Nurses can assist Pts in assessing their own risk
• Recognition of risk is a first step before changes in
• Most common causes of endocervicitis, although behavior occur
Mycoplasma may also be involved • Pts should be discouraged from assuming that a
• Chlamydia causes about 2.86 million infections every partner is “safe” without open, honest discussion
year in the United States; it is most commonly found • Nonjudgmental attitudes, educational counseling, and
in young people who are sexually active with more role-playing may be helpful
than one partner and is transmitted through sexual • Counsel Pts about safer sex practices
contact • Pts should be advised to refer partners for evaluation
o Untreated chlamydia infections can spread and treatment
to the fallopian tubes and uterus leading to • All women aged 25 and younger who are sexually
serious complications including PID, and active should be screened annually
increased risk of ectopic pregnancy, and • Those older than 25 years should be screened if risk
infertility factors are present
o Chlamydial infections of the cervix often
• Repeat testing should occur 3 months after treatment
produce no symptoms, but cervical
discharge, dyspareunia, dysuria, and
bleeding may occur
o Other complications include conjunctivitis
and perihepatitis
• Gonorrhea is the second most commonly reported
STI, with over a million new infections each year
o The inflamed cervix that results from
infection may leave a woman more
vulnerable to HIV transmission from an
infected partner
o Often asymptomatic and a major cause of
PID, tubal infertility, ectopic pregnancy, and
chronic pelvic pain
o Diagnosis can be confirmed by urine culture
or other methods such as using a swab to
obtain a simple of cervical or penile
discharge from the Pt’s partner

Medical Management

• The CDC recommends treating chlamydia with

doxycycline for 1 week or with a single dose of
azithromycin
• Antimicrobial resistance to fluoroquinolones in the
treatment of gonorrhea has left cephalosporins as the
remaining recommended treatment
• Dual therapy with azithromycin and ceftriaxone
given simultaneously on the same day is the
recommended first-line treatment for gonorrhea
infection
• Partners must also be treated
• Women who are pregnant are cautioned not to take
tetracycline because of potential adverse effects on
the fetus
o In these cases, erythromycin bay be
prescribed
• Results are not usually good if treatment begins early
o Possible complications from delayed or no
treatment are tubal disease, ectopic
pregnancy, PID, and infertility
• Cultures for chlamydia and other STIs should be
obtained from all Pts who have been sexually
assaulted when they first seek medical attention; Pts
are treated prophylactically
o Cultures should then be repeated in 2 weeks
• Annual screening for chlamydia is recommended for
all young women who are sexually active and older
women with new sex partners or multiple partners
 •
CANDIDIASIS If a woman is uncertain about the cause of her
symptoms or if relief has not been obtained after
using these creams, she should be instructed to seek
health care promptly
• Vulvovaginal candidiasis is a fungal or yeast • Yeast infections can become recurrent or complicated
infection caused by strains of Candida o Women with recurrent infections benefit
• Second most common type of vaginal infection from a comprehensive gynecologic
• An estimated of 75% of women will experience at assessment
lease one yeast infection, and 40% to 45% will • Women may have more than four infections in a year
experience two or more in their lifetime and severe symptoms due to preexisting conditions
• Candida albicans accounts for approximately 90% of such as diabetes and immunosuppression
the cases, but other strains, such as Candida • Cell-mediated immunity may be a factor
glabrata, may also be implicated
• Many women with a healthy vaginal ecosystem
harbor Candida but are asymptomatic
• Certain conditions favor the change from an
asymptomatic state to colonization with symptoms
o For example, the sued of antibiotic agents
decreases bacteria, thereby altering the
natural protective organisms usually present
in the vagina
• Although infections can occur at any time, they occur
more commonly in pregnancy or with a systemic
condition such as diabetes of human immune
deficiency virus (HIV) virus infection, or when Pts
are taking medications such as corticosteroids or oral
contraceptive agents)

Clinical Manifestations

• Vaginal discharge that causes pruritus (itching) and

subsequent irritation
o Discharge may be watery or thick but
usually has a white, cottage cheese-like
appearance
• Symptoms usually more severe just before
menstruation and may be less responsive to treatment
during pregnancy
• Diagnosis is made by microscopic identification of
spores and hyphae (long, branching filamentous
structures) on a glass slide prepared from a discharge
specimen mixed with potassium hydroxide
• With candidiasis, the pH of the discharge is 4 to 5
• Manifestations may be uncomplicated, occurring
sporadically in women who are healthy, or recurrent
and complicated in women who have diabetes,
pregnant, have a compromised immune system, or
have obesity

Medical Management

• The goal of management is to eliminate symptoms

• Treatment includes antifungal agents such as
miconazole, nystatin, clotrimazole, and terconazole
cream
o These agents are inserted into the vagina
with an applicator at bedtime
o There are 1-, 3-, and 7-night treatment
courses available
• Oral medication (fluconazole) is also available in a
one-pill dose
o Relief should be noted within 3 days
• Some vaginal creams are available without a
prescription
o However, Pts are cautioned to use these
creams only if they are certain that they
have a yeast of monilial infection
• Pts often use these remedies for problems other than
yeast infection
 •
TRICHOMONIASIS This condition can be complicated by infection from
phylogenic bacteria, resulting in atrophic vaginitis
• Leukorrhea (vaginal discharge) may cause itching
and burning
• Trichomonas vaginalis is a flagellated protozoan that • Management is similar to bacterial vaginosis
causes a common STI often called trich • Estrogenic hormones, either taken orally or inserted
• May be transmitted by an asymptomatic carrier who into the vagina in a cream form, can also be effective
harbors the organism in the urogenital tract in restoring the epithelium
• It may increase the risk of contracting HIV from an • Desquamative inflammatory vaginitis is an
infected partner and may play a role in development uncommon but severe purulent form of vaginal
of cervical neoplasia, postoperative infections, infection that occurs mostly in Caucasian women
adverse pregnancy outcomes, pelvic inflammatory who are perimenopausal
disease (PID), and infertility • It results in vaginal inflammation, burning, discharge,
and dyspareunia (pain while penile-vaginal
Clinical Manifestations intercourse)
• Topically anti-inflammatory and antibiotic treatment
• Vaginal discharge that is thin (sometimes frothy), is usually effective
yellow to yellow-green, malodorous, and very
irritating
• An accompanying vulvitis may result, with
vulvovaginal burning and itching
• Diagnosis is made most often by microscopic
detection of the motile causative organisms or less
frequently by culture
• Inspection with a speculum often reveals vaginal and
cervical erythema (redness) with multiple small
petechiae (“strawberry spots”)
• Testing of a trichomonal discharge demonstrates a pH
greater than 4.5

Medical Management

• Most effective treatment for trichomoniasis is

metronidazole or tinidazole
• All partners receive a one-time loading dose or a
smaller dose twice a day for 7 days
o One-time dose is more convenient;
consequently, adherence tends to be greater
o The week-long treatment has occasionally
been noted to be more effective
o Some Pts complain of an unpleasant but
transient metallic taste when taking
metronidazole
▪ Nausea and vomiting, as well as
hot, flushed feeling can occur when
taking this medication with an
alcoholic beverage
▪ Pts are strongly advised to abstain
from alcohol during treatment and
for 24 hours after taking
metronidazole or 72 hours after
completion of a course of
tinidazole
▪ About 1 in 5 people will be
reinfected with trichomoniasis
within 3 months of treatment
▪ All sexual partners should be
treated, and Pts are encouraged to
abstain from sexual activity for 7 to
10 days after treatment

Gerontologic Considerations

• After menopause, the vaginal mucosa becomes

thinner and may atrophy
o While vulvovaginal atrophy can occur at
any time in a woman’s life, it is more
common in women who are
postmenopausal, with an increase of nearly
50%
 Clinical Manifestations
HERPES VIRUS TYPE 2
•
INFECTION (HERPES GENITALIS, Itching and pain occurs as the infected are becomes
red and edematous
HERPES SIMPLEX VIRUS) • Infection may begin with macules and papules and
progress to vesicles and ulcers
o The vesicular state often appears as a blister,
• Herpes simplex virus 2 (HSV-2) is a recurrent, which later coalesces, ulcerates, and
lifelong viral infection that causes herpetic lesions encrusts
(blisters) on external genitalia and occasionally the • In women
vagina and cervix o The labia are the usual primary site,
• It is an STI but possibly may also be transmitted although the cervix, vagina, and perianal
asexually from wet surfaces or by self-transmission skin may be affected
(i.e., touching a cold sore and then touching the • In men
genital area) o The glans penis, foreskin, or penile shaft is
• The initial infection is usually very painful, and typically affected
blisters may take 2 to 4 weeks to heal, but it can also • Influenzalike symptoms may occur 3 or 4 days after
be asymptomatic the lesions appear
• Over 87% of infected individuals are unaware of • Inguinal lymphadenopathy (enlarged lymph nodes in
their infections; most HSV transmission occurs from the groin), minor temperature elevation, malaise,
asymptomatic viral shedding headache, myalgia (aching muscles), and dysuria
• Recurrences are less painful, self-limited, and usually (pain on urination) are often noted
produce less severe symptoms • Pain is evident during the first week and then
• Some Pts have few or no recurrences, whereas, others decreases
have frequent bouts • The lesions last 2 to 12 days before crusting over
o Recurrence can be associated with stress, • Rarely, complications may arise from extragenital
sunburn, dental work, or inadequate rest or spread, such as to the buttocks, upper thigh, or even
poor nutrition, or any situations that tax the the eyes, as a result of touching lesions and then
immune system touching other areas
• There are more than 400 million affected by HSV-2 • Pts should be advised to wash their hands after
worldwide contact with lesions
• The prevalence of other STIs has decreased slightly, • Other potential problems are aseptic meningitis,
possibly because of increased condom use, but herpes neonatal transmission, and severe emotional stress
can be transmitted by contact with skin that is not related to the diagnosis
covered by a condom
• Transmission is possible even when a carrier does not Medical Management
have symptoms (subclinical shedding)
• Lesions increase vulnerability to HIV infection and • Currently, there is no cure for genital herpes
other STIs infection, but treatment is aimed at relieving the
symptoms
Pathophysiology • Management goals include preventing the spread of
infection, making Pts comfortable, decreasing
• Herpes simplex virus (HSV) is a double-stranded potential health risks, and initiating a counseling and
DNA virus that is differentiated into two types of education program
HSC infection • Three oral antiviral agents can suppress symptoms
o Herpes simplex type 1 (HSV-1) are shorten the course of infection, these agents are
▪ Associated with cold sores of the effective at reducing duration of lesions and
lips (herpes labialis) and preventing recurrences
gingivostomatitis o Acyclovir, Valacyclovir, and Famciclovir
o Herpes simplex type 2 (HSV-2) • Antispasmodic agents and a saline compress
▪ Associated with genital herpes o Can provide additional relief of symptoms
• Close human contact by mouth, oropharynx, mucosal • Resistance and long-term side effects do not appear
surface, vagina, or cervix appears necessary to to be major problems
acquire the infection • Recurrent episodes are often milder than the initial
• Other susceptible sites are skin lacerations and episode
conjunctivae • Prophylactic vaccine and topical gel development for
• Usually, the virus is killed at room temperature by genital herpes continues to be investigated in clinical
drying trials
• When the viral replication diminishes, the virus
ascends the peripheral sensory nerves and remains
inactive in the nerve ganglia
• Another outbreak may occur when the host is
subjected to stress
• In women who are pregnant and have active herpes,
infants delivered vaginally may become infected with
the virus
o There is a risk of fetal morbidity and
mortality if this occurs; therefore, a cesarean
delivery may be performed if the virus
recurs near the time of delivery
 stream and the sensation of stream and the sensation
BENIGN PROSTAIC of incomplete bladder emptying, abdominal straining
with urination, a decrease in the volume and force of
HYPERPLASIA (ENLARGED the urinary stream, dribbling (urine dibbles out after
PROSTATE) urination), and complications of acute urinary
retention and recurrent UTIs
• Normally, residual urine amounts to no more than 50
• Noncancerous enlargement or hypertrophy of the mL in the middle-aged adults and less than 50 to 100
prostate mL in the older adult
• One of the most common diseases in aging men • Ultimately, chronic urinary retention and large
• It can cause bothersome lower urinary tract residual volumes can lead to azotemia (accumulation
symptoms that can affect quality of life by interfering of nitrogenous waste products) and kidney failure
with normal daily activities and sleep patterns • Generalized symptoms may also be noted, including
• Typically occurs in men older than 40 years fatigue, anorexia, nausea, vomiting, and pelvic
o By the tune they reach 60 years, 50% of discomfort
men will have PBH • Other disorders that produce similar symptoms
o If affects as many as 90% of men by 85 include urethral stricture, prostate cancer, neurogenic
years of age bladder, and urinary bladder stones
• Second most common cause of surgical intervention
in men older than 60 years Assessment and Diagnostic Findings

Pathophysiology • The health history focuses on the urinary tract

infection, previous surgical procedures, general
• Cause is not well understood, but testicular health issues, family history of prostate disease, and
androgens have been implicated fitness for possible surgery
• Dihydrotestosterone (DHT) • Voiding diary is used by the Pt to record voiding
o Metabolite of testosterone, is a critical frequency and urine volume
mediator of prostatic growth • A DRE (digital rectal exam) often reveals a large,
• Estrogens may also play a role in the cause of BPH; rubbery, and nontender prostate gland
BPH generally occurs when men have elevated • Urinalysis to screen for hematuria and UTI is
estrogen levels and when prostate tissue becomes recommended
more sensitive to estrogens and less responsive to • PSA level is obtained if the Pt is without a terminal
DHT disease and for whom knowledge of the presence of
• Risk factors of DPH prostate cancer would change management
o Smoking • Used to assess the severity of symptoms
o Heavy alcohol consumption o American Urological Association (AUA)
o Obesity Symptom Index
o Reduced activity level o Index or International Prostate Symptom
o Hypertension Score (IPSS) c
o Heart disease • Other diagnostic tests may include recoding urinary
o Diabetes flow rate and the measurement of postvoid residual
o Western diet (high in animal fat and protein urine
and refined carbohydrates, low in fiber) • If invasive therapy is considered, urodynamic studies,
• Develops over a prolonged period; changes in the urethrocystoscopy, and ultrasound may be performed
urinary tract are slow and insidious • Completed blood studies are performed
• Result of complex interactions involving resistance in • Cardiac status and respiratory function are assessed
the prostatic urethra to mechanical and spastic because a high percentage of Pts with BPH have
effects, bladder pressure during voiding, detrusor cardiac or respiratory disorders due to their age
muscle strength, neurologic functioning, and general
physical health Medical Management
• The hypertrophied lobes of the prostate may obstruct
the bladder neck or urethra, causing incomplete • Goals are to improve quality of life, improves urine
emptying of the bladder and urinary retention flow, relive obstruction, prevent disease progression,
o As a result, hydroureter (dilation of the and minimize complications
ureters) and hydronephrosis (dilation of the • Treatment depends on the severity of symptoms, the
kidneys) can gradually occur cause of the disease, the severity of the obstruction,
• Urinary retention may result in UTIs because urine and the Pt’s condition
that remains in the urinary tract serves as a medium • If a Pt is admitted on an emergency bases because he
for infective organisms is unable to void, he is immediately catheterized
o The ordinary catheter may be too soft and
Clinical Manifestations pliable to advance through the urethra into
the bladder
• May or may not lead to urinary tract symptoms; if o In such cases, a stylet (thin wire) is
symptoms occur, they may range from mild to severe introduced (by a urologist) into the catheter
• Severity of symptoms increases with age, and half of to precent the catheter from collapsing when
men with BPH report having moderate to severe it encounters resistance
symptoms o A metal catheter with a pronounced prostatic
• Obstructive and irritative symptoms may include curve may be used if obstruction is severe
urinary frequency, urgency, nocturia, hesitancy in • A cystostomy (incision into the bladder) may be
starting urination, decreased and intermittent force of needed to provide urinary drainage
• Discussion of all treatment options by the primary are directed to the prostatic tissue.
provider enables the Pt to make an informed The targeted tissue becomes
decisions based on symptom severity, the effects of necrotic and sloughs
BPH on his quality of life, and preference ▪ To minimize damage to the urethra
• Pts with mild symptoms and those with moderate or and decrease the discomfort from
severe symptoms, who are not bothered by the and the procedure, some systems have
have not developed complications, may be managed water-cooling apparatus
with “watchful waiting” o Transurethral needle ablation by
o With this approach, the Pt is monitored and radiofrequency energy and insertion of a
reexamined annually but receives no active stent
intervention ▪ Uses low-level radiofrequencies
• Other therapeutic choices include pharmacologic delivered by thin needles placed in
treatment, minimally invasive procedures, and the prostate gland to produce
surgery localized heat that destroys prostate
• Pharmacologic Therapy tissue while sparing other tissues
o Includes the use of alpha-adrenergic ▪ The body then reabsorbs the dead
blockers and 5-alpha-reductase inhibitors tissues
▪ Include alfuzosin, terazosin, ▪ Prostatic stents are associated with
doxazosin, and tamsulosin significant complications (e.g.,
▪ Relax the smooth muscle of the encrustation, infection, chronic
bladder neck and prostate pain); therefore, they are only for
▪ This improves the urine flow and Pts with urinary retention and in
relieves symptoms of BPH Pts who are at poor surgical risk
▪ Side effects includes • Surgical Resection
• Dizziness, headache, o Option or Pts with moderate to severe lower
asthenia/fatigue, urinary tract symptoms of BPH and for
orthostatic hypotension, those with acute urinary retention or other
rhinitis, and sexual complications
dysfunction o The specific surgical approach (open or
o Another method of treatment involves endoscopic) and the energy source
hormonal manipulation with antiandrogen (electrocautery vs. laser) varies
agents. The 5-alpha-reductase inhibitors o All clotting defects must be corrected and
▪ Finasteride and dutasteride medications for anticoagulation withheld
▪ Used to prevent the conversion of o Transurethral resection of the prostate
testosterone to DHT and decrease (TURP)
prostate size ▪ Remains the benchmark for
▪ Side effects include surgical treatment
• Decreased libido, ▪ Involves surgical removal of the
ejaculatory dysfunction, inner portion of the prostate
erectile dysfunction, through an endoscope inserted
gynecomastia (breast through the urethra
enlargement), and flushing ▪ Can be performed with ultrasound
▪ Combination therapy (doxazosin guidance
and finasteride) ▪ Performed in the outpatient setting
• Has decreased symptoms and usually results in less
and reduced clinical postoperative bleeding than a
progression of BPH traditional prostatectomy
o The use of alternative and complimentary o Transurethral incision of the prostate
phytotherapeutic agents and other dietary (TUIP), transurethral electrovaporization,
supplements laser therapy, and open prostatectomy
▪ Serenoa repens (saw palmetto ▪ Other surgical options for BPH
berry) and Pygeum africanim ▪ TUIP is an outpatient procedure
(African plum) are not used to treat smaller prostates
recommended by the medical ▪ One or two cutes are made in the
community, although they are prostate and prostate capsule to
commonly used reduce constriction of the urethra
▪ They may function by interfering and decrease resistance to flow of
with the conversion of testosterone urine out of the bladder; no tissue is
to DHT removed
▪ S. repens may directly block the ▪ Open prostatectomy involves the
ability of DHT to stimulate prostate surgical removal of the inner
cell growth portion of the prostate via a
▪ These agents should not be used suprapubic, retropubic, or perineal
with finasteride, dutasteride, or (rate) approach for large prostate
estrogen-containing medications glands
• Minimally Invasive Therapy • May also be performed
o Transurethral microwave therapy laparoscopically or by
▪ Involves the application of heat to robotic-assisted
prostatic tissue laparoscopy
▪ A transurethral probe is inserted
into the urethra, and microwaves