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Forløbsbeskrivelse Af Urologiske Sygdomme Uiopasdfghjklzxcvbnmqwertyui

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Forløbsbeskrivelse Af Urologiske Sygdomme Uiopasdfghjklzxcvbnmqwertyui qwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvb nmqw ertyuiopasdfghjklzxcvbnmqwer tyuiopasdfghjklzxcvbnmqwertyForløbsbeskrivelse af urologiske sygdomme uiopasdfghjklzxcvbnmqwertyui Udarbejdet af de kliniske sygeplejespecialister; Gitte Petersen, Gry opasdfghjklzxcvbnmqwertyuiopMedonos, Liselotte Vitoft og Stina Lindedam asdfghjklzxcvbnmqwertyuiopas dfghjklzxcvbnmqwertyuiopasdf ghjklzxcvbnmqwertyuiopasdfgh jklzxcvbnmqwertyuiopasdfghjkl zxcvbnmqwertyuiopasdfghjklzx cvbnmqwertyuiopasdfghjklzxcv bnmqwertyuiopasdfghjklzxcvbn mqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbnmqw i df hjkl b i Urologisk specialsygepleje – Patientforløbsbeskrivelse Indhold Cancer prostata ............................................................................................................................................... 2 Blærecancer .................................................................................................................................................... 7 Nyrekirurgi ...................................................................................................................................................... 14 Cancer renis .................................................................................................................................................. 14 Nyrepelviscancer og uretercancer............................................................................................................... 15 Nyrecyster ................................................................................................................................................... 16 Binyretumorer ............................................................................................................................................. 16 Urolithiasis...................................................................................................................................................... 18 Sygdomme i scrotum .................................................................................................................................... 20 Epididymitis: ............................................................................................................................................... 20 Torsio Testis .............................................................................................................................................. 21 Vaso-vasostomi ......................................................................................................................................... 22 Hydrocele ................................................................................................................................................... 22 Varicocele .................................................................................................................................................. 25 Cancer testis .............................................................................................................................................. 26 Penilkirurgi ..................................................................................................................................................... 28 Erektil dysfunktion ..................................................................................................................................... 28 Penisprotese .............................................................................................................................................. 30 Phimosis ..................................................................................................................................................... 31 Kontinenskirurgi ............................................................................................................................................ 33 Pro-Act balloner ........................................................................................................................................ 35 LUTS ............................................................................................................................................................... 38 Smertefuldt blæresyndrom (interstitiel cystit) ....................................................................................... 38 1 Cancer prostata Definition: Cancer i prostata. Den hyppigste cancerform for mænd. Ca. 4.400 mænd får årlig konstateret prostatacancer. Mindste 10 % skyldes arvelighed, ellers kendes årsagen ikke. Arvelig prostatacancer ses typisk før 55 års alderen. Symptomer på prostatacancer: Der er sjældent symptomer forbundet med den afgrænset og helbredelig prostatacancer. Når patienten først mærker symptomer som smerter i skelettet, evt. blodig sæd samt smerter ved endetarm og perineum, kan det være tegn på at prostatacanceren har bredt sig og patienten er uhelbredelig syg. Antallet af nye tilfælde har været stigende de sidste 20 år (1995), grundet flere får stillet diagnosen på baggrund af en PSA måling. Den normale PSA-værdi skal være 3≤ (60år) ≤4 (60-70 år) 5(≤70 år). Hvis PSA er større end dette giver det anledning til videre udredning, dog må PSA-værdien ikke stå alene ved prostatacancer udredning. I følgende bilag gives en oversigt over et forløb for en patient med prostatacancer. (Se bilag: Flowchart) Når der hos en patient er mistanke om prostatacancer henvises han fra egen læge eller anden sygehusafdeling til urologisk afdeling. Herefter indgår patienten i et pakkeforløb, dvs. at for langt de fleste patienters vedkommende indgår de i et ambulant udredningsforløb. Dog har enkelte patienter allerede symptomer på prostatacancer, der kræver indlæggelse i en sengeafdeling hvor udredningsforløbet så kommer til at foregå. Se listen nedenfor for forundersøgelser/udredning i forbindelse med prostatacancer. Forundersøgelser/udredning: Blodprøve: PSA, evt. prostatacancerpakke Rectaleksploration ved speciallæge TRUS med biopsi: http://vip.regionh.dk/VIP/Admin/GUI.nsf/Desktop.html?open&openlink=http://vip.regionh.dk/VIP/Slu tbruger/Portal.nsf/Main.html?open&unid=XC1257EEA0045F97AC1257F060033E508&level=1501Z 6&dbpath=/VIP/Redaktoer/1501Z6.nsf/&windowwidth=1100&windowheight=600&windowtitle=S%F 8 Histologisvar Knoglescintigrafi/ MR-scanning af skelettet/ naf PET-CT MDT- konference (fælles faglig konference hvor radiolog, urolog, onkolog, patolog diskuterer behandling). Gleasonscore: Hvis der er cancer i biopsiprøverne, vil de blive givet en gleasongrad. Gleason angiver hvor aggressiv canceren er, med andre ord hvor sandsynligt det er at canceren vil vokse og brede sig udenfor for prostata. Gleason gradieringen ligger fra 1-5. Grad 1-2 angives ikke for at være cancer. Gleason er opdelt i 2 tal, det første tal fortæller den hyppigste grad af cancer i alle prøverne, det andet tal er den højeste grad i resten af prøverne. Når man har lagt den hyppigste og den højeste grad sammen, er summen gleasonscore. Eks. hvis biopsiprøverne viser at: 2 - den grad der ses ofte er 3 - og den højeste grad i de andre prøver er 4, så er gleasonscore 7 (3+4) Stadieinddeling: Prostatacancer inddeles desuden efter TNM systemet. Og angiver for udbredt canceren er. T stadiet angiver tumor spredning omkring prostatakirtlen N stadiet angiver om, cancer har spredt sig til lymfeknuderne(Nodes) M stadiet angiver om, canceren har spredt sig til andre dele i kroppen(metastaser) Kirurgisk behandling: Kurativ behandling: -Radikal prostatektomi (laparaskopisk eller åben operation): Operativ fjernelse af prostata og sædblære på grund af lokaliseret prostatacancer. Laves evt. nervebesparende. Evt. samtidig udførelse af glandelstaging ved risiko for lymfeknudemetastaser over 10 %. http://vip.regionh.dk/VIP/Admin/GUI.nsf/Desktop.html?open&openlink=http://vip.regionh.dk/VIP/Sl utbruger/Portal.nsf/Main.html?open&unid=XC1257EEA0045F97AC12579370036A931&level=1501 Z6&dbpath=/VIP/Redaktoer/1501Z6.nsf/&windowwidth=1100&windowheight=600&windowtitle=S% F8g http://vip.regionh.dk/VIP/Admin/GUI.nsf/Desktop.html?open&openlink=http://vip.regionh.dk/VIP/Slu tbruger/Portal.nsf/Main.html?open&unid=XC1257EEA0045F97AC12579370036AD7E&level=1501 Z6&dbpath=/VIP/Redaktoer/1501Z6.nsf/&windowwidth=1100&windowheight=600&windowtitle=S% F8g - Glandelstaging (lymfadenaktomi): Operativ fjernelse af lymfeknude i bækkenområdet. Denne operation foretages når der ses kapselindvækst men ikke knoglemetastaser. Ligeledes ved PSA > 10 og/eller gleasonscore > 6 . Evt. efterfølgende ekstern strålebehandling med et kurativt mål. - Brakyterapi: Behandling mod cancer prostata med kurativt sigte, ved ultralydsvejledt implantation af seeds. Implantationen foregår i UA, via kanyle gennem perineum typisk 20 nåle med 50-70 seeds i alt. http://vip.regionh.dk/VIP/Admin/GUI.nsf/Desktop.html?open&openlink=http://vip.regionh.dk/VIP/Slu tbruger/Portal.nsf/Main.html?open&unid=XC1257EEA0045F97AC1257E540022CBB3&level=1501 Z6&dbpath=/VIP/Redaktoer/1501Z6.nsf/&windowwidth=1100&windowheight=600&windowtitle=S% F8g Pallierende behandling: Bilateral orkiektomi: Operativ fjernelse af testiklerne. Standard behandling for patienter med metastaserende cancer prostata. http://vip.regionh.dk/VIP/Admin/GUI.nsf/Desktop.html?open&openlink=http://vip.regionh.dk/VIP/Slu 3 tbruger/Portal.nsf/Main.html?open&unid=XC1257EEA0045F97AC1257C39004E3119&level=1501 Z6&dbpath=/VIP/Redaktoer/1501Z6.nsf/&windowwidth=1100&windowheight=600&windowtitle=S% F8g Dobbelt J-kateter/tumorstent: Anlægges ved ureterobstruktion, forårsaget af prostataindvækst. Medicinsk behandling: Endokrin behandling
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