A.

TESTICULAR TUMORS
Testicular cancer, which ranks Iirst in cancer deaths among men in the age group 20 to 35
years, is the most common cancer in men aged 15 to 35 years and is the second most common
malignasi in the age group 35 years to 39 years . Such cancers are classiIied as germ or
nongerminal. Germ cell tumors arise Irom germ-cell testis (seminoma, teratocarcinoma, and
embryonal carcinoma). Nongerminal Tumors arising Irom epithelium. Most oI the neoplasms are
nongerminal, with about 40 are seminomas. Seminoma tends to remain local, while
nonseminoma tumors grow rapidly. The cause oI testicular not known, but the crypto-khidisme,
inIections, and genetic Iactors and endocrine visible role in the occurrence oI such tumors.
The risk oI testicular cancer is 35 times higher in men with all types oI undescended testes in
skortum on appeal to the general population. Testicular tumors are usually malignant and tend to
early metastatic, spreading Irom the testicles into the lymph nodes in retroperineum and into the
lungs.

Epidemiology
Age 20-40 years. The most common is a solid tumor in young men.

Etiology
O rypto-orkidisme-risk oI developing testicular cancer increased 50-Iold. The risk is not
aIIected by orchidopexy.
O ncidence is higher in white men.

$tadium
O Stage conIined to skortum
O Stage the spread to the retroperitoneal lymph nodes below the diaphragm
O Stage spread Iar



eployment
O Germ cell tumors metastasize to the lymph nodes, para-aortic, pulmonary, and brain.
O Stromal tumors rarely metastasize.

linical Manifestations
Symptoms occur very gradually with a mass or lump in the testes and generally painless
testicular enlargement. Patients may complain oI tightness in skortum, inguinal or abdominal
area inside. Back pain (due to the expansion oI nodes retroperineal), abdominal pain, weight loss,
and general weakness can be caused by metastatic.
Enlarged testicle with no pain is a signiIicant diagnostic Iindings.
The only eIIective method oI early detection is testicular selI-examination. An important part oI
health promotion practice Ior men should include independent examination.
O Swelling oI the testicles that are not painIul, oIten Iound incidental or aIter trauma
O Iten Iound in testicular discomIort vague, bleeding in the tumor may resemble acute
torsion
O #arely have metastatic disease or gynecomastia
O The examination showed testicular mass is hard, irregular, and nontender.
iagnostic Evaluation
uman chorionic gonadotropin and u-Ietoprotein is a marker oI tumor that may be
elevated in patients with testicular cancer. (Tumor marker is a substance synthesized by tumor
cells and released into the circulation in the number oI abnormal). munositokimia latest
techniques that can help identiIy the cell-selyang seems meghasilkan this marker. levels oI tumor
markers in the blood used to diagnose, classiIy, and monitor response to treatment. Another
diagnostic test include intravenous urography to detect all Iorms oI urethral deviation caused by
the tumor mass; limIangiograIi to assess the breadth oI deployment tumorke lymphatic system;
and chest and abdominal T scan to determine extent oI disease in the lungs and retroperineum.



Management
Testicular cancer is one oI solid tumors can be cured. Management goal is to get rid oI
the disease and achieve healing. Selection oI treatment depends on cell type and extent oI
anatomic disease. Testes removed through an incision inguinal orkhioektomi with high cord
ligation spermatikus. Filled with a gel prosthesis can be implanted to Iill in the missing testicle
aIter unilateral orkhioektomi to testicular cancer, most patients do not experience damage to
endocrine Iunction. owever, other patients decreased hormonal levels, which indicates that a
healthy testicle was not Iunctioning at normal levels. #etroperineal lymph node dissection
(#PLND) to prevent the spread oI cancer through the lymphatic pathway may be done aIter
orkhioektomi. Although not a normal libido and impaired orgasm aIter #PLND patients may
experience ejaculatory dysIunction with inIertility due. Store sperm in a sperm bank beIore
surgery may be a consideration.
Post-operative irradiation oI lymph nodes daru diaphragm to the iliac region used to treat
seminoma and only given to the other testicular tumors are protected Irom radiation to rescue
Iertility. #adiation is also used Ior patients who showed no response to chemotherapy or Ior
those who are not recommended Ior lymph node surgery.
Testicular carcinoma is very responsive to medication therapy. hemotherapy with multiple
sisplantin and other preparations such as vinblastine, bleomycin, daktinomisin, and sikloIosIamit.
give high percentage oI remissions. Good results can be achieved by combining diIIerent types
oI treatments, including surgery, radiation therapy, chemotherapy. Even though disseminated
testicular cancer, the prognosis is still good, and probably incurable disease because oI advances
in diagnosis and treatment.
#adical orchidectomy (through the groin incision cells) and histological diagnosis.
Subsequent therapy depends on the histology and stage.
Seminoma
W Stage radiotherapy to the abdominal lymph nodes
W Stage radiotherapy to the abdominal lymph nodes
W Stage chemotherapy (bleomycin, etoposide, cisplatin)

Nonseminoma germ cells
W Stage retroperitoneal lymph node dissection (retroperitoneal lymph node dissection, #PLND)
W Stage hemotherapy #PLND
W Stage hemotherapy ( #PLND iI good response)

ursing interventions / patient education
Because patients may have diIIiculty in accepting these conditions, issues related to body
image and sexuality should be disclosed. Patients need encouragement to maintain a positive
attitude during the course oI therapy. Patients should also be aware that radiation therapy should
not always prevent a patient to become a Iather, and excision oI the tumor should not unilaterally
reduce virilitas.
Patients with a history oI testicular tumors have a greater opportunity to experience
subsequent tumors. Follow-up examination including x-rays, urography ekskretori,
radioimmunoassay Ior human chronic gonadotropins and a-Ietoprotein levels, and examination
oI lymph nodes to detect recurrent malignasi.
Examination Support
O Blood Ior tumor markers, such as AFP and -G
O AFP is elevated in 75 and 65 embryonal teratocarcinoma
O AFP is not elevated in pure seminoma or choriocarcinoma
O -G increased at 100 choriocarcinoma, 60 embryonal carcinoma, teratocarcinoma
60, and 10 pure seminoma.
O &ltrasound skortum diagnosis
O Thoracic T scan to assess both the lungs and mediastinum metastases
O Laparoscopy (retroperitoneoskopi) to assess the abdominal lymph nodes

. !ENIS CANCER
Penile cancer occurs in men over the age oI 60 years and represents about 0.5 malignasi in
men in the &nited States. Nevertheless, in some countries, incidentnya around 10. Penile
cancer is rare in men who are circumcised. This condition is seen in the penile skin as a wart-like
growth period, no pain, or as an ulcer. Penile cancer may include glands, coronal sulcus under
the prepuce, the corporal bodies, urethra, and the regional lymph nodes or distant lymph nodes.
Bowen disease is a Iorm oI squamous cell carcinoma in situ oI the penis shaIt. Typically, men
delay to seek treatment Ior more than a year, possibly because oI guilt, shame, or neglect.

Management
Smaller lesions involving the skin can be controlled only by excision biopsy. Topical
chemotherapy with 5-Iluorouracil cream may be an option in certain patients. radiation therapy
used to treat small squamous cell carcinoma oI the penis or Ior palliation in advanced tumors or
lymph nodes mentastasi. penektomi partial (removal oI penis) preIerred over total penektomi iI
possible; about 40 oI patients will be able to participate in sexual relationships and be able to
urinate. ShaIt oI the penis can continue to respond to sexual stimulation with erectile capacity
and have sensory and ejaculation. Penektomi total indicated when the tumor can not be resolved
with conservative treatment. AIter penektomi total, patients can still experience orgasm by
stimulation oI the perineum and skortum area.

Patient education
ircumcision in inIancy almost deIinitely rule out the possibility oI penile cancer, due to
chronic irritation and inIlammation oI the glans penis trigger tumors. n men who are not
circumcised, personal hygiene is an important preventive measure.
C. ! (enign !rostatic 5er5lasia)
s a condition oI unknown cause. haracterized by increased size oI the zone in
(periurethral glands) oI the prostate gland.
Epidemiology
ccurs in 50 oI men 60-90 years old.

Etiology
Endocrine imbalance with age seems to be the most important Iactor. Possible
mechanism is the progressive decline oI output, especially testicular androgen hormones. Thus
there is a state oI relative hiperestrogenik, mostly Irom that cause endocrine hyperplasia.


linical
ncreased Irequency oI urination, nocturia, urge to urinate, Anyang-anyangan, abdominal
tension, decreased urine volume and should be straining during urination, irregular urine Ilow,
dribbling (urine continues to drip aIter urination), Ieeling like the bladder does not empty
properly, retention Acute urine (iI more than 60 ml oI urine remains in the bladder aIter voiding)
and recurrence oI urinary tract inIections. May eventually occur azotemia (accumulation oI
nitrogen waste products) and renal Iailure with chronic urinary retention and a large residual
volume. ommon symptoms may also appear include Iatigue, anorexia, nausea and vomiting,
and epigastric discomIort on.

omplications
a) &rethra
DeIormity oI the prostatic urethra, oIten associated with obstruction caused by
enlarged median lobe, eventually causing urinary retention.
b) Bladder
O bstruction causing hypertrophy and trabekulasi bladder wall.
O Bladder Diverticula
O Acute or chronic cystitis aIter stasis oI urine
O t is the predisposition oI stone Iormation
c) &reter idroureter
d) Kidney ydronephrosis, pyelonephritis, pioneIrosis, kidney Iailure
iagnostic Examination
a) &rinalysis yellow, dark brown, dark red / bright, cloudy appearance, p 7 or greater,
bacteria.
b) &rine culture the staphylokokus aureus. Proteus, Klebsiella, Pseudomonas, e. coli.
c) B&N / creatine increased
d) 'P show slowing the emptying oI the bladder and prostate enlargement, abnormal
thickening oI the bladder muscle.
e) ystogram measuring blood pressure and volume in the bladder
I) SistouretrograIi micturition n place oI 'P to visualize the bladder and urethra by
using a local contrast material
g) Sistouretroscopy To describe the degree oI prostate enlargement and urinary
conceived
h) Transrectal ultrasonography knowing an enlarged prostate, measure the residual
urine and pathological conditions such as tumors or stones.
Diagnosis oI urethral obstruction and consequently
istory symptoms and signs
eight urinary tract obstruction and state oI the proximal
O &ltrasound is needed
Knowing an enlarged prostate, bladder volume determining, measuring
residual urine, and other pathological conditions such as diverticular, tumors
and stones.
O Pielogram oIten required intravenous
&rolithiasis?
Examination oI renal physiology (urea, creatinine)
s there an inIection?
O Examination oI urinary sediment
O urine cultures
s there a prostate carcinoma?
O Anal Plug
To determine the presence oI asymmetry, nodules on the prostate, the upper
limit can be palpated, iI there carcinoma oI the harder consistency
O Apuncture needle
Should the catheter?
Physical Examination
1. #ectal examination
2. &rinalysis
3. &rodinamis examination to assess any obstruction in urine Ilow pattern
4. omplete blood
5. ardiac and respiratory Iunction assessed
6. Anamnesis
7. s there a prostate carcinoma
Pathophysiology
microscopic stromal nodules grow around the periurethral glands.
gland hyperplasia originate Irom the area around the nodules.
The size oI the growing gland will suppress the urethra and cause urinary tract
obstruction.
Symptoms oI obstructive
aiting at the beginning oI micturition - intermittent micturition - dripping at the
end oI micturition - stream micturition becomes weak - the taste was not satisIied aIter
micturition
These symptoms occur because the detrusor Iails to contract / discontinuous

Symptoms oI irritation
ncreased Irequency oI micturition - nocturia - micturition hard to resist - disturia
These symptoms occur because penggosongan incomplete at the time oI micturition.

linical
Early in the outIlow tract obstruction
emission is weak, hesitancy, intermitensi, dripping, straining during micturition,
acute urinary retention.
Detrusor instability causes
Frequency, urgency, nocturia, dysuria, incontinence.
Finally detrusor muscle Iailure and chronic retasi
The bladder is palpable (or can diperkusi) inkontensia
Enlarged prostate is smooth on the #T examination.
Management
a. Medical
1. hange the oral Iluid intake, reduce the consumption oI caIIeine
2. Bioker u-adrenerik (Ienoksibenzamin eg, prazosin)
3. Antiadrogen that works selectively on the cellular level oI the prostate (eg Firas
teride)
4. ntermittent catheterization iI there is Iailure oI the detrusor muscle
5. Balloon dilatation and stenting oI the prostate (in patients who are not ready Ior
operation)
b. Surgery
1. n most patients surgery
2. Appointment oI the adenomatous prostate surgery
3. Elektrokakter or T&#P with laser
4. Thermal ablation oI the prostate
5. Prostatekorasi open to a large size which can be either transverse or retropubic.

Sources
Pierce, Grace & Neil #. 2006. Surgery at a Glance. Ed-3. London publisher
Smeltzer, Suzanne . Festive & Brenda G.Bare.2001.Buku oI Medical Bedah.Ed-
8.Jakarta EG