Disorders of Male Reproductive SystemNURS 304 – Adult Nursing 2Lecturer: K. Mackey

Structures of the Male Reproductive Tract

Assessment Sexual function

Diseases e.g. diabetes, multiple scerosis, CVA, cardiac disease

Medications e.g antihypertensives, psychotrophic agents, antihyperlipedemia

Alcohol use

stress

Urinary symptoms

Assessment

• Urinary function and symptoms

• Symptoms related to urinary obstruction– urinary frequency– Decreased force of stream– “Double” or “triple” voiding– Nocturia– Dysuria– Hematuria– hematospermia

Physical Assessment Digital rectal exam

Testicular exam

Assessment Digital rectal exam (DRE)

Used to screen for prostate CA

Recommended in men 40yrs and over

prostate gland is assessed

Inspect male genitalia Note any abnormalites

Palpate for masses

Discharges, inflammation

Assesment Scrotum

Palpated for nodules, masses, inflammation

Note abnormalities such as hydrocele, hernia, masses

Tumours of testes

Instruct pt. on TSE and purpose

Performing TSE Best performed either in the shower or after a warm bath,

when the scrotal skin is relaxed.

Look in the mirror at the testicles

Observe size & shape of each testicle. Hold the scrotum in the palms of the hands. Examine one testicle at a time. Gently roll each testicle

(with slight pressure) between the thumb, middle and index fingers.

Place the thumbs over the top of your testicle and gently roll

Each testicle should be smooth, with no lumps or swellings.

TSE contd. Locate and palpate the epididymis and spermatic cord

Check for any small irregularities, enlargements and: An increase in firmness of a testicle

Pain or discomfort in a testicle or in the scrotum

An unusual difference between one testicle and the other.

A heavy feeling in the scrotum

A dull ache in the lower stomach, groin or scrotum.

Normal for one testis to be slightly larger than the other

Diagnostic Tests

Prostate specific antigen (PSA) 0.2 – 4.0 ng/ml

Annual testing

Ultrasonography (TRUS)

Prostate fluid or tissue analysis

Tests of male sexual function

Common Conditions of Male Reproductive Organs

Crytorchidism

Orchitis

Epididymitis

Phimosis

Priaprism

Circumcision

Common Conditions of Male Reproductive System

• Hydrocele – collection of fluid in testes• Varicocele – abnormally dilated veins in the scrotum• Hypospadias – shortened urethra, urethral opening located on

ventral side of penis (congenital anomaly)• Epispadias – urethral opening is on dorsum of penis• peyronie’s disease – build up of fibrous plaque in corpus

cavernosum• urethral stricture – narrowing of urethra

Disorders of Male Sexual Function

• Erectile dysfunction• The inability to achieve/sustain an erection sufficient

to accomplish intercourse– Psychogenic and organic causes– Organic causes include vascular, endocrine, hematological,

and neurologic disorders, trauma, alcohol, medications, and drug abuse

– Medications associated with erectile dysfunction (pg. 1745; 49-1)

Erectile Dysfunction• Pharmacologic therapy–Oral medications—sildenafil (Viagra), cialis,

levitra• Side effects include headache, flushing,

dyspepsia• Use cautiously in pts. with retinopathy

Injected vasoactive agents Surgical implants

• Complications of erectile dysfunction include priapism (persistent abnormal erection)

Prostatitis

• Inflammation of prostate gland caused by an infectious agent

• Clinical manifestations– Fever, chills– Dysuria– Frequency– Urgency– Perineal pain– Nocturia– Rectal or lower back pain

ProstatitisPathophysiology

Inflammation of the prostate gland cause by infectious agents E. coli is the most common

Microorganisms are usually carried to the prostate from the urethra

Prostatitis Diagnosis (May be acute or chronic)

History

Culture of prostate gland

Urine for C & S

Histological examination of the tissue

D.R.E.

Swollen, tender & firm prostate gland

Prostatic massage Obtain prostatic fluid

Prostatitis Management

Antibiotic therapy broad-stectrum antibiotic

(rimethroprim sulfamethoxazole (Bactrim)Cirpfloxacin (Cipro) Analgesics for pain

Sitz bath (10-20mins)

Educate pt. on disease process

Stool softeners

Prosatitis1. AVOID Foods and liquids that have diuretic actions or that increase

Prostatic secretion should be avoided 1. Alcohol

2. Coffee

3. Tea

4. Chocolate

5. Cola

6. Spices

2. Avoid intercourse

3. Avoid sitting for long periods

Prostatitis Complications

Swelling of prostate gland

Urinary retention

Epididymitis

Bacteremia

pyelonephritis

Benign Prostatic Hypertrophy

• Non malignant enlargement of the prostate gland.• Characterized by formation of large nodular lesions in the periurethral region

of the prostate.

• Etiology– Unknown– Dihydrotestosterone (DHT) active metabolite in testosterone contibutes to

BPH– Free plasma testosterones enters prostatic cells where about 90% is converted

to DHT

• Predisposing factors– Men over the age of 50 years• Smoking• Heavy alcohol consumption• Diabtes, hypertension, heart disease• Race, ethnicity• Family history

Benign Prostatic Hypertrophy Clinical Manifestations

Signs of urinary obstruction Acute urinary retention Frequency Urgency Nocturia Abdominal straining with urination Hesitancy in passing urine Decrease in volume and force of urinary stream Dribbling urinary tract infections Sensation that bladder is not completely emptied General symptoms, fatigue, anorexia, pelvic discomfort

Renal failure can occur with chronic urinary retention

BPH: Pathophysiology• Pathophysiology not clearly understood

– Hormonal contribution in men with elevated testosterone levels – Develops over long period– Hypertrophied lobe of prostate obstruct the prostatic urethra– This causes the bladder to become over distended, urinary retention occurs with

incomplete emptying of the bladder– Frequency of urination occurs with constant desire to empty the bladder– Frequency becomes worse at nights Gradual dilation (hydroureter) of ureters and kidneys (hydronephrosis) occur

UTI may result from urinary stasis,

Urine remaining in the urinary tract serves as a medium for infectious organisms

BPH Diagnosis

History Digital rectal exam Urine analysis CBC’s Ultrasound scan (trans abdominal or rectal) PSA Serum creatinine levels

Medical Management: BPH Treatment

Pharmacologic—alpha-adrenergic blockers, alpha- adrenergic antagonists, antiandrogen agents

Antiandrogen agents Relax smooth muscle of bladder, relieving urinary symptoms Catherization if unable to void

Prostate surgery TURP surgical resection Strinking of prostate

Prostate Cancer

Second most common cancer and the second most common cause of cancer death in men

Risk factors: increasing age familial predisposition African-American race

Early diagnosis is vital; health screening

Prostate Cancer• Clinical Manifestations

– Frequency of urination– urgency– hesitancy in starting urination– recurrent UTI– dribbling– interruption of urinary flow– sensation that bladder has not emptied– decrease in volume and force of urine stream

• Diagnosis– Digital rectal exam– PSA, Transrectal Ultrasound guided biopsy

Nursing Diagnoses Anxiety

Acute pain preoperatively

Acute pain postoperatively

Deficient knowledge

Nursing Management—Planning

Major goals preoperatively: adequate preparation and reduction of anxiety

Reduction of pain.

Major goals postoperatively: maintenance of fluid volume balance

relief of pain and discomfort

ability to perform self-care activities

absence of complications

Interventions• Routine preoperative management

– enema

• Reduction of anxiety– Be sensitive to potentially embarrassing and culturally charged issues – Establish a professional, trusting relationship – Provide privacy– Allow patient to verbalize concerns– Provide and reinforce information

• Provide patient teaching including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience.

• Preparation of pt. for actual surgery

Management Surgery

Transurethral resection of the prostate (TURP)

Chemotherapy

Radiation therapy

Prostate Cancer Surgical Management

Radical prostatectomy: removal of the prostate, seminal vesicles, tips of the vas deferens, surrounding fat, nerve and blood vessels may also be removed.

Radiation therapy If detected in the early stages radiation treatment can be used to destroy tumor

hormonal therapy Use of antiandrogen drugs to decrease growth of tumor

Chemotherapy Use of ketoconazole to lower testosterone levels

Post operative• Pain management• V/S• Fluid balance management• Irrigation of bladder

– Close monitoring of fluid intake, output– Amount of fluid used for irrigation– Irrigate according to Dr.’s order

• Ensure tubing is secured properly

• Monitor urinary drainage and keep catheter patent– Drainage is red then pink within 24hrs

• Cather care to prevent infection

Post operative care Observation of dressing site

Observe abdomen for distension Assessment of pain

Bladder spasms cause feelings of pressure and fullness urgency to void

bleeding from the urethra around the catheter. Educate pt. not to pull on catheter/tubing Advice re: feelings of urge to void is normal

Relief of Pain

Warm compresses or sitz baths to relieve spasms Administer analgesics and antispasmodics as ordered Encourage patient to walk, but to avoid sitting for prolonged

periods. Prevent constipation Ambulation begins 24hrs. post op Wound care using strict asepsis

Three-Way System for Bladder Irrigation

Collaborative Problems/Potential Complications

Hemorrhage and shock

Infection

DVT

Catheter obstruction

Sexual dysfunction

Rehabilitation and Home Care

Patient and family teaching for home care including care of urinary drainage devices and recognition and prevention of complications

Regain bladder continence Information that regaining control is a gradual process (dribbling may continue

for up to 1 year depending upon type of surgery) Perineal exercises

Avoidance of straining, heavy lifting, long car trips (6–8 weeks)

Diet: encourage fluids and avoid coffee, alcohol, and spicy foods

Assessment and referral of sexual issues

Testicular Cancer

• Most common cancer in men ages 15–40• Highly treatable and curable• Risk factors: undescended testicles, positive family history, cancer of one

testicle, Caucasian-American race• Manifestations: painless lump or mass in the testes• Early diagnosis: monthly testicular self-exam (TSE) and annual testicular exam • Treatment: orchidectomy, retroperitoneal lymph node dissection (open or

laparoscopic), radiation therapy, chemotherapy

Testicular cancer

Tumor markers that may be elevated in testicular cancer: Human chorionic gonadotropin

alpha fetoprotein.

Nursing Management Assessment of physical and psychological status

Support of coping

Address issues of body image and sexuality

Encourage a positive attitude

Patient teaching

TSE and follow-up care

References Salzano, C. (2008). Testicular Cancer

Bare, B., Cheever, K., Hinkle, J.L. & Smeltzer, S.C. (2008). Brunner, & Suddath’s textbook of medical-surgical nursing. (11th Ed.). Philidelphia: Lippincot Williams & Wilkins.