Assessment and management of problems related to male reproductive processes
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Assessment and Management of Problems Related to Male Reproductive Processes. Anatomy and Physiology. The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens).

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Anatomy and physiology
Anatomy and Physiology Reproductive Processes

  • The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens).

  • The prostate (an encapsulated gland that encircles the proximal portion of the urethra).

  • The penis.



Inflammatory diseases epididymitis
Inflammatory Diseases: Reproductive ProcessesEpididymitis

  • A sterile or nonsterile inflammation of the epididymis.

  • A sterile inflammation may be caused by direct injury or reflux or urine down the vas deferens.

  • Nonsterile inflammation may occur as a complication of gonorrhea, chlamydia, mumps, tuberculosis, prostatitis, or urethritis.

  • Symptoms include sudden, severe pain in the scrotum, scrotal swelling, fever, dysuria, and pyuria.


Inflammatory diseases orchitis
Inflammatory Diseases: Reproductive ProcessesOrchitis

  • An inflammation of the testes that most often occurs as a complication of a bloodborne infection originating in the epididymis.

  • Causes include gonorrhea, trauma, surgical manipulation, and tuberculosis and mumps that occur after puberty.

  • Symptoms include sudden scrotal pain, scrotal edema, chills, fever, nausea, and vomiting.


Inflammatory diseases prostatitis
Inflammatory Diseases: Reproductive ProcessesProstatitis

  • An inflammation of the prostate which is a common complication of urethritis caused by chlamydia or gonorrhea.

  • Symptoms include perineal pain, fever,dysuria, and urethral discharge.


Nursing interventions
Nursing Interventions Reproductive Processes

  • Inflammatory Disorders:

    • Encourage bed rest

    • Monitor VS, esp. temp for fever

    • Monitor I & O

    • Assess pain

    • Sitz bath – provide comfort = PROSTATITIS

    • Provide ice pack to scrotum to decrease swelling

    • Elevate or provide scrotal support


Inflammatory disorders
Inflammatory disorders Reproductive Processes

  • Interventions

    • Analgesic

    • Antibiotic

    • Procaine = anesthetic

    • Stool softeners

    • Digital massage – rectally – release infected fluid


Benign prostatic hyperplasia
Benign Prostatic Hyperplasia Reproductive Processes

  • BPH is a progressive adenomatous enlargement of the prostate gland that occurs with aging.

  • More than 50% of men over the age of 50 and 75% of men over the age of 70 demonstrate some increase in the size of the prostate gland.

  • Although this disorder is not harmful, the urinary outlet obstruction is a problem.

  • Early symptoms include hesitancy, decreased force of stream, urinary frequency, and nocturia.


Benign prostatic hyperplasia1
Benign Prostatic Hyperplasia Reproductive Processes

  • Diagnosis:

    • PSA – prostate specific antigen = high

    • Rectal examination – most reliable

    • Ultrasound

    • Cystoscopy – visualization of bladder

    • IVP – Intravenous Pyelography – inject a dye through vein – visualize bladder, ureters, kidney – allergic to shellfish or iodine?

    • BUN – blood, urea, nitrogen – urine, blood – increase

    • Serum creatinine – Increased


TURP Reproductive Processes

  • Transurethral Resection of the Prostate

  • Continuous irrigation = reduce or prevent clot formation = clogs urethra = urinary retention = kidney damage

  • Monitor I & O

    • 3-way f/c

  • Monitor fluid overload=water intoxication

    • Edema, mental status = agitation, lethargy

  • Monitor for distention - bladder


Benign prostatic hyperplasia2
Benign Prostatic Hyperplasia Reproductive Processes

  • Management

    • Stent

    • Balloon

  • Surgical

    • TURP

    • TULIP – Transurethal Ultrasound-guided Laser-induced prostatectomy

      • Less invasive

    • PROSTATECTOMY

    • Perineal prostectomy – incision through perineum

    • Suprapubic resection – lower abdomen – incision through the bladder – urethrotomy

    • Retropubic – lower abdomen – does not go through the bladder


Benign prostatic hyperplasia3
Benign Prostatic Hyperplasia Reproductive Processes

  • Pharmacological

    • Alpha blockers – relax the smooth muscles along urinary tract (Hytrin, Cardura) – p. 852

      • S/E: dizziness – orthostatic hypotension

    • Belladonna & Opium suppository – reduce post-op bladder spasm

    • Narcotic analgesic – relieve p-op pain – Vicodin, Morphine, Codeine – S/E constipation

    • Proscar – androgen hormone inhibitor – may arrest prostate enlargement


Benign prostatic hyperplasia4
Benign Prostatic Hyperplasia Reproductive Processes

  • Nsg. Interventions

    • Increased fluids – monitor I & O

    • Maintain gravity drainage of F/C

    • Monitor blood clots and color = bright red = bleeding

    • Keep irrigation flowing, note clots

    • Monitor VS – pain level, temp – orally, NOT rectal

    • Avoid straining, provide stool softeners

    • Teach deep breathing, relaxation technique

    • Avoid straining

    • Observe bladder distention & spasms = ask for antispasmodic – stops spasms = pain, increase blood clots


Malignant neoplasms breast cancer
Malignant Neoplasms: Reproductive ProcessesBreast Cancer

  • Breast cancer in males is an uncommon disorder. Because it is so uncommon, it is all the more dangerous as it is not considered a threat.

  • Late diagnosis is quite common; therefore, males need to be educated in self-examination.

  • Signs and symptoms include breast lumps, pain, or discharge from nipple.


Malignant neoplasms breast cancer1
Malignant Neoplasms: Reproductive ProcessesBreast Cancer

  • Management

  • Chemo, radiation, surgical removal

  • Subjective data assessment

    • pain,emotional & educational needs

  • Objective data assessment

    • Rating scale, drainage, VS –temp increase, BP, Pulse, Resp – increased d/t pain

  • Nursing management

    • P-op: elevate affected arm, not to apply pressure, B/P, drawing blood, IVs


Malignant neoplasms prostate cancer
Malignant Neoplasms: Reproductive ProcessesProstate Cancer

  • The second leading cause of cancer deaths in men.

  • Risk factors include: advancing age (over 55); first-degree relative with prostate cancer; African-American heritage; high level of serum testosterone.

  • Five-year survival rate is 89%.


Prostate cancer
Prostate Cancer Reproductive Processes

  • S/S

    • Early tumor – no symptoms

    • Subjective

      • Back pain, same symptoms as BPH – hesitancy, decrease pressure, frequency, dysuria, urinary retention

    • Objective

      • Symptoms from metastasis

        • Lumps – inguinal

        • Enlarged lymph nodes

        • Blockage of urethra, and rectal dysfunction


Diagnostic test prostate ca
Diagnostic Test – Prostate CA Reproductive Processes

  • Rectal examination

  • PSA- prostate specific antigen – elevated

  • Prostatic smear – abnormal cells, dysplasia

  • Acid phosphatase – prostate – 100x higher than normal – PAP – prostatic acid phosphatase

  • Serum alkaline phosphatase – increased if bone metastasis

  • Bone scan – metastasis

  • MRI, CT scan


Treatment prostate ca
Treatment – Prostate CA Reproductive Processes

  • Radiation, chemo, surgical removal

    • Radical perineal prostatectomy – removal of prostate, surrounding tissues, lymph nodes – inguinal area

    • Urethra is anastomosed to the bladder

    • Urostomy

  • Bilateral orchiectomy (removal of testes)

  • TURP

  • Estrogen therapy – inhibits serum testosterone = contradicts

  • Agonists of LH – estrogen

  • Radioactive seed implant – rectally


Nsg interventions prostate ca
Nsg interventions – Prostate CA Reproductive Processes

  • BPH interventions

  • Be supportive – expect feminization, more emotional, educate

  • Gynecomastia – enlargement of the breast

  • Control pain – terminally ill = hospice, palliative care


Malignant neoplasms testicular cancer
Malignant Neoplasms: Reproductive ProcessesTesticular Cancer

  • Although it accounts for only 1% of all cancer in men, it is the most common cancer in young men between the ages of 15 and 35.

  • Essential for clients to learn TSE (testicular self-examination). – monthly

    • During shower

  • Five-year survival rate is 95%.

  • Management same as prostate cancer


Assessment
Assessment Reproductive Processes

  • Subjective data

    • Heaviness in scrotum

    • Weight loss

    • Scrotal pain

    • Emotional and educational needs

    • Anxiety or depression

  • Objective data

    • Palpation of abdomen and scrotum – enlarged

    • Gynecomastia – enlarged breasts

    • Mass in testes

    • Drainage, swelling, hemorrhage – post-op


Malignant neoplasms testicular cancer1
Malignant Neoplasms: Reproductive ProcessesTesticular Cancer


Malignant neoplasms penile cancer
Malignant Neoplasms: Reproductive ProcessesPenile Cancer

  • A rare cancer that has a high correlation with poor hygiene and delayed or no circumcision.

  • Males with a history of STDs are also predisposed to developing penile cancer.

  • Symptoms include a painless, nodular growth on the foreskin, fatigue, and weight loss


Penile cancer
Penile cancer Reproductive Processes

  • Surgery – primary treatment

  • Penectomy – removal of the penis

  • Urostomy – suprapubic or perineal

  • No catheterization


Crytorchidism
Crytorchidism Reproductive Processes


Hydrocele
Hydrocele Reproductive Processes

  • Collection of amber fluid within the testes, tunica vaginalis, and spermatic cord

  • Painful

  • Swelling

  • Discomfort in sitting and walking

  • Treatment: aspiration (usually in children)

    • Inject a sclerosing solution – decrease the swelling

  • Hydrocelectomy – remoal of the sac

  • Nsg Interventions:

    • Preoperative and postoperative management

    • Scrotal support (elevation)

    • Supportive to parents/patient


Hypospadias
Hypospadias Reproductive Processes

Classes of hypospadias by location of the meatus.

  • (A) Anterior, on the inferior surface of the glans penis.

  • (B) Coronal, in the balanopenile furrow.

  • (C) Distal, on the distal third of the shaft.

  • (D) Penoscrotal, at the base of the shaft in front of the scrotum.

  • (E) Scrotal, on the scrotum or between the genital swellings.

  • (F) Perineal, behind the scrotum or genital swellings.

Abnormal placement of the urethral opening

Tx: repair of the foreskin, surgery


Spermatocele herniation protrusion
Spermatocele – herniation, protrusion Reproductive Processes

-non-tender cyst, epididymis, rete testis

Contains milky fluid and sperm


Varicocele
Varicocele Reproductive Processes

  • Vein- dilation

  • Spermatic cord = Vas deferens

  • Occurs when incompetent or absent valves in the spermatic venous system permits blood to accumulate and increase hydrostatic pressure

  • Hyperthermia – decrease spermatogenesis = fertility

  • Bluish discoloration

  • Wormlike mass


Torsion of the spermatic cord
Torsion of the spermatic cord Reproductive Processes

  • Abnormal scrotal pain

  • Scrotal edema

  • Nausea & vomiting, sl. Fever

  • Treatment:

  • immediate surgery to untwist the cord, suturing of the testicle to the scrotum


Impotence
Impotence Reproductive Processes

  • The inability of an adult male to have an erection firm enough or to maintain it long enough to complete sexual intercourse.

  • Three types: functional (psychosocial factors); atonic (result of medications and disease) and anatomic (Peyronie’s disease, which causes development of nonelastic, fibrous tissue just beneath the penile skin).


Peyronie s disease
Peyronie’s disease Reproductive Processes

  • Fibrous plaque

    • Can not penetrate vagina

  • Atonic impotence

    • Antihypertensive, sedatives, antidepressants, tranquilizers, nicotine, drugs & alcohol

    • Diabetes, vascular neurological disorder

  • Functional

    • Decreased libido

Sx – silicone cylinder flexible or inflexible

Hydraulic implant, has pump


Infertility
Infertility Reproductive Processes

  • Causes of infertility in males include varicoceles, cryptorchidism, impaired sperm, insufficient number of sperm, and hormonal imbalance.

  • Tight-fitting underwear and use of hot tubs or saunas may decrease the sperm count.

  • Treatment includes counseling, medications, circulatory aids, and surgery.


Contraception
Contraception Reproductive Processes

  • Contraceptive options available to males include abstinence, coitus interruptus - withdrawal, condoms, or voluntary surgical sterilization (vasectomy)

  • Coitus – sexual intercourse


Vasectomy
Vasectomy Reproductive Processes

  • http://www.vasectomymedical.com/features/vasectomy-videos.html


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