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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
  • 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:Epididymitis
  • 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: Orchitis
  • 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:Prostatitis
  • 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
  • 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
  • Interventions
    • Analgesic
    • Antibiotic
    • Procaine = anesthetic
    • Stool softeners
    • Digital massage – rectally – release infected fluid
benign prostatic hyperplasia
Benign Prostatic Hyperplasia
  • 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
  • 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
slide11
TURP
  • 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
  • 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
  • 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
  • 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:Breast 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:Breast 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:Prostate 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
  • 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
  • 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
  • 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
  • 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:Testicular 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
  • 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 penile cancer
Malignant Neoplasms:Penile 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
  • Surgery – primary treatment
  • Penectomy – removal of the penis
  • Urostomy – suprapubic or perineal
  • No catheterization
hydrocele
Hydrocele
  • 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

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

-non-tender cyst, epididymis, rete testis

Contains milky fluid and sperm

varicocele
Varicocele
  • 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
  • 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
  • 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
  • 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
  • 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
  • Contraceptive options available to males include abstinence, coitus interruptus - withdrawal, condoms, or voluntary surgical sterilization (vasectomy)
  • Coitus – sexual intercourse
vasectomy
Vasectomy
  • http://www.vasectomymedical.com/features/vasectomy-videos.html