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Male Reproductive System. Chapter 48 10/20/08. Anatomy of the Male Reproductive System. The male reproductive system consists of the scrotum, testes, epididymis, vas deferens, seminal vesicles, prostate gland, ejaculatory duct, internal urethra, and penis. Scrotum .

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male reproductive system

Male Reproductive System

Chapter 48

10/20/08

anatomy of the male reproductive system
Anatomy of the Male Reproductive System
  • The male reproductive system consists of the scrotum, testes, epididymis, vas deferens, seminal vesicles, prostate gland, ejaculatory duct, internal urethra, and penis
scrotum
Scrotum

A thin sac that encloses each of the two testicles in separate compartments.The scrotum contracts into thick folds during fear, anger, arousal, or cold,drawing the testes close to the body for protection and insulation.

slide5

The two testes (Testicles) are the male reproductive organs.

  • They are composed of numerous tubules that produce spermatozoa and sex hormones.
  • The testicles develop in the embryo at about the 7th week of gestation.
  • They descend into the scrotum during the last 2 months of gestation.
  • At around 10 to 13 years of age, during puberty, the increased production of testosterone results in the production of sperm and the development of body hair, muscle mass, and other secondary sex characteristics.
epididymis
Epididymis
  • Newly developed sperm move from each testicle through the epididymis, acoiled tubule almost 20 feet long.
vas deferens
Vas Deferens
  • As mature sperm leave the epididymis, they enter the vas deferens, which aretubes that serve as the primary storage sites for sperm and help propel themature sperm into the urethra during ejaculation.
seminal vesicles
Seminal Vesicles
  • Hollow, twisted, tubular secretory glands located on the posterior side of the bladder.
  • They produce a mucoid fluid that constitutes about 60% of the volume of semen and provides nutrients and hormones important for motility and successful fertilization.
prostate gland
Prostate Gland
  • A walnut-sized fibromuscular gland that surrounds the neck of the urinarybladder and the first inch of the internal urethra.
  • It produces a thin, milky, alkaline liquid that enhances the motility and fertility of the sperm and contracts to propel semen into the urethra during ejaculation
cowper s glands
Cowper's Glands
  • Pea-sized structures, located just below the prostate, that secret a clearmucous into the urethra. The secretion provides lubrication during sexualarousal.
urethra
Urethra
  • The urethra extends from the bladder to the urinary meatus at the end of thepenis. Although the urethra serves to empty urine from the bladder andprovide outflow for semen during ejaculation, urine and semen are never in the urethra at the same time.
penis
Penis
  • The external penis in its flaccid state is a soft, round cylinder ending in an acorn-shaped tip known as the glans.
  • The glans has a sensitive ridge at its base called the corona that gives rise to a hood or foreskin.
  • About one half of the penis extends within the body toward the anus and attaches to the pelvis.
  • Two corpora cavernosa lie on the upper side of the penis.
  • These erectile chambers provide a huge surface area for the inflow of blood and blood storage, which results in expansion of the penis during sexual arousal,called an erection.
spermatogenesis
Spermatogenesis
  • Sperm are produced in the testes from about age 13 throughout the remainderof life.
  • Testosterone is believed to set in motion the division of germinal cells into spermatocytes, which develop into sperm.
  • The process may take 75 days.
slide16

The function of the scrotum is essential for spermatogenesis.

  • An increase in testicular temperature may cause degeneration of some of the cells and may contribute to sterility.
slide17

Cryptorchidism, or failure of the testicles to descend from the abdomen into the cooler scrotum, may result in sterility.

  • If fetal testes do not secrete enough testosterone to cause the testicles to descend, surgical intervention is unlikely to be successful.
  • The tubular epithelium of the testes thatremain in the warm abdomen degenerates completely and is incapable of producing sperm.
erection
Erection
  • For the penis to become erect, it must have a high pressure supply of arterial blood, a means of relaxing the smooth muscle tissue of the cavernosal arterioles, and a functioning blood storage mechanism to keep the blood in the penis long enough for sexual function.
  • The blood pressure in the flaccid corpus cavernosa is about 6 to 8 mm Hg--very low when compared with the 120/90 mm Hg blood pressure in the arm or cavernosal artery.
slide19

During sexual arousal, parasympathetic nerves release neurotransmitters that cause the cavernosal arteriole walls to relax.

  • This increases the blood volume of the penis to 8 to 10 times the flaccid volume.
  • The elastic limitations severely decrease the drainage of blood from the chamber sinuses and maintain erection.
  • After stimulation ceases or ejaculation occurs,sympathetic nerves release constricting neurotransmitters that narrow the arteriole walls and decrease the inflow of blood.
  • The penis returns to flaccid state.
emission and ejaculation
Emission and Ejaculation
  • Emission is the result of sympathetic stimulation leaving the spinal cord at L1 and L2.
  • Physical stimulation of external and internal sex organs initiatescontractions of the vas derferens and prostatic capsule.
  • The contractions move sperm to the ejaculatory ducts and expel them into the internal urethra.
  • The filling of the urethra excites nerves in the sacral region of the spinal cord to initiate rhythmic muscular contractions of the internal genital organs, pelvis, and body trunk and results in ejaculation of semen.
age related changes
Age-Related Changes
  • Assessment of the male reproductive system should include information onchanges in the patient's health, sexual function, and sexual relationships,as well as patient's knowledge level and ability for self-care. Establishinga comfortable relationship with the patient is most successful when usingopen-ended questions.
health history
Health History
  • If the symptoms are acute, detailed information about the onset anddevelopment of the problem and about activities related to the symptomsshould be documented.
  • Medications should be noted because many drugs, including antihypertensives, can impair sexual function.
  • Past medical history, family history and a complete review of systems with a focus on male reproductive system as well as functional assessment will be performed
physical examination
Physical Examination
  • The physical examination is usually done by a physician or nursepractitioner.
  • The patient is instructed to empty the bladder before the examination and to collect a urine specimen if needed.
  • The skin of the external organs and perineum should be warm, dry, and free of lesions. edema, and odor.
scrotum24
Scrotum
  • The left testicle hangs lower than the right.
  • Both should be oval in shape, smooth, firm, and without masses or tenderness.
  • It is important, especially in the young patient, to note that there are two testes.
  • If abnormalities are discovered, they can be further investigated by shining a light through thescrotum in a darkened room (transillumination).
  • Hydrocele, a mass filled with serous fluid, glows red in the light. If the mass is solid(e.g., a hematocele or tumor), no light passes through it, making it appear as a dark shadow.
laboratory diagnostic tests page 1083
Laboratory & Diagnostic TestsPage 1083
  • Semen Analysis
  • Endocrinologic Studies
  • Urinalysis
  • Blood Studies
  • CT
  • Ultrasound
  • Table 48-1~Laboratory Tests
  • Chart ~The Male Reproductive System~ Page 1086
laboratory studies
Laboratory Studies
  • Analysis of the semen may be done to assess male fertility or to documentsterilization after a vasectomy.
  • The patient is instructed to abstain fromsexual activity for 2 to 3 days and then collect a semen specimen in a cleancontainer.
  • The specimen should be kept at room temperature protected form heat or cold and brought to the lab within one hour
  • Gross evaluation of semen for volume, thickness, color and pH as well as sperm count , motility , shape and ability to penetrate cervical mucous will be examined.
  • Discourage patients from prolonged abstinence because it may result in diminished quality and motility of the sperm.
endocrinologic studies
Endocrinologic Studies
  • The endocrine system secretes hormones directly into the blood that regulate metabolism, growth, stress response and reproduction.
  • Testosterone is secreted by Leydig cells in the testes.
  • Below-normal levels of testosterone may be the result of hypothalamic or pituitary dysfunction orseminiferous tubule destruction.
  • The causes of increased levels of testosterone in the adult male are testicular tumor, adrenal tumor, adrenal dysfunction, and some drugs (anticonvulsants, barbiturates).
  • Testosterone levels fall with age, beginning around age 30.
endocrinologic studies28
Endocrinologic Studies
  • Follicle-stimulating hormone (FSH) is secreted by the anterior pituitary gland and causes stimulation of Stertoli cells in the testes to complete theformation and maturation of sperm.
  • Luteinizing hormone (LH) is secreted bythe anterior pituitary gland and causes stimulation of Leydig cells in the testes to produce testosterone.
  • Prolactin, another hormone secreted by theanterior pituitary gland, has a potentiating effect on testosterone production.
tumor markers
Tumor Markers
  • Tumor markers are substances found in the serum of cancer patients.
  • Prostate-specific antigen (PSA) is used as a screening tool to detect prostate cancer.
  • Annual PSA screening is recommended for all men after age 50 (high risk age 40).
  • There is no special preparation for this test.
general laboratory studies
General Laboratory Studies
  • Blood studies may include a CBC in forming a diagnosis when anemia or bone metastases are suspected.
  • Alkaline phosphate and serum calcium levels also may be measured because they increase with metastasis to the bone.
  • The acid phosphate level also may be increased with prostate cancer and with bone metastasis.
radiologic imaging studies
Radiologic Imaging Studies
  • A CT may be used in assessing metastatic testicular and prostate tumors.
  • Ultra sound may be used to examine scrotal masses or define prostatic lesions.
  • Examination of the prostate is done via the rectum.
slide33

Radionuclide imaging may be done to assess testicular abnormalities such as torsion, tumors, abscesses, epididymitis or hydrocels.

  • Radioactive substances are injected intravenously or given orally.
  • After a waiting period to allow for distribution of the substance throughout the body, scans are done to locate organs and tissues that have increased concentrations of the isotopes due to abnormal tissue metabolism.
infections and inflammatory conditions
Infections and Inflammatory Conditions
  • The most common inflammatory conditions are prostatitis and epididymitis.
  • Orchitisis rare, but important because it can cause sterility.
prostatitis
Prostatitis
  • An inflammation of the prostate gland.
  • There are four categories of prostatitis: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomaticinflammatory prostatitis.
  • Inflammation caused by bacterial infection can beacute or chronic.
  • The patient who has prostate pain but no evidence ofinfection is said to have chronic prostatitis/chronic pelvin pain syndrome.
  • When no pathogens can be detected, the condition is classified as asymptomatic inflammatory prostatitis.
slide38

A 4 week course of antibiotics usually is prescribed for acute bacterialprostatitis, and up to 16 weeks of therapy for chronic bacterial prostatitis (Bactrium/Cipro)

  • Chronic prostatitis/chronic pelvic pain syndrome may be treated with a shortcourse of antibiotics, but it often is ineffective.
  • Anti-inflammatory drugsor opiod analgesics may be used.
slide39

The patient is advised to increase fluid intake and to rest.

  • Stool softners may be prescribed to prevent constipation, which is especially painful withprostatitis.
  • Urethral catherization is contraindicated with urethralinflammation, but suprapubic catherization may be necessary if the patient has difficulty voiding.
slide40

Asymptomatic inflammatory prostatitis may be treated with a single daily doseof an alpha-adrenergic blocker to improve voiding by relaxing the bladderneck and prostate.

  • Symptoms are managed with analgesics, anti-inflammatory agents, and sitz baths.
  • Prostate massage and ejaculation may be helpful with some types of prostatitis because they drain excess prostatic secretions.
epididymitis
Epididymitis
  • An inflammation of the epididymis. Signs and symptoms are painful scrotaledema, nausea, vomiting, chills, and fever.
  • Epididymitisis treated with bedrest, ice packs, sitz baths, analgesics, antibiotics, anti-inflammatory drugs, and scrotal support.
  • A bridge made of tape and gauze or a rolled towel can be placed across the patient's thighs while in bed to elevate the scrotum and reduce pain.
orchitis
Orchitis
  • An inflammation of one or both of the testes. It may be related to trauma orto infections such as mumps, pneumonia, or tuberculosis.
  • Signs and symptoms include fever, tenderness and swelling of the affected testicle, and scrotal redness. The inflammation can lead to reduced fertility or sterility.
bph hyperplasia page 1088
BPH (Hyperplasia)Page 1088
  • Benign prostatic hypertrophy is enlargement of the prostate gland.
  • It is a common age-related change, the exact cause is unknown.
  • Diagnosis is based on rectal examination, laboratory and radiographic studies, endoscopy, ultrasound, catheterization for residual urine and sometimes urodynamic testing.
signs and symptoms
Signs and Symptoms
  • Signs and symptoms of BPH are described as obstructive or irritative.
  • Obstructive symptoms include decreasing size and force of the urinary stream,urine retention, and post-void dribbling.
  • Irritative symptoms include urgency, frequency, dysuria, nocturia, hematuria, and sometimes urge incontinence.
  • Factors that may trigger retention are alcohol, infections, delayed voiding, bed rest, opiods, antihistamines, and chilling.
slide46

Consider the alternative--Saw Palmetto effectively relieves urinary symptomsassociated with BPH without reducing the size of the prostate. Also, itreduces serum levels of PSA, which could give a false-negative result inpatients with prostate cancer.

medical treatment
Medical Treatment
  • 5-alpha reductase inhibitors suppress prostatic tissue growth by decreasingtestosterone levels > Finasteride (Proscar)
  • Alpha-adrenergic blocking agents are used to relax smooth muscle in thebladder neck and prostate, thereby reducing obstruction to urinary flow >tamsulosin (Flomax) terazosin (Hytrin)
surgical invasive treatments
Surgical/Invasive Treatments
  • In general, invasive procedures involve surgical removal of all or part ofthe prostate (prostatectomy) or ablation (destruction) of prostate tissue.
types of prostatectomy
Types of Prostatectomy
  • The most widely used surgical procedure is the transurethral resection of the prostate (TURP), in which obstructing portions of the gland are cut away through a resectoscope inserted into the urethra.
  • There is no external incision. Atriple-lumen urinary catheter commonly is used to maintain continuous irrigation and bladder drainage
slide50

A suprapubic prostatectomy is performed through the bladder by way of a lowabdominal incision.

  • This may be selected when the prostate is very large or when there are also bladder abnormalities that require surgical correction.
  • Some patients develop incontinence or erectile dysfunction.
slide51

A retropubic prostatectomy employs a low abdominal incision on the front ofthe prostate. The bladder is not cut.

slide52

A perineal prostatectomy requires an incision between the scrotum and theanus to gain access to the prostate.

alternative invasive procedures
Alternative Invasive Procedures
  • These employ heat to destroy selected prostate tissue or laser incision andvaporization of prostate tissue. Stents can be placed to prevent obstructionof urine flow.
complications
Complications
  • Urinary infections
  • Incontinence
  • Hemorrhage
  • Urinary leakage
  • Inflammation of the pubic bone
  • Erectile dysfunction
  • Retrograde ejaculation
interventions for the patient with bph
Interventions for the patient with BPH
  • Impaired Urinary Elimination- Instruct the patient to void promptly when theurge is felt and to space fluid intake throughout the day.
  • Fluid restriction is not recommended because it increases the risk of UTI.
  • The patient should avoid alcohol and antihistamines.
nursing care of the prostatectomy patient
Nursing Care of the Prostatectomy Patient
  • Inspect urine, dressings, and wound drainage for excess bleeding.
  • Maintain careful records of fluid intake and output to avoid over distention of the bladder.
slide58

Risk for Fluid Volume Deficit-

  • Restlessness and an increasing heart rate are early signs of fluid volume deficit.
  • Blood in the urine is expected forseveral days; however, the drainage should be light pink within 24 hours.
  • Bleeding with clots can signal hemorrhage and must be reported immediately to the physician.
  • Continuous bladder irrigation helps prevent clot formation
slide59

Monitor for acute pain (may give antispasmodics ~ analgesics)

  • Monitor for infection ~ strict aseptic technique
  • Assess for injury related to renal complications
  • Monitor self esteem
  • Pt teaching very important ( see teaching plan page 1093)
slide60

Urge Urinary Incontinence

  • Urinary incontinence or dribbling is common immediately after the catheter is removed.
  • In most cases, control can beimproved with perineal exercises.
  • Instruct the patient to contract and relax perinealmuscles 10 to 20 times each hour.
  • Some patients never regain fullcontrol of urination.
erectile dysfunction impotence
Erectile Dysfunction (Impotence)
  • An adequate erection requires intact neurologic function, sufficient inflowof blood to fill the corpus cavernosa, and a leak-proof storage mechanism formaintaining the erection.
contributing factors
Contributing Factors
  • A number of vascular, neurologic, endocrine, and psychological factors may cause or contribute to ED.
vascular disorders
Vascular Disorders
  • Systemic or local changes in blood flow can impair the ability to achieve an erection.
  • Generalized atherosclerosis may be a factor in inadequate filling of the corpus cavernosa.
  • Many modifiable factors contribute to the development of atherosclerosis: High cholesterol levels, smoking, excessive alcohol consumption, illicit drug use, and inadequate exercise.
  • The cavernosal artery in the perineum between the scrotum and the anus may be damaged by physical injury to the pelvis, falls on the crossbar of a bike, horseback riding, or other blows.
endocrine disorders
Endocrine Disorders
  • Patients with diabetes mellitus are at risk for ED due to atherosclerosis andautonomic neuropathy.
  • Approximately 50% of men who have diabetes develop ED, making diabetes the most common cause of ED.
  • Atherosclerosis may be accelerated by diabetes.
slide65

Autonomic neuropathy in patients with diabetes affects the ability of nervesto relax the smooth muscle surrounding the tiny sinuses of the erectilechambers (which means, adequate filling with blood for an erection may not be possible)

slide66

Vascular surgery to clear blocked arteries is not usually recommended forpeople with diabetes.

  • Penile implants may be recommended for people with problems of failure to initiate (nerve damage) or failure to fill (artery damage). As many as 1/3 of penile implant patients have diabetes.
  • Figure 48-8 page 1094
slide67

Sildenafil (Viagra) is an oral drug that may be effective.

  • Papverine plus phentolamine self-injection is indicated as a treatment for failure toinitiate or fill and has been widely accepted.
  • Alprostadil is available in an injectable form and as a pellet that is inserted into the urethra.
  • Patients need training in self-injection and must have hand dexterity and adequatevision.
neurologic disorders
Neurologic Disorders
  • Spinal cord injuries and other neurologic disorders may cause ED.
  • The more complete the injury and the lower the injury, the more likely it is that erection will be affected.
medication side effects
Medication Side Effects
  • Medications used to treat a variety of conditions may cause or contribute to ED.
  • Antihypertensives are the most likely to interfere with erection.
  • Antihypertensives that lower the blood pressure in all the arteries of the body may reduce the blood pressure in penile arteries to the extent that failure to fill occurs.
  • Digoxin may increase levels of estrogen and decrease levels of testosterone
  • Medications for stomach ulcers, such as cimetidine, and anticancer may decrease libido; anticholenergics and antihistamines may block neurotransmitters that cause relaxation of smooth muscle.
psychological factors
Psychological Factors
  • Psychogenic erectile dysfunction is often the result of anxiety aboutperformance.
  • Anxiety may cause constriction of smooth muscle tissue in the penis and its arteries, reducing inflow and increasing outflow of blood from the penis, leaving it flaccid.
consider the alternative
Consider the Alternative
  • Siberian ginseng and Ginkgo biloba are herb that some believe increase penile blood flow.
  • Therapies that may be used alone or with traditional medications to treat erectile dysfunction include acupuncture, aromatherapy ( with essential oils of sandalwood, rose, jasmine, and ylangylang), imagery, biofeedback, and progressive relaxation.
drug therapy
Drug Therapy
  • Phospodiesterase Type 5 Inhibitors- Viagra, Cialis, and Levitra are oral vasodilators that may be prescribed for failure to fill or store.
  • They must be prescribed with care in patients with cardiovascular disease because of the risk of myocardial infarction and sudden death.
  • They are contraindicated in patients taking nitrate vasodilators or alpha-adrenergic antagonists due to risk of hypotension and cardiovascular collapse.
drug therpay
Drug Therpay
  • Alprostadil- Caverject and MUSE are vasodilators, too, but produce a morelocalized effect
drug therpay74
Drug Therpay
  • Papaverine- Self-injected drug that increases blood flow to the penis.Erection is acheived within 10 to 15 minutes and lasts 30 to 60 minutes.
drug therpay75
Drug Therpay
  • Testosterone- Testosterone replacement for men with low hormone levels may be recommended for decreased desire and failure to initiate.
vacuum constriction devices
Vacuum Constriction Devices
  • The flaccid penis is slipped into a cylinder, and then the patient squeezes a pump that removes all of the air from the space in the cylinder around the penis, creating a vacuum that draws blood into the penis.
  • When the erection has been achieved, a rubber ring is slipped off the bottom of the cylinderonto the penis near the base, trapping blood safely for up to about 30 minutes.
revascularization
Revascularization
  • Surgical procedure that bypasses blocked arteries, removes or ties off incompetent veins, and tightens the surrounding tissue.
penile implants
Penile Implants
  • Semirigid implants are silicon cylinders placed in the erection chambers that keep the penis firm at all times but without increasing the circumference.
  • Some models are inflexible and create problems concealing the erection, but others are flexible enough that they can be bent downward and more easily concealed.
  • Hydraulic implants have cylinders that can be inflated by squeezing a pump in the scrotum or at the end of the penis behind the glans.
nursing care of the patient with ed
Nursing Care of the Patient with ED
  • ED may be the first sign of diabetes mellitus, so a complete exploration ofthe patient's general health and family history to look for diabetes isimportant.
  • The management of erectile dysfunction requires sensitivity and knowledge.
  • Listen and be careful not to dismiss the issue as unimportant
  • Provide factual information
peyronie s disease
Peyronie's Disease
  • Peyronie's disease is the development of a hard, nonelastic, fibrous tissue(plaque) just under the skin of the penis. The plaque is usually located onthe dorsal midline surface of the penis and results in an upward bending ofthe penis during erection that may be painful and interfere with successfulvaginal penetration.
medical treatment83
Medical Treatment
  • Treatment of Peyronie's disease may include topical or oral medications withvitamin E and other components.
  • Local radiation, injections into the lesions, ultrasound, and surgical correction are also options
  • Choice of treatment depends on the size to the plaque and the degree of curvature and dysfunction
priapism
Priapism
  • A prolonged penile erection that is not related to sexual desire.
  • Priapism may be caused by many factors including injury to the penis, sickle cell crisis, and neoplasms of the brain or spinal cord.
  • Prolonged priapism can interfere with blood flow to the penis.
  • It can also obstruct urine flow, causinghydronephrosis. this erection may be very painful and constitutes an emergency situation.
  • Failure to resolve the problem within 12 to 24 hours may result in penile ischemia, gangrene, fibrosis, and erectile dysfunction.
medical treatment86
Medical Treatment
  • Immediate removal of blood may be accomplished by aspirating blood from the erectile chambers or by injecting drugs that cause contraction of smooth muscle, inhibiting inflow of blood and allowing outflow.
  • Emergency surgery my be needed.
  • Understanding the condition and alleviating pain are important.
  • Can be very embarrassing for the patient
phimosis
Phimosis
  • Normally the penile foreskin can be retracted, exposing the glans.
  • Inflammation under the foreskin, often associated with poor hygiene, causesedema that may prevent retraction of the foreskin.
  • It is treated with antimicrobials and proper cleansing.
  • Uncircumcised men need to retract the foreskin for cleaning as part of daily hygiene.
infertility
Infertility
  • Infertile is a term used to describe couples who have had unprotectedintercourse over a 12 month period and have been unable to become pregnant.
etiology and risk factors
Etiology and Risk Factors
  • Male infertility may be related to endocrine disorders, testicular problems,or abnormalities of the ejaculatory system. Correction of endocrine disordersmay restore fertility.
infections
Infections
  • Mumps may result in acute orchitis and epididymitis, accompanied by fever and debilitating pain, bilateral swelling, and redness of the testicles. If damage to seminiferous epithelium occurs, the size of the testes will be reduced.
slide92

Genitourinary tract infections can cause infertility in males.

  • Chlamydia trachomatis is sexually transmitted and is most commonly limited to the urethra and causes varying degrees of painful urination and discharge.
  • Neisseria gonorrhea is a common urethral infection. It is sexually transmitted and may cause extremely painful urination and a purulent discharge.
  • Infections that ascend to the epididymis may result in decreased fertility
cryptorchidism
Cryptorchidism
  • Defined as any testis located in other than a dependent scrotal position.
  • Cause is generally unknown
  • The abdominal cavity is warmer than the scrotum.
  • Excessive warmth can damage the seminiferous epithelium of undescended testes and result in decreased spermatogenesis.
slide94

Cryptorchidism must be corrected within the first 18 months of life to give the best chance for fertility.

Men with undescended testes have a 10 to 30 times higher incidence of testicular cancer, even if the condition is corrected.

Whether medical or surgical therapy is indicated, it is performed after the first birthday and before the second birthday.

testicular torsion
Testicular Torsion
  • This occurs unilaterally when the testicle is mobile and the spermatic cord twists, cutting off the blood supply to the testicle.
  • It is an acute surgical emergency requiring immediate release of the torsion or removal of the testicle.
  • Symptoms are intense pain, often accompanied by nausea and vomiting.
  • After testicular torsion is corrected, lowered sperm counts and infertility may follow.
  • There is sometimes a collateral effect on the healthytesticle.
  • After the testicle that underwent torsion is removed, sperm counts are normal.
varicocele
Varicocele
  • This is a lengthening and enlargement of the scrotal portion of the venous system that drains the testicle.
  • Most often, only the left testicle is affected
vasectomy
Vasectomy
  • Vasectomy is the surgical removal of a portion of the vas deferentia.
  • It is usually performed as an outpatient procedure in a physician's office or outpatient clinic.
  • Postoperative pain or swelling can be managed with application of an ice bag, mild analgesics, and scrotal support.
  • The patient can resume intercourse as soon as he feels comfortable.
  • It is important that he use other methods of birth control until analysis of the semen determines that there is complete absence of sperm.
  • The patient can expect the analysis to be done after about 15 ejaculations following the vasectomy.
penile cancer
Penile Cancer
  • Penile cancer is relatively rare and occurs almost exclusively inuncircumcised men.
  • Risk factors include chronic irritation, poor hygiene, a history of multiple sexual partners, sexually transmitted infection, and long term tobacco use
  • Cancer may appear as a dry wart-like, painless growth on the penis that does not respond to antibiotic therapy.
  • Extensive resection or amputation and resection of nearby lymph nodes may be necessary
testicular cancer
Testicular Cancer
  • Testicular germ cell carcinoma most often occurs in young men between theages of 18 and 34 years.
  • The three established risk factors for this type of cancer are crytorchidism, white race, and previous testicular cancer.Patients most often present with hard, painless tumors.
early detection
Early Detection
  • Self-examination and early diagnosis offer the highest chance of findingearly-stage disease and subsequent cure.
  • Men need to be educated about theneed for self-examination.
testicular exam
Testicular Exam
  • The examination is best done after a warm bath or shower, when he is warm and the scrotum is relaxed.
  • The scrotum is held in the palm of his hands with theindex and middle fingers on the underside of the testicle and the thumb on top.
  • The left testicle is usually lower than the right.
  • The testicles are egg-shaped and should feel firm but not hard, and smooth without lumps.
  • The epididymis, located on the top and posterior side of each testicle, feels soft and spongy.
  • The spermatic cords are smooth, firm, tubular structuresthat run upward from the testicles on the back side.
medical diagnosis
Medical Diagnosis
  • Diagnostic procedures include ultrasound and blood studies to measure tumor markers: alpha-fetoprotein and human chorionic gonadotropic.
medical treatment109
Medical Treatment
  • Dependant on type of cancer and the stage
  • Orchiectomy, radical orchiectomy, radiation, chemotherapy
  • Sperm banking my be necessary
  • Follow-up includes monitoring tumor marker levels and radiographicexaminations of lymph nodes for a period of 5 years from diagnosis.
interventions
Interventions
  • Acute Pain- There is no pain in the early stages of testicular cancer. If thedisease is advanced or if the patient has undergone surgery or radiotherapy,pain may be a problem.
  • Anxiety – produces threats to self image and esteem
  • Impaired Urinary Elimination- patient may have a catheter
slide111

Risk for Injury- Some patients with testicular cancer undergo radicalretroperitoneal lymph node dissection. These patients have extensive surgicalincisions and usually need intensive nursing care initially. As with any majorabdominal surgery, the patient is at risk for shock, infection, bowel andbladder dysfunction, and fluid and electrolyte imbalances

  • Constipation- Encourage ambulation and diet with fiber when permitted
slide112

Situational Low Self-Esteem- After radiotherapy, the patient's sperm counttypically declines at first but usually returns to normal by 2 to 3 yearsafter treatment is completed.

  • Deficient Knowledge- Individualized teaching is essential
prostatic cancer
Prostatic Cancer
  • Cancer of the prostate is found on postmortem examination in 30% of men over the age of 50.
  • The cause is unknown.
  • The risk factors include over 50 years of age, African-American race, overweight, ingestion of a high-fat diet, and family history of prostate cancer.
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Medical Diagnosis
  • Prostatic lesions are typically slow-growing and confined to the prostatic capsule.
  • Prostatic tumors may go undetected until the disease is advanced and has metastasized to bone or liver.
  • Large tumors may cause bladder outlet obstruction, rectal pressure, stool changes, painful defecation, or painful ejaculation.
  • American Cancer Society recommends that all men over age 50 undergo annual digital rectal examinations and that PSA blood tests be done annually beginning at age 50.
  • If a diagnosis of prostate cancer is made, additional procedures may be done to identify the stage of the disease.
  • These may include radiographs, radionuclide imaging, bone scans, excretory urography, transurethral ultrasound, CT and MRI.
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Medical Treatment
  • Using PSA as a tumor marker has allowed earlier identification and treatmentof prostatic cancer.
  • PSA is a product of prostatic tissue.
  • It is extremely important to measure this antigen during the follow-up of patients who have undergone treatment.
  • PSA can be free or bound to plasma proteins.
  • Prostate cancer cells produce more bound than free PSA.
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Sometimes "watchful waiting" is recommended for patients with a life expectancy of less than 10 years.

  • The patient is monitored frequently, andtreatment is initiated if the tumor begins to enlarge. Cryoablation, freezing of prostatic tissue, is used mainly to treat prostate cancer.
  • However, it is associated with a significant incidence of postoperative complicationsincluding necrosis.
  • Most operations include removal of the pelvic lymph nodes to check for metastasis.
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Radiation alone often is effective when the cancer is confined to the prostate.

  • Radiation can be delivered by external beam or by implanting seeds (brachytherapy) of radioactive gold, iodine, or iridium in the prostatethrough hollow needles inserted under anesthesia.
  • The radioactive seeds affect surrounding tissues less than external beam radiation.
  • Patients often have some urinary symptoms of irritation or obstruction after the seeds areimplanted.
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Many men elect drug therapy over the surgical option.

  • Types of drugs used in hormonal therapy include estrogen, luteinizing hormone-releasing hormone (LHRH) agonists, and androgen receptor blockers.
  • Estrogen decreases production of testosterone, inhibits LH secretion, and blocks circulating testosterone.
  • It is used less often now than in the past because of itsadverse effects, including blood clots, heart failure, and breastenlargement.
  • Lluteinizing releasing hormone analogues inhibit the release of pituitary hormones necessary for testosterone production.
  • They are given IM or Sub Q.
  • With initial therapy, patients may experience bone pain, which resolves over time.
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The adverse effects of all these agents can include hot flashes and ED.

  • Other drugs that may be used that reduce testosterone production in the adrenals are spironolactone (Aldactone), aminoglutethimide (Cytadren), andgluccocorticoids.
  • Hormonal therapy is usually effective for a limited periodof time, generally 1 to 3 years.
  • Bone pain and fractures are complications ofprostate cancer.
  • Bisphosphonatessuch as alendronate (Fosamax) may be ordered to help relieve bone symptoms.
nursing care of the patient with prostatic cancer
Nursing Care of the Patient with Prostatic Cancer
  • Encouragement to have annual screening
  • Stress the value of early diagnosis and treatment
  • Specific individualized interventions needed for bladder spasms, erectile disturbances associated with the changes in the reproductive system