Male Reproductive System

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Male Reproductive System

• Linda Harmon

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Male Reproductive System

• Several organs serve as parts of both the urinary
  tract and the reproductive systems.
• The structures are the tests, the vas deference
  and the seminal vesicles, the penis, certain
  accessory glands, such as the prostate and
  Cowpers gland..
• Disorders in these organs may interfere with the
  function of either or both systems.
• Diseases are usually treated by a urologist.

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Health History and Assessment

• Changes in urinary function and symptoms of
  obstruction caused by an enlarged prostate
• Changes in physical activity
• Sexual function and any manifestations of sexual
  dysfunction
• Factors that affect sexual functioning (stress,
  physical disease, use of medications, drugs, or
  alcohol)

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Physical Examination

• Digital-Rectal Exam
• Recommended for every man over the age of 40
• Assess the size, shape, and consistency of the
  prostate
• Screening for cancer of the prostate
• Testicular Exam
• The male genitalia are inspected for
  abnormalities
• Note nodules, masses, or inflammation
• Instruct the patient about the technique for TSE

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Diagnostic Studies

• Prostate-Specific Antigen
• The prostate gland produces a substance known as
  Prostate-Specific Antigen (PSA). This is measured
  in the blood and increases in prostate cancer. It
  needs to be drawn prior to a rectal exam or
  urinary catheterization.
• Ultrasound
• Transrectal ultrasound studies are used in
  detecting nonpalpable prostate cancers and in
  staging localized prostate cancers,. Needle
  biopsies of the prostate are commonly guided by
  ultrasound. Ultrasounds are more sensitive than a
  digital rectal exam.

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Diagnostic Studies

• Prostate Fluid or Tissue Analysis
• A biopsy may be necessary to obtain tissue for
  histologic examination. This can be done with a
  prostatectomy or via a perineal or transrectal
  needle biopsy.
• Test of Male Sexual Functioning
• Usually conducted by a special team of health
  care providers.

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Medications Associated with Erectile Dysfunction

• Antiadrenergics and antihypertensives
• Anticholinergics and phenothiazines
• Antiseizure agents
• Antifungals
• Antihormone
• Antipsychotics
• Antispasmodics
• Anxiollytics

• Betablockers
• Calcium channel blockers
• Carbonic anhydrase inhibitors
• H2 antagonists
• Nonsteroidal anti-inflammatory drugs
• Thiazides diuretics
• Tricyclic antidepressant

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Conditions of the Prostate
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Prostatitis

• Inflammation of the prostate gland caused by
  infectious agents or other conditions
• Clinical manifestations perineal discomfort,
  burning, urgency, frequency and pain with or
  after ejaculation, fever, chills, rectal or low
  back pain, urinary tract infections.
• Complications swelling, urinary retention,
  epididymitis, bacteremia, pyelonephritis.

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Prostatitis

• Management avoid complications, broad spectrum
  antibiotic agent, bed rest, analgesic agents,
  antispasmodics, bladder sedatives, sitz baths.
  Chronic is difficult to treat.
• Nursing Management antibiotics, comfort
  measures, analgesics, sitz baths, teaching.
• Self care administration of antibiotics, sitz
  baths, fluids encouraged but not forced, foods
  and liquids with diuretic action or that increase
  prostatic secretions should be avoided.

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Benign Prostatic Hyperplasia

• Enlargement of the prostate, extending upward
  into the bladder and obstructing the outflow of
  urine by encroaching on the vesical orifice.
• BPH is one of the most common pathologic
  conditions in men over 50
• Cause is uncertain
• Hypertrophied lobes cause incomplete emptying and
  urinary retention.

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Benign Prostatic Hyperplasia

• Manifestations frequency, nocturia, urgency,
  hesitancy, abdominal straining, decrease in
  volume and force of stream, interruption of
  stream, dribbling, urinary retention, recurrent
  UTI, fatigue, anorexia, nausea, vomiting,
  epigastric discomfort.
• Medical Management Plan is dependent on cause,
  severity and condition. Immediate, hormonal,
  pharmacological, surgical

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Cancer of the Prostate

• The most common cancer in men.
• Prostate cancer rates twice as high in African
  American men. They are more likely to die than
  men in any other racial or ethnic group.
• Risk factors increasing age, African American,
  familial predisposition, diet high in red meat
  and fat

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Cancer of the Prostate

• Manifestations urinary obstruction, difficulty
  and frequency, retention,decrease in size and
  force of stream, painful ejaculation, hematuria,
  late signs include backache, hip pain, perineal
  and rectal discomfort, anemia, weight loss,
  weakness
• Diagnosis Early detection increases likelihood
  of cure. Over 40 requires a digital rectal exam
  (DRE) early cancer may be detected as a nodule
  within the substance of the gland or as an
  extensive hardening in the posterior lobe.
• Men with prostate cancer experience sexual
  dysfunction before the diagnosis is made.

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Cancer of the Prostate

• Medical Management based on the stage, age,
  symptoms. Surgical management, radiation therapy,
  hormonal therapy, others.
• Surgical Procedures the procedure chosen depends
  on the size of the gland, the severity of the
  obstruction, the patients age, physical status,
  presence of associated diseases, and patient
  preference.
• Complications hemorrhage, clot formation,
  catheter obstruction and sexual dysfunction.

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Prostatectomy

• Assessment BPH or Cancer how has it affected
  lifestyle, presenting urinary problem, family
  history, physical condition.
• Nursing Diagnosis Preop anxiety, acute pain,
  knowledge deficit Postop acute pain, knowledge
  deficit
• Potential complications hemorrhage and shock,
  infection, deep vein thrombosis, catheter
  obstruction, sexual dysfunction.

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Prostatectomy

• Planning and Goals Preop- reduced anxiety and
  knowledge about disorder and postop experience.
  Postop fluid volume balance, relief of pain and
  discomfort, ability to perform self-care
  activities and absence of complications.
• Preop Nursing Interventions reduce anxiety,
  relieve discomfort, provide instruction, prepare
  patient.

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Prostatectomy

• Postop Nursing Interventions
• Fluid Balance carefully monitor intake and
  output including irrigation, observe for
  electrolyte imbalance, elevated blood pressure,
  confusion and respiratory distress.
• Pain Relief determine cause and location,
  obstruction may require irrigation, walk but do
  not sit for prolonged periods.

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Prostatectomy

• Monitoring and managing complications
• Hemorrhage drainage normally reddish-pink then
  clears to light pink within 24 hours after
  surgery.
• Infection first by MD, use aseptic technique.
  Avoid rectal thermometers, rectal tubes and
  enemas, monitor for fever chills, sweats, etc.
• Deep Vein Thrombosis high incidence of DVT and
  pulmonary embolism,
• Obstructed Catheter observe for distention,
  restlessness, cold sweats, pallor, drop in blood
  pressure and increase pulse rate.
• Complications after catheter removal
  incontinence
• Sexual Dysfunction related to erectile
  dysfunction , decreased libido and fatigue.

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Prostatectomy

• Promoting home and community based care.
• Length of stay depends on type of surgical
  procedure performed.
• Instruct on how to manage drainage system, assess
  for complications, promote recovery.
• Teach about bladder control issues, perineal
  exercises, and avoiding activities that produce
  Valsalva effects.
• Teach signs and symptoms of complications such as
  bleeding, clots, decrease in stream, retention or
  infection.

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Prostatectomy

• Evaluation
• Preoperatively
• Reduced anxiey
• Pain and discomfort reduced
• Understanding of procedure and postop course
• Postoperatively
• Relief of discomfort
• Fluid and electrolyte balance
• Self-care measures
• Free of complications

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Conditions Affecting the Testes and Adjacent
Structures
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Testes and Structures

• Undescended Testis (Cryptorchidism)
• Congenital condition, failure of one or both
  testes to descend into the scrotum.
• Treated by orchiopexy
• Orchitis
• Inflammation of testes caused by pyogenic, viral,
  spirochetal, parasitic, traumatic, chemical or
  unknown factors. (Mumps)
• Treatment directed at infecting organism, rest,
  scrotal elevation, icepacks, antibiotics analgesia

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Testes and Structures

• Epididymitis
• Infection of the epididymis may be due to
  infected prostate or urinary tract, complication
  of gonorrhea. Chlamydia trachomatis
• Treatment of organism, bed rest, scrotal
  elevation,antimicrobial agents, cold compresses,
  avoid straining , lifting and sexual stimulation.

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Testes and Structures

• Testicular Cancer
• Most common cancer in men 15 to 35, highly
  treatable and usually curable
• Treatment dependent on type of cancer.
• Risk factors undescended testis, family
  history, race and ethnicity (Caucasian American
  men 5 times greater than African American and
  double the risk of Asian American) ,occupational
  hazards

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Testes and Structures

• Manifestations mass or lump, generally painless,
  heaviness in scrotum, backache, abdominal pain ,
  weight loss, general weakness. Tend to
  metastasize early.
• Diagnosis monthly Testicular Self Examinations
  (TSE), human chorionic gonadotropin and
  alpha-fetoprotein and tumor markers that may be
  elevated in those with testicular cancer.

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Testes and Structures

• Medical Management
• Orchiectomy with gel-filled prosthesis.
  Retroperitoneal lymph node dissection, radiation,
  chemotherapy, long term side effects.

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Testes and Structures

• Hydrocele
• a collection of fluid in the tunica vaginalis of
  the testes
• Varicocele
• Abnormal dilation of the veins of the pampiniform
  venous plexus in the scrotum
• Vasectomy
• Legation and transaction of part of the vas
  deferens with or without removal of a segment of
  the vas deferens.

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Conditions Affecting the Penis
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Penis

• Hypospadias and Epispadias
• Congenital anomalies of the urethral opening
• Phimosis
• A condition in which the foreskin is constricted
  so that it cannot be retracted over the glans,
  can occur congenitally or from inflammation and
  edema. Correctable by circumcision.

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Penis

• Cancer of the Penis
• Mostly in uncircumcised men.
• Appears as a painless, wartlike growth or ulcer.
• Bowens Disease is a form of squamous cell
  carcinoma in the situ of the penile shaft.
• Prevention is circumcision in infancy
• Treatment by excision, topical chemotherapy,
  radiation, partial or total penectomy.

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Penis

• Priapism
• An uncontrolled, persistent erection of the penis
  that causes the penis to become large, hard, and
  painful.
• Peyronies Disease
• Buildup of fibrous plaques in the sheath of the
  corpus cavernosum. When erect, curvature occurs.

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Penis

• Urethral Stricture
• A condition in which a section of the urethra is
  narrowed.
• Treatment involved dilation of the urethra or
  urethrotomy.
• Circumcision
• The excision of the foreskin, or prepuce,of the
  glans penis. Usually performed in infancy