Nursing Care of Male Patients with Genitourinary Disorders Chapter 43 Nursing Care of Male Patients with Genitourinary Disorders

Prostatitis Etiology Signs and Symptoms Acute Bacterial Chronic Bacterial Chronic Prostatitis/Chronic Pelvic Pain Syndrome Asymptomatic Inflammatory Prostatitis Signs and Symptoms Pain Urgency Frequency Dysuria Urine Retention Fever, Chills Prevention of prostatitis regular emptying and complete emptying of the bladder to prevent infection; avoid excess consumption of alcohol because it irritates the bladder; avoid high risk sexual practices i.e. multiple partners. All symptoms are acute and need nursing attention, however crisis occurs when the patient is unable to urinate, swollen prostate will prevent the bladder from emptying and therefore set it up for further infection and then the infection will be systemic since the urine possibly backs up into the kidneys.

Prostatitis

Prostatitis (cont’d) Diagnosis Interventions Interventions (cont’d) Digital Rectal Exam Urine Culture EPS Interventions Antibiotics Anti-inflammatory Agents Interventions (cont’d) Stool Softeners Sitz Baths Prostatic Massage Avoid Alcohol and Spicy Foods Surgery

Nursing Diagnoses: Prostatitis Urinary Retention Risk for Ineffective Self-Health Management Acute Pain Anxiety

Benign Prostatic Hyperplasia (BPH) Increase in Number of Cells Signs and Symptoms Urinary Retention Dribbling Nocturia Dysuria Urgency Diagnosis DRE BUN, Creatinine PSA Urodynamic Flow Studies Transrectal Ultrasound Cystoscopy Some emergency situations occur with these patients not having urinated in many hours. First thing to do is to insert a foley ASAP and get the bladder drained. At times this requires the physician to use “sounds” which are steel rods in sequential size that are introduced into the urethra through the prostate bed into the bladder, the sizes increase incrementally until the catheter can be passed.

Enlarged Prostate

Therapeutic Interventions Symptom Control Catheterization Fluids Antibiotics Intervention Watchful Waiting Alpha-Adrenergic Antagonists Hormone Blockers TUMT, TUNA Surgery Watchful waiting is where the patient is followed closely by the practitioner assessing for increasing symptoms that the urethra is becoming constricted. So catheter may be used to drain the bladder and to hold the urethra open. Oral fluids to keep bladder flushed out. ATBX to prevent infection. Alpha blockers may be used as well these relax smooth muscle of the prostate and the bladder neck they block male hormone to prevent tissue growth or to shrink tissue growth, one issue with these is they affect blood pressure and therefore pt is at risk for negative SE r/t hypotension. TUMT is transurethral microwave therapy applies heat directly to the area to prevent growth. TUNA is transurethral needle ablation uses radio waves to destroy part of the gland.

Transurethral Resection of the Prostate Resectoscope into Urethra Overgrown Tissue Chipped Away

Transurethral Resection of the Prostate (TURP) Following the TURP a foley is left in place with a 30-60 mL balloon this offers pressure of a tamponade in the prostate area to assist with stopping the bleeding. Irrigation solution flows continuously to maintain the patency of the catheter and removes any clots or chips of prostate not evacuated at the end of the procedure. Foley is removed when there is no longer danger of a hemorrhage. The removal of the prostate does not cause impotency but may cause erectile dysfunction which can be equated with impotency by the patient. Semen is still produced however it may be decreased and it may not be able to be ejaculated fully or possibly no ejaculate.

Prostate Cancer Most common cancer in American Men Usually over 65 years of age Rare in men under 40 years of age Risk Factors African American (highest rates) American Indian and Alaskan (lowest rates) Occupational exposure to cadmium

Prostate Cancer Signs and Symptoms Rarely occur early stages Latent stages symptoms Urinary obstruction Hematuria Urinary retention Advanced metastatic stages: pain in the back or hip anemia weakness weight loss overall fatigue

Prostate Cancer Complications Bladder problems Difficulty urinating Bladder or kidney infections Erectile Dysfunction Bone fractures Depression Eventual death if treatment is unsuccessful

Prostatectomy

Postoperative Nursing Diagnoses Risk Bleeding Monitor Urine Output and Bleeding Encourage Fluids Teach Patient to Avoid Constipation Lifting Aspirin and NSAIDS

Acute Pain: Bladder Spasm Monitor Pain Irrigate Catheter as Ordered Administer Analgesics, Antispasmodics Teach Relaxation and Deep Breathing

Urge Urinary Incontinence Teach Kegel Exercises Offer Condom Catheter or Pads Encourage to Continue Fluids Discuss Prolonged Incontinence with Physician

Risk for Ineffective Self-Health Management Teach to Avoid (About 6 Weeks) Heavy Lifting Stairs Driving Strenuous Exercise Straining Sexual Activity Aspirin and NSAIDS

PENILE DISORDERS Peyronie’s Disease Priapism Phimosis Curved or crooked look to penis Priapism Painful erection lasting longer than 4 hours. Phimosis Foreskin is retracted and unable to be pulled back over head of penis.

TESTICULAR DISORDERS Cryptorchidism Hydrocele Varicocele Epididymitis Undescended testicle (in infancy) Hydrocele Fluid collected in scrotal sac Varicocele Varicose veins of the scrotum Epididymitis Inflammation of the epididymitis Orchitis Inflammation or infection of the testicle Undescended testicle is a congenital condition usually will drop down in 1-2 months from birth. If not by age 2 surgically brought down. If not reduces his potential for conceiving a child. Hydrocele usually not dangerous, no tx it is eventually reabsorbed unless it causes discomfort, embarrassment, or threat to the blood supply to the testicles, If treated it can be aspirated, or surgically drained. Varicocele may feel like a bag of worms pt may report pulling sensation or dull ache or scrotal ache. Usually occurs on the left testicle r/t the way the scrotal vein enters from the left renal vein. Not usually discovered until searching for fertility issues. Can be surgically repaired. Epididymitis is where the sperms mature before ejaculation. Infection or inflammation can be caused by bacteria, viruses, parasites, chemicals or trauma. R/F include sexual or nonsexual contact, STD, complication of a urological procedure, or reflux of the urine. May be seen with prostate infections. Usually painful the skin is tender, red and warm to touch. Treated with atbx to pt and partner, may require bedrest, elevation of the scrotal sac, ice packs, analgesics. Some symptoms subside in a week, but swelling may last for weeks. Can become chronic can cause an abcess to form and lead to sterility. Orchitis caused by trauma or infection, epididymitis, a UTI, STD or systemic disease like flu, Mono, TB, gout, Pneumonia, Mumps (after puberty) Swollen tender testicles, red scrotal sac, fever. Interventions same as for epididymitis.

TESTICULAR CANCER Most common cancer in men 15-34 years of age in the US. Cause is unknown Risk Factors are: Cryptorchidism, Family History White ethnicity High socioeconomic status.

TESTICULAR CANCER Early detection is the best prevention. Signs and Symptoms Early warning signs: small, usually painless. Lump on the side or front of the testicle. Swollen scrotum and feels heavy Latent symptoms: back pain, shortness of breath, difficulty swallowing, breast enlargement, changes in vision or mental status changes (indicative of metastasis)

TESTICULAR CANCER Staging of testicular tumors Stage I only in 1 testicle Stage II tumor spread to abdominal LN Stage III tumor spread past LN usually to: Lungs, Liver, Bones and/or Brain

TESTICULAR CANCER Treatment based on the stage First complete removal of the cancerous testicle, spermatic cord, and local LN Radiation or Chemo be necessary depending on the stage If found early!! Complete recovery is expected. Require continued follow up and regular testing.

TESTICULAR CANCER Nursing care: first is prevention Teaching young men TSE and to seek treatment at the first changes noted. If diagnosed, teach about banking sperm for future off spring after treatment. Help with expression of feelings and prognosis. Assist with dealing with pain and side effects of treatment