Chapter 90 Male Reproductive Disorders

The Male Reproductive System The male reproductive system is closely linked to the urinary system. For this reason, urologists often treat male reproductive disorders.

Diagnostic Tests Testosterone level Prostate-specific antigen (PSA) Nocturnal penile tumescence (NPT) tests Duplex Doppler ultrasonography Prostatic biopsy Transrectal biopsy Transurethral resection of the prostate (TURP)

Common Medical Treatments Bladder irrigation Radiation therapy

Nursing Process Data collection Urinary and reproductive history, general health history, and history of sexually transmitted infections or exposure Erectile and urinary dysfunction Inspection of external reproductive structures Prostate and testicular examination Planning and implementation Evaluation

Erectile Dysfunction Inability to achieve or maintain an erection sufficient to complete sexual intercourse. Contributing factors Drug use Chronic diseases Endocrine disorders Trauma Cardiovascular disorders Surgery

Erectile Dysfunction (cont’d) Medical and surgical treatment Oral medications Intraurethral suppositories Vasoactive intracorporeal pharmacotherapy Mechanical devices Penile implants Penile revascularization

Question Is the following statement true or false? The incidence of erectile dysfunction increases with age.

Answer True Erectile dysfunction and loss of libido are common in older men, particularly when illness is present. The incidence of erectile dysfunction increases with age. The erection can take longer to achieve, and ejaculation can be less intense with aging—this mainly stems from medication side effects, neuropathy, or vascular problems.

Other Erectile Disorders Priapism Abnormal and persistent penile erection without sexual stimulation Premature ejaculation Ejaculation takes place before, during, or immediately after penetration Peyronie’s disease Accumulation of plaques or scar tissue along the corpora cavernosa, causing a painful curvature of the penis when erect

Structural Disorders Undescended testicle (cryptorchidism) Abnormal urethral placement Hypospadias Epispadias Phimosis Torsion of the spermatic cord Varicocele Hydrocele

Inflammatory Disorders Epididymitis Orchitis Prostatitis Acute bacterial prostatitis Chronic bacterial prostatitis Nonbacterial prostatitis Nursing considerations

Neoplasms Benign prostatic hyperplasia (BPH) The prostate gland enlarges. Primary complications Urinary tract infection Acute urinary retention

Question Is the following statement true or false? A client who experiences an episode of acute urinary retention should try a warm shower.

Answer True If a client experiences an episode of acute urinary retention at home, he can try a warm shower or bath to relax the sphincter muscles. He should allow the urine to flow in the shower or tub. If a shower or bath does not work, he should go to the emergency department for immediate treatment.

Neoplasms (cont’d) Cancer of the prostate Risk factors Age >50 years African American heritage Excessive alcohol use Diet high in animal fats Family history of prostate cancer Environmental exposure PSA elevation

Neoplasms (cont’d) Prostate surgery Preoperative nursing considerations Transurethral resection of the prostate (TURP) Prostatectomy Suprapubic, perineal, nerve-sparing radical, radical Cryosurgery Postoperative nursing considerations

Neoplasms (cont’d) Medical treatments for cancer of the prostate Radiation therapy Radioactive seed implantation Radiation cystitis Proctitis Hormone ablation therapy Pain management in advanced disease Prostate cancer screening may not be desirable or effective for all men.

Question Is the following statement true or false? If a client has prostrate cancer, he should consider the option of removing the affected testicle.

Answer True Prostate cancer needs testosterone to grow. Therefore, removing testosterone will destroy the prostate cancer’s chance of survival and growth. An orchiectomy will simply solve this problem. A partial orchiectomy can also be performed to remove the portion of the testicle that produces testosterone. Orchiectomy has little effect on libido and ability to have an orgasm. However, it may impair fertility.

Neoplasms (cont’d) Cancer of the testes Risk factors include Age 20 to 34 years, Caucasian race History of undescended testicle at birth or of testicular swelling with mumps or of maternal use of oral contraceptives and diethylstilbestrol (DES) during pregnancy Higher social class Unmarried or married late or not sexually active

Neoplasms (Cont’d) Cancer of the testes Testicular tumors Seminoma Nonseminoma Monthly testicular self-examination from early adolescence onward

Neoplasms (cont’d) Cancer of the penis Relatively rare, especially in circumcised men Tends to occur in uncircumcised men who practice poor hygiene

End of Presentation