Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes

Male Reproductive System Includes conditions that affect reproduction, sexuality, and urinary elimination Patient may experience anxiety and embarrassment Be sensitive to cultural and emotional issues related to sexuality and the genitals to accomplish effective assessment and communication Provide for privacy and education

Structures of the Male Reproductive Tract

Assessment Urinary function and symptoms Sexual function and manifestations of sexual dysfunction Symptoms related to urinary obstruction Increased urinary frequency Decreased force of stream “Double” or “triple” voiding Nocturia, dysuria, hematuria, and hematospermia Medications, drug, and alcohol use Presence of conditions that may affect sexual function (diabetes, cardiac disease, and multiple sclerosis)

PLISSIT Model of sexual assessment and intervention Permission Limited Information Specific Suggestions Intensive Therapy

Physical Assessment Digital rectal exam Testicular exam

Examination of the Prostate

Diagnostic Tests Prostate specific antigen (PSA) Ultrasonography Prostate fluid or tissue analysis Tests of male sexual function

Disorders of Male Sexual Function Erectile dysfunction Psychogenic and organic causes Organic causes include vascular, endocrine, hematological, and neurologic disorders, trauma, alcohol, medications, and drug abuse Chart 49-1 lists classes of medications associated with erectile dysfunction Ejaculation problems Premature ejaculation Retrograde ejaculation

Evaluation and Treatment of Erectile Dysfunction

Medical Management Pharmacologic therapy Oral medications: sildenafil (Viagra) Side effects include headache, flushing, dyspepsia Caution with retinopathy Contraindicated with nitrate use Injected vasoactive agents Complications include priapism (persistent abnormal erection) Urethral suppositories Penile implants Negative pressure devices See Table 49-2

Conditions of the Prostate Prostatitis: inflammation caused by an infectious agent Treatment includes appropriate anti-infective agents and measures to alleviate pain and spasm Benign prostatic hyperplasia (BPH, enlarged prostate) Affects half of men over age 50 and 80% of men over age 80 Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections Treatment Pharmacologic: alpha-adrenergic blockers, alpha- adrenergic antagonists, and antiandrogen agents Catheterization if unable to void Prostate surgery

Prostate Cancer Second most common cancer and the second most common cause of cancer death in men Risk factors include increasing age, familial predisposition, and African American race Manifestations Early disease has few/no symptoms Symptoms include urinary obstruction, blood in urine or semen, and painful ejaculation Symptoms of metastasis may be the first manifestations Early diagnosis is vital; regular health screening is crucial Treatment may include prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy

Prostate Surgery Procedures

Prostate Surgery Procedures (cont.)

Nursing Process—Assessment of the Patient Undergoing Prostatectomy Assess how the underlying disorder (BPH or prostate cancer) has affected the patient’s lifestyle Urinary and sexual function Health history Nutritional status Activity level and abilities

Nursing Process—Diagnosis of the Patient Undergoing Prostatectomy Anxiety Acute pain preoperatively Acute pain postoperatively Deficient knowledge

Collaborative Problems/Potential Complications Hemorrhage and shock Infection DVT Catheter obstruction Sexual dysfunction

Nursing Process—Planning the Care of the Patient Undergoing Prostatectomy Major goals preoperatively include adequate preparation and reduction of anxiety and pain Major goals postoperatively include maintenance of fluid volume balance, relief of pain and discomfort, ability to perform self-care activities, and absence of complications

Relief of Pain Monitor urinary drainage and keep catheter patent Assessment of pain Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter Medication and warm compresses or sitz baths relieve spasms Administer analgesics and antispasmodics as needed Encourage patient to walk but to avoid sitting for prolonged periods Prevent constipation Irrigate catheter as prescribed

Three-Way System for Bladder Irrigation

Interventions Reduce anxiety Be sensitive to potentially embarrassing and culturally charged issues Establish a professional, trusting relationship Provide privacy Allow the patient to verbalize concerns Provide and reinforce information Provide patient teaching including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience

Rehabilitation and Home Care Provide patient and family teaching for home care including care of urinary drainage devices and recognition and prevention of complications Regain bladder continence Regaining control is a gradual process (dribbling may continue for up to one year depending upon the type of surgery) Perineal exercises Avoid straining, heavy lifting, long car trips (for 6 to 8 wks) Diet: encourage fluids and avoid coffee, alcohol, and spicy foods Assess sexual issues and provide referrals as needed

Testicular Cancer Most common cancer in men age 15 to 40 Highly treatable and curable Risk factors: undescended testicles, positive family history, cancer of one testicle, Caucasian American race Manifestations: painless lump or mass in the testes Early diagnosis: monthly testicular self-exam (TSE) and annual testicular exam Treatment: orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy

Testicular Self-Exam

Nursing Management Assess physical and psychological status Support coping ability Address issues of body image and sexuality Encourage a positive attitude Provide patient teaching Provide TSE and follow-up care

Conditions Affecting the Penis Hypospadias and epispadias Phimosis Penile cancer Bowen’s disease Priapism Peyronie’s disease Urethral stricture Circumcision