Genital-Urinary System Male Reproductive System

Behavioral Objectives By the end of this lecture the student will be able to: Review the anatomy and physiology of the genito-urinary systems Describe the physical assessment of the GU systems Discuss the application of the nursing process as it relates to patients with disorders of the GU system Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following GU disorders: Prostatitis, Orchitis Prostaic hypertrophy Prostatic neoplasms Discuss the nursing interventions in pre and post-operative care of patients undergoing the following GU system surgeries: Prostatectomy By the end of this lecture the student will be able to: Review the anatomy and physiology of the genito-urinary systems Describe the physical assessment of the GU systems Discuss the application of the nursing process as it relates to patients with disorders of the GU system Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following GU disorders: Prostatitis, Orchitis Prostaic hypertrophy Prostatic neoplasms Discuss the nursing interventions in pre and post-operative care of patients undergoing the following GU system surgeries: Prostatectomy

Introduction Several organs are both urinary tract and reproductive system Disease of male reproductive system are usually treated by an urologist. Review the anatomy and physiology of the genito-urinary systems Brunner and Suddarth’s Medical Surgical Nursing pg 1486 Several organs are both urinary tract and reproductive tract Disorders of the reproductive tract may interfere with the other (and visa-versa) therefore disease of the male reproductive system are usually treated by an urologist

Anatomy & Physiology Brunner and Suddarth’s Medical Surgical Nursing Volume 2 Ch. 49 pg 1739 - 1776 Review the anatomy and physiology of the genito-urinary systems Brunner and Suddarth’s Medical Surgical Nursing pg 1486 Several organs are both urinary tract and reproductive tract Disorders of the reproductive tract may interfere with the other (and visa-versa) therefore disease of the male reproductive system are usually treated by an urologist

Testes Descend into peritoneum in the last month of fetal life, Paired Ovoid Smooth Firm – not soft Encased in the scrotum i temp Testes are formed in the embryo within the abdominal cavity near the kidneys and in the last month of fetal life, they descend into the peritoneum and into the scrotum (maybe even later) Accompanied by lymph tissue, nerves, ducts and support tissue which all make up the “spermatic cord” -- like a bungee jump and bungee cord. Paired Ovoid Smooth Firm – not soft Testes are encased in the scrotum, which keeps the at a slightly lower temperature than the rest of the body

Spermatogenesis What is Spermatogenesis? Formation of Sperm Spermatozoa Immature sperm Collecting tubules Transmit the spermatozoa in the epididymis The scrotum location facilitates spermatogenesis The testes consist of numerous tubules in which the spermatozoa form (immature sperm) Collecting tubules transmit the spermatozoa in the epididymis (a hood-like structure lying on the testes and containing winding ducts that lead into the vas deferens. Testes have two functions Formation of spermatozoa Secretion of the male sex hormone - testosterone

Testes Testes have two functions Formation of spermatozoa Secretion of the male sex hormone - testosterone

Vas deferens (ductus deferens) Tube upward  abd. cavity downward  base of the bladder Firm tubular structure passes upward through the inguinal canal to enter the abdominal cavity behind the peritoneum. It then extends downward toward the base of the bladder.

Seminal vesicles It acts as a reservoir for testicular secretions The tract is continued called the ejaculatory duct – Passes through the prostate gland and enters into the urethra Seminal vesicles An out-pouch of the vas deference is the seminal vesicle. It acts as a reservoir for testicular secretions. The tract is continued called the ejaculatory duct – Passes through the prostate gland and enters into the urethra

Accessory glands Prostate gland Location: Function: below the neck of the bladder Surrounds the urethra Function: Secrets chemicals to help spermatozoa Accessory glands Prostate gland Lies just below the neck of the bladder. It surrounds the urethra and is traversed by the ejaculatory duct This gland produces a secretion that is chemically and physiologically suitable to the needs of the spermatozoa in their passage from the testes Cowper’s gland / bulbourethral gland (bul-bo-urethral) Lies below the prostate within the posterior aspect of the urethra This gland empties its secretions in to the urethra during ejaculation, providing lubrication.

Accessory glands Cowper’s gland / bulbourethral gland Location Below the prostate Function Lubrication for sperm (bul-bo-urethral)

Penis Dual function Copulation Urination Urethra Tube carries urine & semen Opens at the tip of the glans Penis Dual function Copulation Urination The urethra, the tube that carries urine and also semen, opens at the tip of the glans The glans is naturally covered or protected by elongated penile skin – foreskin, which may be retracted to expose the glans. Many men have had the foreskin removed - circumcision

Penis The glans Covered penile skin – foreskin Retracted to expose the glans. Circumcision Foreskin removal

Physical Assessment Brunner and Suddarth’s Medical Surgical nursing pg 1742-1744 Private and personal, develop a relationship of trust. Begin with the less sensitive info  more sensitive (i.e. sex practices, STD’s etc.)

Health History Evaluate urinary & sexual function Frequency Force of stream, “double” or “Triple” voiding Dysuria Hematuria Hematospermia blood in the ejaculate semen/sperm Medications Diuretics Psychotropic agents Anti-hypertensives Diagnosis DM HTN Smoking Begins with an evaluation of urinary function and symptoms Also a focus on sexual function Increased urinary frequency Decreased force of stream, “double” or “Triple” voiding (urinating several times over a period of a few minutes to completely empty bladder) Dysuria Hematuria Hematospermia – blood in the ejaculate semen/sperm Use of medications Diuretics, Psychotropic agents Anti-hypertensives Diagnosis – DM/HTN Smoking

Physical Assessment Digital Rectal Examination (DRE) > 40 yrs Annually Prostate gland Size, shape and consistency Digital Rectal Examination (DRE) Recommended for every man over age 40 The DRE enables the examiner to assess the size, shape and consistency of the prostate gland Sit in front of the standing patient Use a glove Check the penis, scrotum and testes

Physical Assessment Testicular exam Monthly (self) Abnormalities & masses Testicular examination Inspected for abnormalities and palpated for masses Testicular self examination - monthly

Physical Assessment Prostate Specific Antigen h PSA level is = ?prostate Cancer? h PSA  Prostate pathology screen BPH Prostatitis Foley catheter DRE does not cause Increase in PSA PSA Prostate Specific Antigen A specific glucoprotein that is detected only in the epithelial cells of the prostate Increase PSA level is indicative of prostate Cancer Increase in PSA  Prostate pathology – not always cancer! BPH Prostatitis Foley catheter DRE does not cause Increase in PSA Blood test

Small group questions: Describe the path a spermatozoa takes from formation to ejection What are the male sex hormones and where are they formed? What type of doctor would a man see if he is having sexual dysfunction? While assessing the testes what would be normal findings? Describe the path a spermatozoa takes from formation to ejection Testes  epididymis  Vas deferens  Seminal vesicles  (Prostate gland & cowper’s gland)  Urethra  penis  glans  What are the male sex hormones and where are they formed? Testosterone - testes What type of doctor would a man see if he is having sexual dysfunction? Urologist While assessing the testes what would be normal findings? Paired, ovoid, smooth, firm

4. What are the male accessory glands and what are their purposes? 5. Describe the purpose of a DRE, Testicular exam and PSA screen. How often should men have these screens done? What are the male accessory glands and what are their purposes? Prostate  chemical for spermatozoa passage Cowper’s  lubricating for ejaculation 5. Describe the purpose of a DRE, Testicular exam and PSA screen. How often should men have these screens done? DRE  Annually after 40 Testicular exam  monthly PSA  Annually after 50 (40 if high risk group)