1. Male Reproductive Disorders
Understanding Med-Surg Nsg. Ch.43
Pharmacology Clear and Simple, Ch 20
Intro. To Maternity & Pedi Nsg.
Objectives:
Explain the pathophysiology associated with male GU & reproductive disorders.
Discuss the etiologies, S&S and treatments for prostate, testicular, and penile disorders,
Explain causes for erectile dysfunction & infertility.
Describe pathogens involved with each of the common STDs.
Discuss preventions and treatments for STDs.
Explain nursing interventions that are effective.

2. Anatomy Review
Testes (testicles)-The 2 oval testes _______ are enclosed in the ________, a sac-like structure which lies suspended from the exterior abdominal wall. This position keeps the temperature in the testes below normal body temperature which is necessary for viable sperm production and storage. Each teste contains 1-3 coiled ________ tubules that produce the sperm cells. The testes also produce the hormone________which is responsible for the development of male secondary sex characteristics.

3. Ductal System
The __________is a tightly coiled tube structure that lies superior to the testes and extends posteriorly. With sexual stimulation, the walls of the epididymis contract forcing the sperm along the __________ tubules of the testes to the __________ _________.
The ______ _________ is approximately 18 inches long and rises along the posterior wall of the testes. As it moves upward, it passes through the _________canal into the pelvic cavity and loops over the urinary bladder.

4. Accessory Glands
Produce seminal fluid and include the________ ________, __________, and _________ _________. With each ejaculation of 2 to 5 ml, 200 to 500 million sperm are released.
The _______ _________ are paired structures that lie at the base of the bladder and produce 60% of the volume of semen. The fluid is released into the ejaculatory ducts to meet with the sperm.

5. Accessory Glands Con’t
The _________ gland is doughnut-shaped and surrounds the neck of the bladder and urethra. A firm structure about the size of a chestnut composed of muscular and glandular tissue. The ejaculatory duct passes obliquely through the posterior part of the gland. The ________often hypertrophies with age, expanding to surround the urethra thus making voiding difficult.

6. Accessory Glands Con’t.
There are 2 pea sized glands under the male urethra known as ________ glands. They provide lubrication during intercourse.

7. AGE RELATED ∆’S
Testosterone production declines after age 50 (male climacteric)
Slower to arouse with longer period between erections
Spermatogenesis lasts entire life
Chronic medical diseases (HTN, DM), medication

8. Lifestyle issues: Dietary habits Alcohol consumption Obesity
AGE RELATED ∆’S WHICH MAY CONTRIBUTE TO A LOSS OF SATISFACTORY SEXUAL EXPERIENCE
Lifestyle issues:
Dietary habits
Alcohol consumption
Obesity

9. Male Assessment History Medication Use Family History Personal Habits
Health Promotion
Mental Health
Circulatory
Respiratory
Gastrointestinal
Musculoskeletal
Neurological
Metabolic/Endocrine
Genitourinary
Sexual Practices

10. Physical Examination
Clinical Breast Exam
Penis Glans and Shaft
Scrotum
Testes
Spermatic Cord
Inguinal Ring & Lymph Nodes
Digital Rectal Examination

11. Diagnostics
1. Testicular Biopsy- a means to detect abnormal cells and the presence of sperm. Can be done by aspiration or through an incision. The anesthetic used depends on the choice of technique.
Post Biopsy- Nursing Care
Scrotal Support
Ice pack
Analgesics as ordered
Warm sitz baths may be helpful
Call MD if bleeding occurs

12. Diagnostics Con’t.
2. Semen Analysis-Performed to substantiate the effectiveness of a vasectomy, to detect semen on the body or clothing of a suspected rape victim, and to rule out paternity.
**Is generally the first test to evaluate male fertility.**

13. Diagnostics Con’t.
3. Prostatic Smears- Obtained to detect and identify microorganisms and tumor cells in the prostate.
The physician massages the prostate by way of the rectum, and the patient voids into a sterile container prepared with additive preservative. The specimen is collected and a smear is prepared in the lab
It is possible to detect some cases of cancer and even TB of the prostate gland by this method.

14. Diagnostics Con’t.
4. Cystoscopy-A man’s prostate and bladder can be examined by passing a lighted cystoscope through the urethra of the bladder.
The exam is usually performed without anesthesia but a local anesthetic may be instilled into the bladder.
Cystoscopy can be done for both men and women to detect bladder infections and tumors.

15. Diagnostics Con’t.
5.Digital Rectal Exam (DRE)- palpation of the anus, rectum, and prostate gland with a gloved finger. Used in the diagnosis of intestinal bleeding, anorectal pain, and both benign and malignant diseases of the prostate

16. Diagnostics Con’t.
6. Prostate-Specific Antigen (PSA)- a highly sensitive blood test.
Is normally secreted and disposed of by the prostate; however, it will show up in the blood stream in cancer and a harmless condition known as BPH.
Increased levels means the prostate needs to be checked by a physician.
< 4 is considered normal

17. Peyronie’s disease
The development of fibrous scar tissue inside the penis that causes curved, painful erections.
Symptoms may appear suddenly or may develop gradually.
Scar tissue.
A significant bend to the penis.
Erection problems.
Shortening of the penis.
Pain.

18. TESTICULAR TORSION http://www.youtube.com/watch?v=HBOPY6jjqic
Testicle is mobile & spermatic cord twists
Cuts off blood supply to testicles
Intense pain
Occasional nausea & vomiting
Acute surgical emergency requires immediate release of torsion or
Testicle may be removed

19. PRIAPISM Prolonged penile erection not r/t sexual stimulation
Caused by injury to penis, sickle cell crisis, neoplasms of the brain or spinal cord, drugs
May obstruct blood flow to penis
May be painful
Is an emergency – must be resolved within hr. or may result in penile ischemia, gangrene, fibrosis, or erectile dysfunction

20. TX OF PRIAPISM D/C offending med
Correction of neurological or coagulation problems
Aspiration of blood from erectile chamber
Injection of drugs that cause contractions of smooth muscles, thereby inhibiting inflow of blood & allowing outflow
Emergency surgery

21. PHIMOSIS Inability to retract the penile foreskin
Often caused by inflammation under the foreskin which causes edema
Often related to poor hygiene (smegma)
Treated with antimicrobials & cleansing
Circumcision may be recommended
If able to retract foreskin, but not return foreskin, leads to edema of the glans

22. INFECTIONS & INFLAMMATORY CONDITIONS
Causes: bacteria, viruses, protozoa, fungi, & ectoparasites (through sexual contact)
Most common: prostatitis & epididymitis

23. Prostatitis Etiology Acute Bacterial Chronic Bacterial
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Asymptomatic Inflammatory Prostatitis
Signs and Symptoms
Pain
Urgency
Frequency
Dysuria
Urine Retention
Fever, Chills

24. Prostatitis (cont’d) Diagnosis 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

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

26. EPIDIDYMITIS
Inflammation of the epididymis caused by infection, STD, trauma, or reflux of urine from urethra through the vas deferens
Usually seen in young, sexually active males < 35 yrs. old (STDs usual cause)
May occur in elderly after cystoscopy

27. EPIDIDYMITIS
S&S = painful scrotal edema, nausea, vomiting, chills, & fever
May have dysuria & pyuria
Tx = bedrest, ice packs, sitz baths, analgesics, anti-inflammatory drugs, & scrotal support (to elevate the scrotum)

28. ORCHITIS Inflammation of one or both testes
May be r/t trauma or infection (mumps, pneumonia, or TB)
20% of males who contract mumps develop
S&S = fever, tenderness, swelling of affected testicle, & scrotal redness
May lead to reduced fertility or sterility

29. TX OF ORCHITIS Analgesics Antipyretics Bedrest Scrotal support
Local heat to scrotum

30. Benign conditions of the scrotum
Hydrocele-is an accumulation of fluid between the membranes covering the testicle and the membranes enclosing the testicle.
Usually occurs over the age of 21. The cause is unknown but may be due to trauma, or abnormal lymph drainage from an infection that may be present(Orchitis, Epididymitis).
S/S- The scrotum slowly enlarges as the fluid accumulates. If the fluid accumulates too quickly, pain develops. Usually afebrile with VS within normal limits
Diagnostics-Scrotal/imaging ultrasound is used to identify abnormalities in the testes.
Translumination-a light source shined through the scrotum causes the hydrocele to illuminate.

31. HYDROCELE
Dx – transillumination (shining light through scrotom in a darkened room. Hydrocele glows red)
Tx – surgical excision of sac, pressure dressing, drain, wearing athletic support

32. Hydrocele Con’t.
Treatment-1. Aspiration of the fluid from the sac. The fluid will be a clear amber. This will relieve the pain
2. Bedrest with the scrotum elevated. This is a palliative treatment for the elderly, no cure
3. Surgical excision of the sac is performed to avoid constriction of the circulation of the testes.
Nursing care post-op-There will be a drain present. Assess incision, and presence of the drain. The pt. will have a scrotal support in place. Analgesics. Monitor for infection. Strict I&O!

33. VARICOCELE Dilation & lengthening of scrotal veins (varicosed veins)
Blood pools and veins dilate
Causes a dull ache along the cord
May be visible as bluish discoloration
Tx – scrotal support or surgical ligation of spermatic vein if fertility affected, ice, pain med

34. Benign Prostatic Hyperplasia (BPH)
↑ in # of Cells
Signs & Symptoms
Urinary Retention
Dribbling
Nocturia
Dysuria
Urgency
Diagnosis
DRE
BUN, Creatinine
PSA
Urodynamic Flow Studies
Transrectal U/S
Cystoscopy

35. Therapeutic Interventions
Watchful Waiting
TUMT, TUNA
Surgery
Prostatectomy
Symptom Control
Catheterization
Fluids
Antibiotics

36. Therapeutic Interventions
May prescribe:
Hormone Blockers
testosterone-ablating agents
testosterone-sparing agents
Alpha-adrenergic agents

37. tamsulosin (Flomax)
to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH)
alpha blockers: works by relaxing the muscles in the prostate & bladder so that urine can flow easily.
Swallow capsules whole; do not split, chew, crush, or open
Avoid the use of heavy machinary

38. NURSING IMPLICATIONS FOR CARING FOR A PT POST-TURP
CBI (continuous bladder irrigation):
2 liter bags of NS
Tubing connected to 3 way foley cath
Regulate flow with roller clamp
DO NOT LET IRRIGATION RUN DRY!!!
NOTIFY MD IMMEDIATELY IF URINE NOT DRAINING!!!

39. NURSING IMPLICATIONS FOR CARING FOR POST-TURP cont’d.
Intermittent bladder irrigations – prevents catheter from clotting
Blood clots cause bladder spasms
Catheter is removed when urine becomes clear

40. Prostate Surgery Pre-op Nursing Diagnoses Impaired Urinary Elimination
Knowledge Deficit

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

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

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

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

45. Ineffective Therapeutic Regimen Management
Teach Patient
Catheter Care
Report Signs &Symptoms of UTI
Report ↑ in Bleeding

46. Anxiety: Sexual Function
Explain
Retrograde Ejaculation
Talk with Physician if Erectile Dysfunction Occurs

47. Prostate Cancer Risk Factors Over 65 High Testosterone High Fat Diet
Family History
Occupational Exposures
Incidence rate is 40% higher in African American men

48. Signs & Symptoms Rare in Early Stages Later Stages Urinary Obstruction
Hematuria
Urinary Retention
Advanced
Bone Pain
Anemia
Weakness
Wt. Loss

49. DIAGNOSIS OF PROSTATE CANCER
Digital rectal exam
Needle biopsy
Serologic markers (PSA, prostatic acid phosphatase)
Transurethral U/S with Biopsy
Metastatic Workup- CXR, IVP, CT, MRI, Bone scan

50. Therapeutic Interventions
Early
Testosterone-Suppressing Medications
Later Stages
TURP or Open Prostatectomy
Radiation Therapy
Metastatic
Orchiectomy, Estrogen Therapy
Chemotherapy, Radiation
Radical Prostatectomy

51. Testicular Cancer Risk Factors Cryptorchidism Family History
DES Use by Mother
Caucasian
High Socioeconomic Status

52. Signs & Symptoms Early Painless Lump Swelling Late
Symptoms of Metastasis

53. Diagnosis Ultrasound Chest X-Ray Blood for Tumor Markers Biopsy
Staging

54. Therapeutic Interventions
Surgery
Radiation
Chemotherapy .

55. Nursing Care Teach Testicular Self-Examination
Provide Emotional Support
Discuss Sperm Bank Deposit
Offer CA Support Group

56. Cancer of the Penis Risk Factors Not Circumcised as Baby HPV
Therapeutic Interventions
Surgery
Radiation
Chemotherapy

57. PENILE CANCER Relatively rare, occurs primarily in the glans
Most cases occur in men over 50; 20% in men under 40
Occurs exclusively in uncircumcised men who have chronic irritation & poor hygiene with accumulation of smegma under the foreskin

58. PENILE CANCER
Other risk factors include: Hx of multiple sexual partners, venereal disease, HPV, long-term tobacco use
May appear as dry, wart-like, painless growths that do not respond to antibiotics or skin thickening or accumulation of tissue, ulceration & bleeding, or swollen lymph nodes

59. DIAGNOSIS OF PENILE CANCER
Swelling at end of penis
Biopsy, fine needle aspiration
Ultrasound
CT scan
MRI

60. Penile Cancer Signs and Symptoms
Painless ulcer or growth on the penis
Changes in color, skin thickening or accumulation of tissue
Ulceration and bleeding
A persistent discharge with a foul odor
Swollen lymph nodes

61. TREATMENT OF PENILE CANCER
Surgery
Cryosurgery
Radiation &/or chemo

62. Staging of Penile Cancer
Stage 0-1- disease is limited to the foreskin, can usually be treated with circumcision and removal of a margin of benign skin
Stage II- usually requires a partial or total penectomy with or without radiation therapy
Stage III- total penectomy, and lymph node removal or penectomy followed by radiation therapy
Stage IV- is not considered curable. Rx is palliative

63. Vasectomy Interruption of Vas Deferens
Provides Permanent Birth Control
Effective About 3 Months Following Surgery

64. Erectile Dysfunction
Problem Obtaining or Maintaining Erection

65. Pathophysiology/Etiology
Physical
Circulation
Nerve Supply
Hormone Balance
Limbic System
Psychosocial
Stress
Illness
Fatigue
Alcohol/Drugs

66. Diagnosis History Blood Tests Glucose Testosterone
Evaluation of Circulation
Psychosocial Evaluation

67. Therapeutic Interventions
Medication ∆’s
Oral Medication
Tadalafil
Sildenafil
Vardenafil
Hormone Therapy
Herbal Remedies
Medication
Injection
Transurethral
Devices
Surgery
Implants
Vascular Surgery

68. Nursing Diagnosis
Risk for Ineffective Self Health Management

69. Critical Thinking
Mr. Jones is a 46-y.o. man admitted with exacerbated multiple sclerosis. As you are collecting his admission data, you ask if he is married. He replies, “Yeah, if you can call it that.” 1. How can you respond to his comment? 2. Mr. Jones tells you he has been impotent for more than a year. What additional questions can help you plan his care? 3. What is the nurse’s role in treatment of erectile dysfunction? 4. Mr. Jones tells you that his older brother had testicular cancer several years ago. What teaching should you provide?

70. Infertility Causes Pretesticular Endocrine Testicular Varicocele
Idiopathic
Post-testicular
Surgery

71. Infertility Cigarette smoking Back injury High blood pressure
Cirrhosis of the liver
Diabetes mellitus

72. Diagnosis Sexual Practices Lifestyle Practices Occupation
Medical-Surgical History
Physical Examination
Semen Analysis

73. Therapeutic Interventions
∆’s in Lifestyle Practices
Surgery if Indicated
In Vitro Procedures