1. Chapter 90 Male Reproductive Disorders

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

3. 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)

4. Common Medical Treatments
Bladder irrigation
Radiation therapy

5. 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

6. 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

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

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

9. 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.

10. 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

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

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

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

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

15. 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.

16. 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

17. 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

18. 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.

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

20. 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.

21. 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

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

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

24. End of Presentation