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

2. 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

3. Structures of the Male Reproductive Tract

4. 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)

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

6. Physical Assessment
Digital rectal exam
Testicular exam

7. Examination of the Prostate

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

9. 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

10. Evaluation and Treatment of Erectile Dysfunction

11. 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

12. 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

13. 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

14. Prostate Surgery Procedures

15. Prostate Surgery Procedures (cont.)

16. 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

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

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

19. 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

20. 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

21. Three-Way System for Bladder Irrigation

22. 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

23. 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

24. 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

25. Testicular Self-Exam

26. 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

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