1. Genital-Urinary System
Male Reproductive System

2. 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

3. 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

4. Anatomy & Physiology Brunner and Suddarth’s Medical Surgical Nursing
Volume 2
Ch. 49 pg
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

5. 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

6. 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

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

8. 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.

9. 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

10. 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.

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

12. 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

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

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

15. 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

16. 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

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

18. 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

19. 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

20. 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)