1. Male Genitourinary Disorders
Janet Frascella MSN,Ed,RN

2. Male Reproductive System
Normal Anatomy & Physiology includes:
2 testicles
Ductal System: epididymis, ductus deferens, and ejaculatory ducts
Accessory Glands: seminal vesicles, prostate gland, and bulbourethral or cowper’s glands
External Genitals:urethra and penis

3. Male Reproductive System

4. Male Reproductive System: Prostate
Sits at base of bladder
Wraps around upper part of urethra
Purpose: provide secretions for semen, aid in ejaculation
Does not secrete hormones

5. The Male Reproductive System
The male reproductive organs are shared with the urinary tract.
Disorders of one system often effects the other system.
A male patient who has a disorder or dysfunction of the reproductive tract is often treated by a urologist.

6. Changes That Occur With Aging
Prostate enlargement may occur with risk of urethral obstruction.
Decrease in sperm production, but fertility remains intact.
After the age of 60, cycle of sexual response lengthens.
Sexual activity in the older man is closely related to his sexual activity in younger years.

7. Reversible Contraception
Involves the use of spermicidal creams, gels, or foams applied before intercourse to kill sperm in the vagina.
These are more effective when used with a condom.
Latex condoms provide some protection against sexually transmitted infections (STIs).

8. Permanent Contraception
Vasectomy-sterilization of the male.
Surgical procedure performed on the vas deferens for the purpose of interrupting the continuity of the duct.
Considered permanent but occasionally a vasectomy with microsurgery.

9. Vasectomy Performed on an outpatient basis. Local anesthesia is used.
Incision made into the scrotal sac on each side and vas is lifted out.
Instruct patient to use ice applications and acetaminophen or ibuprofen for scrotal pain and swelling for the first 12 to 24 hours post-op.
2 negative sperm counts are needed for patient to be considered infertile.

10. Male Genitourinary Disorders
Prostate Disorders:
Prostatitis- inflammation of the prostate gland
can occur anytime after puberty
chronic, acute or a single episode
Three types:
1. Acute bacterial
2. Chronic bacterial
3. Nonbacterial

11. Digital Rectal Exam
Physician inserts a lubricated, gloved finger into the rectum to evaluate the size and consistency of the prostate and to detect any nodules.
Should be done yearly after the age of 50.

12. Diagnostic Testing
Semen analysis-patient provides a semen specimen, which is analyzed for volume and for sperm count motility.
Testicular self-exam (TSE)-encouraged regularly for early detection of cancer.
Prostate-specific antigen (PSA) level-blood test, level above 10 may be indicative of cancer.

13. Diagnostic Testing
Prostate tissue analysis(biopsy)-sample tissue or fluid is aspirated and samples sent for pathology.
Testosterone level-need to obtain a morning sample because testosterone levels are highest in the morning. High levels may indicate a testicular tumor.

14. Disorders of the Male Reproductive System
Erectile Dysfunction (ED)- also known as impotence.
Inability to achieve or maintain an erection that is firm enough for sexual intercourse more than 25% of the time.
ED has both psychological and organic causes.

15. Erectile Dysfunction Treatment: Depends on the cause.
Medical conditions are treated, hormone therapy, vascular surgery may be indicated for blood flow obstruction.
Primary intervention for ED is reversing the problem.

16. Erectile Dysfunction Treatment
Erectile dysfunction drugs such as, Viagra, Cialis. (Should not be taken with cardiac problems)
Penile implants.
Priapism-persistent abnormal erection that can develop into a medical emergency.

17. Disorders of the Male Reproductive System
Infertility:
Approximately 25% to 30% of infertility causes may be due to male factors.
Testicular disorders are the most frequent cause of male infertility.
Drugs, infections, systemic disorders can cause testicular failure.
Semen analysis and sperm count is performed.

18. Hydrocele
A larger than normal amount of fluid between the testis and the tunica vaginalis within the scrotum.
The fluid accumulation may be caused by infection.
Hydrocele causes enlargement of the scrotum, usually painless but the weight and bulk of the fluid can cause discomfort.

19. Hydrocele

20. Testicular Torsion Twisting of the testes and the spermatic cord.
Commonly caused by elevated hormone levels in young men or the result of scrotal trauma.
S/S include sudden acute scrotal pain and absence of cermasteric reflex (retraction of the testicles when the inner thigh is stroked)

21. Testicular Torsion Diagnosis is made by ultrasound.
Treatment is emergency surgery to remove the testicle.

22. Peyronie’s Disease
Condition in which a plaque of nonelastic fiberous tissue develops in the tunica portion of the penis.
The penis will curve upward when an erection occurs.
Erection may be painful.
Treatment is conservative, may be treated with injections to dissolve plaque.

23. Benign Prostatic Hyperplasia
Signs/Symptoms:
Symptoms related to obstruction include:
Decrease in size or force of urinary stream
Difficulty starting a stream
Dribbling after urination is thought to be completed
Urinary retention
Feeling that the bladder is not empty
Interrupted stream-(urine stops mid stream and then starts again)

24. Benign Prostatic Hyperplasia
Narrowing causes an obstruction and may lead to urinary retention and eventually distention of the kidney with urine (hydronephrosis)
No known cause other than normal aging
Men over 50, more commonly in men over 70

25. Benign Prostatic Hyperplasia
Complications:
Hydronephrosis - urine back-up into kidneys
Renal insufficiency
Urosepsis

26. Benign Prostatic Hyperplasia
Diagnostic Tests:
Medical history is important
Digital rectal exam (DRE)
Urinalysis
BUN & creatinine
(PSA) - prostate-specific antigen level - this will be elevated (normal = less than 4.0)
Urodynamic flow studies - assesses urine flow rate
Transrectal ultrasound, cystoscopy

27. Benign Prostatic Hyperplasia
Treatment:
Antibiotics for UTI
Indwelling or intermittent catheter
Encourage Fluids
Alpha-adrenergic antagonists - used to relax smooth muscle of the prostate, Ex. Flomax, Hytrin and Cardura

28. Benign Prostatic Hyperplasia
Surgical Treatment:
(TURP)-Transurethral resection - most used to relieve obstruction caused by an enlarged prostate
(TUIP)-Transurethral incision of the prostate,
incision into the gland to relieve the obstruction
(TULIP)-Transurethral ultrasound-guided lasar- induced prostatectomy used to relieve obstruction

29. Benign Prostatic Hyperplasia
Surgical Treatment:
Radical Prostatectomy - removal of the entire prostate gland when the gland is very large, is causing obstruction, or is cancerous

30. Benign Prostatic Hyperplasia
(TURP)-Transurethral Resection of the Prostate
Patient is anesthetized and surgery is performed with a scope
Resectoscope inserted into the urethra and prostate gland is “chipped away” a piece at a time
Chips are flushed out using an irrigating solution and are sent to lab for analysis
Gland is not completely removed but peeled back like an orange

31. Benign Prostatic Hyperplasia
Post-OP:
Bleeding is common
Foley catheter is left in place
Balloon is overinflated with 30-60mL of sterile water and tightly secured to leg
Creates tamponade to compress the prostate and stop the bleeding
(CBI)-continuous bladder irrigation is usually kept running for the first 24 hours

32. Benign Prostatic Hyperplasia
Complications:
Clot formation
Bladder spasms
Infection
Hemorrhage
Erectile dysfunction

33. Benign Prostatic Hyperplasia
Nursing Interventions:
Closely monitor urinary output, amount, color and presence of clots hourly for first 24 hrs
Encourage patient to drink 2500mL per day unless contraindicated
Monitor for acute pain and bladder spasms and administer analgesics as ordered

34. Cancer of the Prostate
Second most common cause of cancer death in US in men over 60 years of age
Usually slow growing and does not cause a major threat to health or life
Prostate cancer rates are highest in African American men

35. Cancer of the Prostate Risk Factors: Age - usually in men over 65
High levels of testosterone
High fat diet
Immediate family history
Occupational exposure to cadmium (e.g. welding, alkaline battery manufacturing)

36. Cancer of the Prostate Signs/Symptoms:
Rare to have symptoms in early stage
Later symptoms:
Urinary obstruction
Hematuria
Urinary retention
Advanced symptoms (metastatic stage):
Bone pain in back or hip
Anemia, weight loss, weakness

37. Cancer of the Prostate Complications: Difficulty urinating
Bladder or kidney infection
Pain
Bone fractures
Weight loss
Depression
Death if treatment is unsuccessful

38. Cancer of the Prostate Diagnosis:
(DRE)-Digital Rectal Exam, examiner may find a hard lump or hardened lobe
(PSA)-Prostate Specific Antigen-levels will be elevated
(PAP)-Prostatic Acid Phosphatase-will be elevated, this test is indicative of cancer spreading out of the capsule

39. Cancer of the Prostate Treatment - Early Stages:
Testosterone-suppressing medications, e.g.
Lupron, Zoladex
TURP or radical prostatectomy
Combination of medication and radiation

40. Cancer of the Prostate Treatment - Later Stages:
Radical prostatectomy, radiation or implantation of radioactive seeds into the prostate
Bilateral Orchiectomy - surgical removal of thetesticles, (relieves symptoms by blocking testosterone)
Estrogen Therapy
Chemotherapy to help relieve symptoms from spread of cancer

41. Cancer of the Prostate Treatment:
Radical Prostatectomy-reserved for patients with cancer of the prostate or when the gland is too large to resect with a TURP
Post-op - the patient will return with large indwelling catheter in the urethra or may have a suprapubic catheter

42. Cancer of the Prostate Nursing Implications:
Assess catheter for patency and s/s of bleeding
Assess level of pain and medicate as ordered
Assess incision for drainage or s/s of infection
Notify physician of any abnormal findings
Instruct men over the age of 40 to have a yearly DRE of the prostate, men over 50 - PSA

43. Penile Disorders
Phimosis - condition in which foreskin of uncircumcised male becomes so tight that it is impossible to clean the area underneath
Smegma -a cottage cheese-like secretion made by the glands of the foreskin, becomes trapped under the foreskin, becomes an excellent place for the growth of bacteria and yeast (infections)

44. Penile Disorders Treatment: Antibiotics Warm soaks to area
Physician may need to cut a slit in foreskin to relieve pressure and treat infection
Full circumcision if problem continues
Problem is preventable by instructing males who are not circumcised to pull the foreskin back carefully and wash with soap and water

45. Penile Disorders
Paraphimosis - occurs when the uncircumcised foreskin is pulled back during bathing or intercourse and not immediately replaced in a forward position
Result is constriction of the dorsal veins which leads to edema and pain
Requires immediate medical attention to
prevent circulation problems or gangrene

46. Penile Disorders
Cancer of the Penis - has been found in men who have not been circumcised as babies or have acquired the human papillomavirus (HPV)
Tumor looks like a small, round, raised wart
One type of cancer that may be spread to the sex partner (HPV – linked with cervical cancer in female)

47. Penile Disorders Treatment: Circumcision Laser removal of the growth
Cutting away all or part of the penis
Radiation
Chemotherapy
Finding and treating any wart-like tumor in it’s earliest stages is an important part of patient education

48. Cancer of the Testes
Most common solid tumor in men 15 to 40 years of age
Peaks between 20 and 34 years of age
Etiology unknown
Risk factors-family history, mothers use of DES (estrogen preparation once used to prevent spontaneous abortion while pregnant), white race

49. Cancer of the Testes Prevention: **Monthly self-testicular exam !
Signs/Symptoms:
Early warning signs = small painless lump on the side or front of the testes
Swollen scrotum that feels heavy

50. Cancer of the Testes Late Symptoms: Back pain Shortness of breath
Difficulty swallowing
Breast enlargement
Changes in vision or mental status indicate
metastasis

51. Cancer of the Testes Complications:
Emotional complications - fear of cancer and death
Loss of masculine body image and sexual function
Dealing with pain
Metastasis to lungs, abdomen, lymph nodes

52. Cancer of the Testes Diagnostic Tests: Ultrasound of the testes
Chest x-ray to look for spread to lungs
Scan of lymph nodes, liver, brain and bones
Blood is drawn for tumor markers (some tumors secrete chemicals, labs are drawn to see if levels are elevated)
Exploration, biopsy and removal of the testes are done to decide the stage of the tumor

53. Cancer of the Testes Staging of Testicular Tumors:
Stage I - tumor only in the testes
Stage II - tumor spread to groin lymph nodes
Stage III - tumor spread past lymph nodes usually to the lungs (or other organ)

54. Cancer of the Testes Treatment: Depends on the stage of the cancer
All treatment begins with complete removal of cancerous testes, spermatic cord, and local lymph nodes
Stage I-radiation to groin and lymph nodes
Stage II-chemotherapy
Stage III-both radiation and chemotherapy

55. Cancer of the Testes Nursing Interventions: Emotional support
If patient does not have children, encourage to make deposit in sperm bank
Helping patient deal with pain and side effects of chemotherapy/radiation