1. DISORDERS OF THE MALE REPRODUCTIVE SYSTEM

2. Male reproductive system. Organs of the urinary system are also shown.
Male reproductive organs and associated structures are illustrated in Figure 41-4, p. 1177
Scrotum is a fleshy structure suspended below perineum and is divided in two parts containing:
Testis
Two smooth oval endocrine glands suspended in scrotum
Certain cells of the testes produce half a billion sperm each day (spermatogenesis)
Secrete testosterone
Spermatogenesis regulated by FSH, produced by the anterior pituitary glandTestosterone regulated by LH, also produced by the pituitary gland
Epididymis
Sperm mature here then travel through vas deferens
Portion of spermatic cord (vas deferens)
Vas deferens travels up and around the bladder
Carries sperm from epididymis to seminal vesicle
Vesicle is small pouch producing secretions when mixed with sperm and prostatic fluid form semen
Prostate is encapsulated gland that encircles proximal portion of urethra
Prostatic fossa, depression of cranial border of prostate, allows entry of ejaculatory ducts
Within prostrate is cluster of 30 to 50 tubuloalveolar glands that secrete fluid
Common site for disease with aging
Penis is cylindrical organ through which urine and semen is ejaculated
Half the penis is located within the body
External half of penis is flaccid; becomes erect with sexual arousal (engorged with blood)
A fold of skin, prepuce, surrounds tip of penis in the uncircumcised male
Male reproductive system. Organs of the urinary system are also shown.  

3. the testes, the ductal system, the accessory glands and the penis
Overview of Anatomy and Physiology
Organs of the male reproductive system include:
the testes, the ductal system, the accessory
glands and the penis
Functions include: producing and storing
sperm, depositing sperm for fertilization
and developing the make secondary sex
characteristics

4. - 2 oval structures enclosed in the scrotum ( a sac like
Testes (gonads)
- 2 oval structures enclosed in the scrotum ( a sac like
structure that lies suspended fro the abdominal wall).
This position keeps the temperature win the testes below
normal body temperature which is necessary for viable
sperm production and storage.
- Seminiferous Tubules
-each testis contains 1-3 coiled seminiferous tubules
that produce the sperm cells
-Produce testosterone which is responsible for the
development of male secondary sex characteristics

5. -includes the epididymis, rete testes, ductus
Ductal System
-includes the epididymis, rete testes, ductus
deferens (vas deferens), ejaculatory duct and
urethra
-Process: Sperm produced in the seminiferous
tubules immediately travels through a network of
ducts called the rete testes. These passageways
contain cilia that sweep sperm out of the testes
into the epididymis (a tightly coiled tube
structure).

6. epididymis contract forcing the sperm along
-With sexual stimulation, the walls of the
epididymis contract forcing the sperm along
the seminiferous tubules to the vas deferens
Ductus Deferens ( vas deferens)
-Approximately 18 inches long
-Rises along the posterior wall of the testes which moves
upward to pass through the inguinal canal into the pelvic
cavity and loops over the bladder
-The ductus deferens, nerves and blood vessels are
enclosed in a connective sheath called the spermatic
cord. (Vasectomy-severing of the ductus deferens.)

7. -Behind the urinary bladder, the ejaculatory duct
Ejaculatory duct and urethra
-Behind the urinary bladder, the ejaculatory duct
connects with the ductus deferens. It unites with
the urethra to pass through the prostate gland.
-Only 1 inch long
-The urethra extends the length of the penis with
the urinary meatus. The urethra carries both
sperm and urine but because of the urethral
sphincter, it does not do so at the same time.

8. -With each ejaculation (2-5 mL fluid), approximately 200-
Accessory Glands
-With each ejaculation (2-5 mL fluid), approximately 200-
500 million sperm are released
-Seminal Vesicles: paired structures that lie at the base of
the bladder and produce 60% of the volume of semen.
Fluid is released into the ejaculatory ducts to meet the sperm
-Prostate Gland: surrounds the neck of the bladder and
urethra. Composed of muscular and glandular tissue.
-Cowper’s Glands: 2 pea sized glands under the male urethra, provide lubrication during sexual intercourse

9. -Urethra: conveys urine from the bladder and carries
Urethra and Penis
-Urethra: conveys urine from the bladder and carries
sperm to the outside
-Penis: organ of copulation. The shaft ends with an
enlarged tip called the glans penis. The skin covering
the glans penis is called the prepuce or foreskin.
-Circumcision: removal of foreskin. Preventative for
phimosis- a tightness of the prepuce (tightness of the
prepuce prevents retraction of the foreskin over the
glans).
-3 masses of erectile tissue containing numerous
sinuses fill the shaft of the penis. These fill with
blood during sexual stimulation causing an erection.
After ejaculation, it returns to a flaccid state. A

10. -3 distinct parts; the head, midpiece and tail
Sperm
-3 distinct parts; the head, midpiece and tail
-Mature sperm live approximately 48 hours in the
female reproductive system
-If comes in contact with a mature egg, the
enzyme on the head of each sperm bombards the
egg in an attempt to breakdown the coating
-Only one sperm enters and causes fertilization.
The remaining sperm disintegrate.

11. Inflammatory Disorders
Epididymitis-an infection of the cordlike
excretory duct of the testicle
Can be sterile or nonsterile inflammation
-Sterile inflammation can be caused by direct injury, reflux of urine down the vas deferens (reflux is related to
a strain while the bladder is full).
-Nonsterile inflammation can be caused by gonorrhea,
chlamydia, mumps, TB, prostatitis or prolonged use of
a catheter
-Common causative organisms are: Staph. Aureus, E.
Coli, Streptococcus and N. Gonorrhea
EPIDIDYMITIS/ORCHITIS/PROSTATITIS
Epididymitis can be a sterile or nonsterile inflammation of the epididymis
Sterile inflammation may be caused by:
Direct injury
Reflux of urine down the vas deferens
Reflux is related to strain while the bladder is full
Nonsterile inflammation may occur as a complication of:
Gonorrhea
Chlamydia
Mumps
Tuberculosis
Prostatitis
Urethritis
Prolonged use of indwelling catheter
Signs and symptoms of epididymitis:
Sudden, severe pain in the scrotum
Scrotal swelling
Fever
Dysuria
Pyuria
Treatment includes bed rest, antibiotics, scrotal support, and ice compresses
Untreated epididymitis leads quickly to testicular tissue necrosis, septicemia, and death
Orchitis is an inflammation of the testes
Most often a complication of a blood borne infection
Other causes include:
Trauma
Surgical manipulation
Mumps that occur after puberty
Usually both testes involved; sterility often results
Unilateral involvement does not cause sterility
Orchitis signs and symptoms include:
Sudden scrotal pain with pain radiating to the inguinal canal
Scrotal edema
Chills
Nausea
Vomiting
Treatment includes bed rest, scrotal support, and ice to the area

12. along the spermatic tube; increased sensitivity and pain with walking
Signs and Symptoms
-Sudden severe pain in the scrotum; radiates
along the spermatic tube; increased sensitivity
and pain with walking
-Edema; scrotal area becomes tender
-Chills and fever

13. -Diagnostic Tests: UA to check for pyuria, CBC for WBC check
Treatment
-Diagnostic Tests: UA to check for
pyuria, CBC for WBC check
-Epididymis is massaged by the physician,
the fluid is expelled and sent to the lab
-Bed rest, scrotal support and cold packs
-Antibiotics
-If abscess forms, incision and drainage
(I & D)

14. -Scrotal support (elevate on folded towel; use
Nursing Interventions
-Monitor bed rest
-Scrotal support (elevate on folded towel; use
athletic support when ambulatory)
-Cold compresses
-Patient teaching-medications, signs of
inflammatory resolution

15. -Most often occurs as a complication of a
Orchitis-inflammation of the testes
-May follow from infection of the urinary or
reproductive tract
-Most often occurs as a complication of a
blood borne infection origination in the
epididymis
-Other causes: secondary to mumps of viral
infection of a salivary gland, trauma of
metastasis

16. Nursing Interventions- Same as for epididymis
Signs and Symptoms
-Swelling
-Severe pain
-Chills, fever, vomiting
-Hiccoughs
-sometimes delirium
Treatment
-Bed rest, scrotal support
-Cold compresses
-NSAIDS
-Antibiotics
Nursing Interventions- Same as for epididymis

17. Inflammatory Disorders
Prostatitis
Common complication of urethritis caused by Chlamydia or Gonorrhea
Bacterial invasion originates in the bloodstream
or from a descending infection from the kidneys
Acute or Chronic
Signs and Symptoms
Prostatitis is an inflammation of the prostate
Common complication of urethritis caused by Chlamydia or gonorrhea
Infecting organisms may reach the genital tract by direct spread through the urethra; or
May be borne by blood or lymph
Condition may be acute or chronic
Acute form leads to development of fibrotic tissue
Fibrotic tissue causes prostate to harden
May be difficult to differentiate from prostate cancer
May take 3 to 6 months for granulomatous form to resolve
Signs and symptoms of prostatitis include:
Perineal pain
Fever
Dysuria
Urethral discharge
Medical-Surgical Management
Medical
With suspected urethritis, do not catheterize
Infection spreads rapidly to genital organs due to:
Trauma of catheterization
Possible spread of bacteria from nonsterile distal part of urethra
Physician may order segmented bacteriologic

18. MEDICAL-SURGICAL MANAGEMENT
Medical: when urethritis suspected
Should not be catheterized
Possible cultures
Pharmaceutical
Antibiotics, Procaine: epididymis, orchitis
Antibiotics, analgesics, and stool softeners: prostatitis
Medical-Surgical Management
Medical
With suspected urethritis, do not catheterize
Infection spreads rapidly to genital organs due to:
Trauma of catheterization
Possible spread of bacteria from nonsterile distal part of urethra
Physician may order segmented bacteriologic localization cultures
Pharmacological
Treatment of epididymitis and orchitis includes antibiotics and injection of procaine around spermatic cord
Antibiotics, analgesics, stool softeners
Activity
Treatment of prostatitis includes bed rest
Scrotum should be elevated and cold packs applied
Drink large amount of fluids
Sitz bath for comfort
Periodic digital massage of the prostate by physician increases flow of infected secretions
Nursing Management
Encourage intake of oral fluids
Objectively assess client’s pain, administer analgesics as ordered
Keep scrotum elevated when client is in bed; have client use athletic support when ambulatory
Apply cold pack under scrotum as ordered

19. MEDICAL- SURGICAL MANAGEMENT
Activity: Treatment for prostatitis
Bed rest
Scrotum elevated
Cold packs to area
Increase fluids
Sitz baths

20. NURSING MANAGEMENT
Monitor vital signs, especially temperature and I&O Encourage intake of fluids Assess pain Maintain bed rest Keep scrotum elevated while in bed Use of athletic support while ambulatory Cold pack, as ordered

22. Benign Prostatic Hyperplasia (BPH)
BENIGN NEOPLASMS
Benign Prostatic Hyperplasia (BPH)
Early symptoms: hesitancy, nocturia, eventually unable to completely empty bladder which could lead to infection.
BENIGN PROSTATIC HYPERPLASIA (BPH)
BPH is a progressive adenomatous enlargement of the prostate gland that occurs with aging
More than 50% of men over 50 show some increase in size of prostate
90% of men over 70 experience some symptoms
Disorder itself not harmful but urinary outlet obstruction is a problem (urethra encircled by prostate)
Partial or complete obstruction of the urethra are common early symptoms of BPH
Other early symptoms include:
Hesitancy (difficulty initiating the stream)
Decreased force of stream
Urinary frequency
Nocturia (awakening at night to void)
Temporary reduction of these symptoms may occur:
Bladder muscles hypertrophy to force urinary stream past obstruction
Eventually muscle decompensates, becoming noncompliant and hypotonic
Decompensation leads to atony of mucous membranes between the muscle bands
Causes stagnant urine to collect in the small compartments (cellules) of the membranes
Additionally, inability to completely empty bladder (post void residual)
Urine pH increased; susceptible to infection (UTI); may eventually lead to kidney damage

23. MEDICAL- SURGICAL MANAGEMENT
Medical: digital rectal exam, diagnostic tests, monitor for increased symptoms. Non-surgical treatment: Balloon dilatation, a prostate urethral stent, and thermotherapy. These treatments do not correct the problem of incomplete bladder emptying. Surgical: Transurethral resection of the prostate, or open surgery (suprapubic or retro pubic ) and perineal prostatectomy.
Medical-Surgical Management
Medical
Physician performs digital rectal exam to identify enlargement of lateral lobes or nodular lumps on surface of prostate gland
Diagnostic tests ordered may be:
Prostate-specific antigen (PSA)
Measurement of residual urine
Cystoscopy
Intravenous pyelogram
Ultrasonography
Physician closely monitors exacerbation of symptoms:
Increased hesitancy
Urgency
Hematuria
Repeated UTIs
Many alternatives to surgical treatment:
Balloon dilation of prostate
Prostate urethral stent
Thermotherapy
Although these minimally invasive treatments are safe, they do not remove obstruction
Surgical
Transurethral resection of the prostate (TURP)
Surgery performed via a resectoscope which includes a cutting and cauterization device
General or spinal anesthetic
Resectoscope removes small pieces of prostate tissue while controlling bleeding
Bladder continuously irrigated with normal saline or another solution during procedure

25. TURP

26. Post-op pain: belladonna and opium, and narcotic analgesics.
MED-SURG MANAGEMENT
Laser prostatectomy: based on thermal action: transurethral ultrasound-guided laser-induced prostatectomy.
Pharmacological: Finasteride (Procar), Alpha Blockers i.e.. terazosin hydrochloride, doxazocin mesylate, tamulosin hydrochloride.
Post-op pain: belladonna and opium, and narcotic analgesics.
Irrigation continued during post-op period to reduce clot formation (urinary drainage interference)
Traditional surgical alternatives to TURP are open operations
Suprapubic resection is performed for large masses; prostate removed via the bladder
In a retro pubic prostatectomy, bladder not opened buy retracted and prostatic tissue removed through incision in anterior prostatic capsule
These surgeries successful but costly; post-op complications can endanger or seriously affect quality of life:
Hemorrhage
Water intoxication
Infection
Thrombosis
Damage to surrounding structures
Sexual dysfunction
Urinary incontinence
Most recently developed is laser prostatectomy based on thermal action
TULIP is performed with a probe that is passed transurethrally into the prostatic urethra
Laser energy is directed at prostate tissue resulting in necrosis and sloughing
Client less likely to experience water intoxication
Pharmacological
Alpha blockers to relax urinary tract muscles:
Terazosin hydrochloride (Hytrin)
Doxazosin mesylate (Cardura)
Blockers also used to treat hypertension; side effect of orthostatic hypotension possible
Belladonna and opium (B & O) suppositories used to reduce post-op bladder spasms
Narcotic analgesics used to relieve post-op pain

27. NURSING MANAGEMENT
Foley catheter considerations Pre-op care as ordered Monitor and accurately record I&O Monitor Vital signs and color of urine Routine post-op care After catheter removed, encourage voiding at first urge.
Nursing Management
When inserting Foley catheter, remove no more than 1,000 mL initially
Monitor and record I&O to prevent water intoxication
After catheter removal, encourage client to void with first urge to prevent increased bladder pressure
NURSING PROCESS
Assessment
Subjective Data
Urinary patterns primary focus pre-op nursing assessment
Frequency
Hesitancy
Dribbling
Night voiding frequency
Force of urinary stream
Chronic UTIs
Post-op assessment for pain related to bladder spasms
Assess client’s emotional needs
Objective Data
Monitor vital signs and assess for hemorrhagic shock or post-op infection (avoid rectal thermometer)
Bright red urine persisting for more than a few hours after surgery may be a sign of hemorrhage
Immediately report to physician:
Hemorrhage
Hyperthermia
Hypotension
Tachycardia
TURP client will have 3-way Foley catheter and continuous irrigation for at least 24 hours
Record intake and output
In measuring output, subtract irrigant amount
After catheter removal, assess for post void residual and incontinence
Palpate abdomen for bladder distention
Check bed linens and clothing for signs of incontinence
Question about loss of urinary control
Assess for water intoxication; common early symptoms include:
Mental status
Agitation
Confusion
Later, convulsions
Slow bounding pulse
Increase in systolic and decrease in diastolic blood pressure
Suprapubic or retropubic prostatectomy does not require Foley
Urethral catheter, tissue drain from the prostatic fossa, abdominal dressing
Assess for incisional pain and do a dressing check
Check linens for back drainage

28. Prostate Cancer: MALIGNANT NEOPLASMS
Second leading cause of cancer deaths in men
Most are adenocarcinomas: slow growing tumors that spread through the lymphatics.
Early symptoms: dysuria, weak urinary stream, increased urinary frequency
Later symptoms: hematuria, urethra obstruction
PROSTATE CANCER
Second leading cause of cancer deaths in men
220,900 new cases in 2003
70% of all prostate cancers diagnosed in men over 65
Survival rate in all cases 97%
Diagnostic tests performed are:
Measurement of serum prostate specific antigen (PSA); not necessarily useful test because of the number of false-positives/false-negatives
Transrectal ultrasonic exam (most useful screening method; annually over 50 years of age)
Prostatic biopsy
Most prostatic cancers are adenocarcinomas, slow growing tumors spreading through lymphatics
Early symptoms include:
Dysuria
Weak urinary stream
Increased urinary frequency
Later symptoms are related to complete urethral obstruction or hematuria
Hematuria (blood in urine) can lead to anemia

29. MED-SURG MANAGEMENT
Medical: Treatment depends on extent of disease. radiation is alternative to surgery. Not always effective depending on condition of patient. Also radioactive seed planting is an alternative. Surgical: Removal of entire prostate gland, including the capsule and adjacent tissue. The urethra is anastomosed to the bladder neck. Usual approach is perineal.
Medical-Surgical Management
Treatment depends on extent of disease and age of client
Medical
Radiation is the traditional alternative to surgery
May fail to eradicate tumor or may lead to:
Diarrhea
Bowel obstruction
Lymphocele formation
Edema of the extremities
Pulmonary embolism
Wound infections
Infection
Impotence
Incontinence
Radiation cystitis
An alternative successful radiation treatment option for early stage is transrectal assisted radioactive seed implant
With ultrasound, physician is able to precisely place rice-sized seeds inside prostate gland
Surgical
Involves removal of entire prostate gland, including capsule and adjacent tissue
Urethra is then anastomosed to bladder neck
Usual approach is perineal with incision made between scrotum and rectum
Urinary incontinence may be a complication
Other complications include:
Sexual dysfunction
Universal surgical risks of hemorrhage, infection, thrombosis, and strictures
Removal of testes (orchiectomy) may also be done as a palliative measure (help eliminate future tumors)
Client should be 70 years or younger
Cryosurgery with ultrasound allows surgeon to selectively freeze gland tissue while temperature of prostatic urethra is kept at 44 degrees by irrigation

30. MED-SURG MANAGEMENT
Medical, con’t: complications of surgery include urinary incontinence, sexual dysfunction, hemorrhage, infection, thrombosis, and strictures. Removal of testes (orchiectomy) may be done as palliative measure Cryosurgery

31. Systemic chemotherapy: not very effective
MED-SURG MANAGEMENT
Pharmacological:
Hormonal agents: diethylstilbestrol, goserelin acetate, or leuprolide acetate
Systemic chemotherapy: not very effective
with heated water; this approach an option for:
Those who cannot tolerate more extensive surgery
Have a localized tumor
Do not have successful radiation treatment
It can be performed more than once
Involves a shorter hospital stay
Produces fewer side effects
Pharmacological
Hormonal agents to counteract production of androgen-dependent hormones such as:
Diethylstilbestrol (DES)
Goserelin acetate (Zoladex)
Leuprolide acetate (Lupron)
Chemo not proven effective; used for clients who fail to respond to hormone manipulation
Response is limited

32. NURSING MANAGEMENT
Encourage all male clients over 40 years of age to have annual rectal exam of the prostate and a PSA serum level. Monitor vital signs, I&O, signs of bleeding, assess for pain, administer analgesics as ordered
Nursing Management
Encourage all male clients 40 and older to have annual rectal examination of the prostate and a PSA serum level
Assess urine for signs of bleeding

33. MALIGNANT NEOPLASMS
Testicular Cancer: Most common cancer in young men ages Etiology unknown. Usually a small, hard, painless lump is first sign noticed.
Early intervention is essential: need to teach clients how to perform self testicular exam.
TESTICULAR CANCER
Accounts for only 1% of all cancer in men but is the most common between the ages of 15 and 35
5-year survival rate is 95%
Etiology unknown; incidence highest for men with: Undescended testicles
Mothers who had taken hormones during pregnancy
Small, hard, painless lump usually the first symptom
Men need to be taught to perform testicular self-exam

34. Surgical: Biopsy contraindicated
MED-SURG MANAGEMENT
Medical: Testicular ultrasound, serum acid or alkaline phosphatase test.
Surgical: Biopsy contraindicated
Removal of testis, spermatic cord, and inguinal contents, with exam of nodes
Teaching plan for TSE
Pharmacological: combination chemotherapy with cisplatin, vinblastine sulfate, and bleomycin sulfate. All in conjunction with a radical inguinal orchiectomy.
Medical-Surgical Management
Medical
Ultrasound to study testes for enlargement or lesions
Serum acid or alkaline phosphatase test done; both show elevation in malignancies
Surgical
Biopsy contraindicated due to increased potential for metastases
Surgical removal of testis, spermatic cord, and inguinal canal contents, with examination of the nodes
If unilateral removal of a testis is indicated, remaining healthy testis continues to maintain sperm and androgen production
Pharmacological
Radical inguinal orchiectomy remains primary intervention
Following chemo combination effective:
Cisplatin (Platinol)
Vinblastine sulfate (Velban)
Bleomycin sulfate (Blenoxane)

35. NURSING MANAGEMENT
ENCOURAGE ALL MALES OVER 15 YEARS OF AGE TO PERFORM TSE! Post-op: monitor vital signs and incisional drainage. Maintain strict asepsis when changing dressings. Provide client to voice fears and concerns.
Nursing Management
Encourage male clients older than age 15 to perform testicular self-examination monthly
Provide opportunities for client to voice fears & concerns

36. Metastases common in inguinal nodes and adjacent organs.
MALIGNANT NEOPLASMS
Penile Cancer: rare; high correlation with poor hygiene or no circumcision, hx of STDs
Symptoms: painless nodular growth on foreskin, fatigue and weight loss.
Metastases common in inguinal nodes and adjacent organs.
PENILE CANCER
Rare; high correlation with poor hygiene and delayed or no circumcision
Bacteria harbored in foreskin are irritants to the glans penis and prepuce
Chronic nature of irritation thought to be carcinogenic
Males with STDs are also predisposed
Symptoms include:
Painless, nodular growth on foreskin
Fatigue
Weight loss
Metastases are common in inguinal nodes and adjacent organs

37. Medical: primary treatment is surgical.
MED-SURG MANAGEMENT
Medical: primary treatment is surgical.
Surgical: If not extensive with no metastases, remaining penis should be long enough for client to void standing.
If penectomy necessary, a suprapubic catheter may be inserted or an ileoconduit may be performed.
Medical-Surgical Management
Medical
Primary treatment is surgery
Radiation alone is ineffective
Chemo alone used only for palliative treatment of penile cancer with deep distant metastases
Client may receive adjuvant therapy with either radiation or chemo
Surgical
If a penectomy is necessary, a permanent fistula opening into the urethra will be made between the scrotum and anus (urethrostomy)

38. NURSING MANAGEMENT
Provide emotional support Monitor vital signs and I&O Elevate scrotum to prevent edema Assess pain and administer analgesics as ordered.
Nursing Management
Provide emotional support if penectomy is required
Elevate scrotum to prevent edema