1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Care of Male Patients with Reproductive Problems

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Glandular units in the prostate that undergo an increase in number of cells, resulting in enlargement of prostate gland

3. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Symptoms ▫Hyperirritable bladder ▫Urgency and frequency ▫Hypertrophied bladder wall muscles ▫Cellules and diverticula ▫Hydroureter ▫Hydronephrosis ▫Overflow urinary incontinence

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

6. Transurethral resection of prostate (TURP) Prostatectomy ▫Suprapubic ▫Retropubic ▫Perineal

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

8. Urinary catheter with retention balloon placed into bladder Traction via taping to patient’s abdomen or thigh Uncomfortable urge to void continuously

9. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Prevalence Slow-growing, predictable malignancy First symptoms related to bladder neck obstruction Assessment ▫Digital rectal examination ▫Prostate-specific antigen (PSA) ▫Biopsy (to confirm)

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

11. Inability to achieve or maintain erection for sexual intercourse Organic vs. functional ED Assessment: ▫Medical, social, sexual history ▫Complete physical examination ▫Duplex Doppler ultrasonography test

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Most common malignancy in men 15 to 34 years of age Curable, with early detection by testicular self-examination and treatment with combination chemotherapy Germ cell vs. non-germ cell tumors

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Cystic mass usually filled with straw-colored fluid forms around testis, results from impaired lymphatic drainage of scrotum, causing swelling of tissue surrounding the testes Treatment ▫Drainage via needle and syringe ▫Surgical removal

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Sperm-containing cyst develops on epididymis alongside the testicle Normally small and asymptomatic, require no intervention If large enough to cause discomfort, spermatocelectomy is performed

15. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Cluster of dilated veins occurring behind and above testis Can cause infertility Varicocelectomy performed through an inguinal incision ; spermatic veins are ligated in the cord

16. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

17. Epidermoid (squamous) carcinomas developing from squamous cells Circumcision in infancy—almost always eliminates possibility of penile cancer Painless, wartlike growth or ulcer Excisional biopsy Radiation therapy Penectomy

18. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Constricted prepuce that cannot be retracted over the glans; prepuce remains down around tip of the penis Emergency; requires immediate treatment! Circumcision Warm bath to allow dressing to loosen Barbiturate sleeping medications

19. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Uncontrolled and long-maintained erection without sexual desire; causes penis to become large and painful Can occur from: ▫Thrombosis of veins of corpora cavernosa ▫Leukemia ▫Sickle cell disease

20. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Diabetes mellitus Malignancies Abnormal reflex Some drug effects Recreational drugs Prolonged sexual activity

21. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Inflammation of prostate gland Acute vs. chronic bacterial prostatitis Nonbacterial/chronic pelvic pain syndrome Asymptomatic inflammatory prostatitis

22. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Inflammation of epididymis resulting from infection or noninfectious source such as trauma Treatment ▫Bedrest ▫Elevation of scrotum ▫Scrotal support when ambulating Comfort measures Epididymectomy

23. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Acute testicular inflammation resulting from trauma or infection Treatment ▫Bedrest with scrotal elevation ▫Application of ice ▫Analgesics and antibiotics Mumps orchitis

24. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 1. Etiologies, risk factors, comorbidities 2. Assessment (holistic approach) 3. Diagnostic tests 4. Nurse’s role in management 5. Interdisciplinary team’s role in management 6. Treatment and interventions 7. Teaching and health promotion (including psychosocial implications) 8. Teaching and health promotion for at-risk individuals

25. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 77-year-old man visiting his health care provider reports difficulty starting his urine stream and feeling like his bladder is not completely emptying, as well as dribbling of urine after urination. 1. What questions should the nurse ask when taking this patient’s history? 2. What diagnosis is suspected based on the patient’s symptoms?

26. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. When assessing the patient with benign prostatic hyperplasia (BPH), what assessment finding would the nurse expect? A. Enlarged painful prostate gland B. Distended bladder C. Rectal bleeding D. Tenderness over the kidneys

27. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient has a prostate ultrasound and is diagnosed with BPH. To manage it, the provider prescribes drug therapy with finasteride (Proscar). What should the nurse teach the patient about this drug? A. It will constrict the prostate gland and improve urine flow. B. It will decrease the level of dihydrotesterone (DHT) and shrink the prostate. C. It may cause postural hypotension; care should be taken when changing positions. D. Drugs used to treat erectile problems such as Viagra can make side effects worse.

28. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Nine months later, the patient’s symptoms have not significantly improved, and he is referred to a surgeon for a transurethral resection of the prostate (TURP). Postoperatively, what are the priority nursing concerns for this patient? (Select all that apply.) A. Assess for signs of infection. B. Keep the patient on bedrest for at least 2 days. C. Administer pain and antispasmodic drugs as needed. D. Monitor for changes in mental status. E. Check urine output every 2 hours. F. Remind the patient that urine will be blood-tinged.

29. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Postoperatively, the patient says that he feels like he needs to urinate all the time. What is the nurse’s best response? A. “Just relax and let the urine go because there is a catheter in place.” B. “I will notify your surgeon immediately because this may signal a complication.” C. “This is a normal sensation because the catheter has a balloon that presses on your urinary sphincter.” D. “If you keep your leg straight, the sensation of needing to void all the time will decrease.”

30. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 30

31. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. An older male is being evaluated for hydronephrosis. What priority health history question may provide information about a possible cause of this disorder? A. “Do you have high blood pressure?” B. “Do you have difficulty starting and continuing urination?” C. “Do you have a family history of kidney disease?” D. “Have you had a recent urinary tract infection?”

32. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient who has undergone a transurethral resection of the prostate (TURP) is at high risk for developing: A. Perforation B. Hemorrhage C. Infection D. Bladder spasms

33. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. How many American males are estimated to die of testicular cancer annually? A. 350 B. 520 C. 725 D. 1050