Male Reproductive System
Male Reproductive System
By:Linda Harmon
Male Reproductive System
* Several organs serve as parts of both the urinary tract and the reproductive systems.
* The structures are the tests, the vas deference and the seminal vesicles, the penis, certain accessory glands, such as the prostate and Cowper’s gland..
* Disorders in these organs may interfere with the function of either or both systems.
* Diseases are usually treated by a urologist.
Health History and Assessment
* Changes in urinary function and symptoms of obstruction caused by an enlarged prostate
* Changes in physical activity
* Sexual function and any manifestations of sexual dysfunction
* Factors that affect sexual functioning (stress, physical disease, use of medications, drugs, or alcohol)
Physical Examination
* Digital-Rectal Exam
o Recommended for every man over the age of 40
o Assess the size, shape, and consistency of the prostate
o Screening for cancer of the prostate
* Testicular Exam
o The male genitalia are inspected for abnormalities
o Note nodules, masses, or inflammation
o Instruct the patient about the technique for TSE
Diagnostic Studies
* Prostate-Specific Antigen
o The prostate gland produces a substance known as Prostate-Specific Antigen (PSA). This is measured in the blood and increases in prostate cancer. It needs to be drawn prior to a rectal exam or urinary catheterization.
* Ultrasound
o Transrectal ultrasound studies are used in detecting nonpalpable prostate cancers and in staging localized prostate cancers,. Needle biopsies of the prostate are commonly guided by ultrasound. Ultrasounds are more sensitive than a digital rectal exam.
* Prostate Fluid or Tissue Analysis
o A biopsy may be necessary to obtain tissue for histologic examination. This can be done with a prostatectomy or via a perineal or transrectal needle biopsy.
* Test of Male Sexual Functioning
o Usually conducted by a special team of health care providers.
Medications Associated with Erectile Dysfunction
* Antiadrenergics and antihypertensives
* Anticholinergics and phenothiazines
* Antiseizure agents
* Antifungals
* Antihormone
* Antipsychotics
* Antispasmodics
* Anxiollytics
* Betablockers
* Calcium channel blockers
* Carbonic anhydrase inhibitors
* H2 antagonists
* Nonsteroidal anti-inflammatory drugs
* Thiazides diuretics
* Tricyclic antidepressant
Conditions of the Prostate
Prostatitis
* Inflammation of the prostate gland caused by infectious agents or other conditions
* Clinical manifestations: perineal discomfort, burning, urgency, frequency and pain with or after ejaculation, fever, chills, rectal or low back pain, urinary tract infections.
* Complications: swelling, urinary retention, epididymitis, bacteremia, pyelonephritis.
* Management: avoid complications, broad spectrum antibiotic agent, bed rest, analgesic agents, antispasmodics, bladder sedatives, sitz baths. Chronic is difficult to treat.
* Nursing Management: antibiotics, comfort measures, analgesics, sitz baths, teaching.
* Self care: administration of antibiotics, sitz baths, fluids encouraged but not forced, foods and liquids with diuretic action or that increase prostatic secretions should be avoided.
Benign Prostatic Hyperplasia
* Enlargement of the prostate, extending upward into the bladder and obstructing the outflow of urine by encroaching on the vesical orifice.
* BPH is one of the most common pathologic conditions in men over 50
* Cause is uncertain
* Hypertrophied lobes cause incomplete emptying and urinary retention.
* Manifestations: frequency, nocturia, urgency, hesitancy, abdominal straining, decrease in volume and force of stream, interruption of stream, dribbling, urinary retention, recurrent UTI, fatigue, anorexia, nausea, vomiting, epigastric discomfort.
* Medical Management: Plan is dependent on cause, severity and condition. Immediate, hormonal, pharmacological, surgical
Cancer of the Prostate
* The most common cancer in men.
* Prostate cancer rates twice as high in African American men. They are more likely to die than men in any other racial or ethnic group.
* Risk factors: increasing age, African American, familial predisposition, diet high in red meat and fat
* Manifestations: urinary obstruction, difficulty and frequency, retention,decrease in size and force of stream, painful ejaculation, hematuria, late signs include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness
* Diagnosis: Early detection increases likelihood of cure. Over 40 requires a digital rectal exam (DRE) – early cancer may be detected as a nodule within the substance of the gland or as an extensive hardening in the posterior lobe.
* Men with prostate cancer experience sexual dysfunction before the diagnosis is made.
* Medical Management: based on the stage, age, symptoms. Surgical management, radiation therapy, hormonal therapy, others.
* Surgical Procedures: the procedure chosen depends on the size of the gland, the severity of the obstruction, the patients age, physical status, presence of associated diseases, and patient preference.
* Complications: hemorrhage, clot formation, catheter obstruction and sexual dysfunction.
Prostatectomy
* Assessment: BPH or Cancer – how has it affected lifestyle, presenting urinary problem, family history, physical condition.
* Nursing Diagnosis: Preop – anxiety, acute pain, knowledge deficit; Postop – acute pain, knowledge deficit
o Potential complications: hemorrhage and shock, infection, deep vein thrombosis, catheter obstruction, sexual dysfunction.
* Planning and Goals: Preop- reduced anxiety and knowledge about disorder and postop experience. Postop – fluid volume balance, relief of pain and discomfort, ability to perform self-care activities and absence of complications.
* Preop Nursing Interventions –reduce anxiety, relieve discomfort, provide instruction, prepare patient.
* Postop Nursing Interventions
o Fluid Balance – carefully monitor intake and output including irrigation, observe for electrolyte imbalance, elevated blood pressure, confusion and respiratory distress.
o Pain Relief – determine cause and location, obstruction may require irrigation, walk but do not sit for prolonged periods.
o Monitoring and managing complications
+ Hemorrhage – drainage normally reddish-pink then clears to light pink within 24 hours after surgery.
+ Infection – first by MD, use aseptic technique. Avoid rectal thermometers, rectal tubes and enemas, monitor for fever chills, sweats, etc.
+ Deep Vein Thrombosis – high incidence of DVT and pulmonary embolism,
+ Obstructed Catheter – observe for distention, restlessness, cold sweats, pallor, drop in blood pressure and increase pulse rate.
+ Complications after catheter removal – incontinence
+ Sexual Dysfunction –related to erectile dysfunction , decreased libido and fatigue.
o Promoting home and community based care.
+ Length of stay depends on type of surgical procedure performed.
+ Instruct on how to manage drainage system, assess for complications, promote recovery.
+ Teach about bladder control issues, perineal exercises, and avoiding activities that produce Valsalva effects.
+ Teach signs and symptoms of complications such as bleeding, clots, decrease in stream, retention or infection.
* Evaluation
o Preoperatively
+ Reduced anxiey
+ Pain and discomfort reduced
+ Understanding of procedure and postop course
o Postoperatively
+ Relief of discomfort
+ Fluid and electrolyte balance
+ Self-care measures
+ Free of complications
Conditions Affecting the Testes and Adjacent Structures
Testes and Structures
* Undescended Testis (Cryptorchidism)
o Congenital condition, failure of one or both testes to descend into the scrotum.
o Treated by orchiopexy
* Orchitis
o Inflammation of testes caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical or unknown factors. (Mumps)
o Treatment directed at infecting organism, rest, scrotal elevation, icepacks, antibiotics analgesia
* Epididymitis
o Infection of the epididymis may be due to infected prostate or urinary tract, complication of gonorrhea. Chlamydia trachomatis
o Treatment of organism, bed rest, scrotal elevation,antimicrobial agents, cold compresses, avoid straining , lifting and sexual stimulation.
* Testicular Cancer
o Most common cancer in men 15 to 35, highly treatable and usually curable
o Treatment dependent on type of cancer.
o Risk factors – undescended testis, family history, race and ethnicity (Caucasian American men 5 times greater than African American and double the risk of Asian American) ,occupational hazards
* Manifestations: mass or lump, generally painless, heaviness in scrotum, backache, abdominal pain , weight loss, general weakness. Tend to metastasize early.
* Diagnosis: monthly Testicular Self Examinations (TSE), human chorionic gonadotropin and alpha-fetoprotein and tumor markers that may be elevated in those with testicular cancer.
* Medical Management:
o Orchiectomy with gel-filled prosthesis. Retroperitoneal lymph node dissection, radiation, chemotherapy, long term side effects.
* Hydrocele
o a collection of fluid in the tunica vaginalis of the testes
* Varicocele
o Abnormal dilation of the veins of the pampiniform venous plexus in the scrotum
* Vasectomy
o Legation and transaction of part of the vas deferens with or without removal of a segment of the vas deferens.
Conditions Affecting the Penis
Penis
* Hypospadias and Epispadias
o Congenital anomalies of the urethral opening
* Phimosis
o A condition in which the foreskin is constricted so that it cannot be retracted over the glans, can occur congenitally or from inflammation and edema. Correctable by circumcision.
* Cancer of the Penis
o Mostly in uncircumcised men.
o Appears as a painless, wartlike growth or ulcer.
o Bowen’s Disease is a form of squamous cell carcinoma in the situ of the penile shaft.
o Prevention is circumcision in infancy
o Treatment by excision, topical chemotherapy, radiation, partial or total penectomy.
* Priapism
o An uncontrolled, persistent erection of the penis that causes the penis to become large, hard, and painful.
* Peyronie’s Disease
o Buildup of fibrous plaques in the sheath of the corpus cavernosum. When erect, curvature occurs.
* Urethral Stricture
o A condition in which a section of the urethra is narrowed.
o Treatment involved dilation of the urethra or urethrotomy.
* Circumcision
o The excision of the foreskin, or prepuce,of the glans penis. Usually performed in infancy
Male Reproductive System
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