Assessment and Management of Problems

Related to Male Reproduction Processes

A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes.

Cryptorchidism is the most common congenital defect in males, characterized by failure
of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the
testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic,
chemical, or unknown factors. Prostatism is an obstructive and irritative symptom
complex that includes increased frequency and hesitancy in starting urination, a decrease
in the volume and force of the urinary stream, acute urinary retention, and recurrent
urinary tract infections.
Phimosis is the term used to describe a condition in which the foreskin is constricted so
that it cannot be retracted over the glans. Bowens disease is an in situ carcinoma of the
penis. Peyronies disease is an acquired, benign condition that involves the buildup of
fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled,
persistent erection of the penis from either neural or vascular causes, including
medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and
tumor invasion of the penis or its vessels.
Perineal discomfort, burning, urgency, frequency with urination, and pain with
ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the
pampiniform venous plexus and the internal spermatic vein in the scrotum (the network
of veins from the testis and the epididymis that constitute part of the spermatic cord).
Epididymitis is an infection of the epididymis that usually descends from an infected
prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele
is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may
collect within the spermatic cord.
The patient must have sexual stimulation to create the erection, and the drug should be
taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running
nose are common side effects of Viagra and do not normally warrant reporting to the
physician. Some visual disturbances may occur, but these are transient.
The urine drainage following prostatectomy usually begins as a reddish pink, then clears
to a light pink 24 hours after surgery.
Testicular cancer is most common among men 15 to 35 years of age and produces a
painless enlargement of the testicle. Testicular cancers metastasize early but are one of
the most curable solid tumors, being highly responsive to chemotherapy.
Elastic compression stockings are applied before surgery and are particularly important
for prevention of deep vein thrombosis if the patient is placed in a lithotomy position
during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or
Fowlers position.
Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia.
The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient
returns home after the procedure. Exposure of others to radiation is minimal, but the
patient should avoid close contact with pregnant women and infants for up to 2 months.

Assessment and Management of Problems

Related to Male Reproduction Processes

Hypertension, edema, and tachycardia would not normally be associated with benign
prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and
renal failure can occur with chronic urinary retention and large residual volumes.
Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil
(Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil
(Viagra) are usually contraindicated with diabetic retinopathy.
The incidence of prostate cancer increases after age 50. The digital rectal examination,
which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor
marker for prostate cancer, are effective diagnostic measures that should be done yearly.
Testicular self-examinations wont identify changes in the prostate gland due to its
location in the body. A transrectal ultrasound and CBC with BUN and creatinine
assessment are usually done after diagnosis to identify the extent of disease and potential
metastases.
Testicular cancer is highly curable, particularly when its treated in its early stage. Selfexamination allows early detection and facilitates the early initiation of treatment. The
highest mortality rates from cancer among men are with lung cancer. Testicular cancer is
found more commonly in younger men.
For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted.
The three lumens provide for balloon inflation and continuous inflow and outflow of
irrigation solution.
The ischemic form of priapism, which is described as nonsexual, persistent erection with
little or no cavernous blood flow, must be treated promptly to prevent permanent damage
to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or

erectile dysfunction.
Past history of infection and lack of exercise do not contribute to impotence. With
advancing age, sexual function and libido and potency decrease somewhat, but this is not
the primary reason for impotence. Vascular problems cause about half the cases of
impotence in men older than 50 years; hypertension is a major cause of such problems.
Prostatitis is an inflammation of the prostate gland that is often associated with lower
urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms
are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge.
Urinary incontinence and retention occur with benign prostatic hyperplasia or
hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force
of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not
cause urinary symptoms.
Some herbal supplements are contraindicated with Proscar, thus their planned use should
be discussed with the physician or pharmacist. The patient should maintain normal fluid
intake. There is no need to abstain from sexual activity and a worsening of urinary
retention is not anticipated.
African American men have a high risk of prostate cancer; furthermore, they are more
than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

Assessment and Management of Problems

Related to Male Reproduction Processes

A number of studies have identified an association of BRCA-2 mutation with an

increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is
associated with breast cancer.
PSA screening is warranted by the patients family history and should not be delayed
until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer.
Alcohol consumption by the patient should be limited. However, this is not the most
important health promotion intervention.
Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland,
which are unaffected by vasectomy, thus no noticeable decrease in the amount of
ejaculate occurs (volume decreases approximately 3%), even though it contains no
spermatozoa. The viscosity of ejaculate does not change.
Several risk factors for penile cancer have been identified, including lack of circumcision,
poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on
the penis, increasing age (two-thirds of cases occur in men older than 65 years of age),
lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk
factors.
Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to
sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.
It is important that the patient know that regaining urinary control is a gradual process; he
may continue to dribble after being discharged from the hospital, but this should
gradually diminish (usually within 1 year). At this point, medical follow-up is likely not
necessary. There is no need to perform urinary catheterization.
Cowper glands lie below the prostate, within the posterior aspect of the urethra. This
gland empties its secretions into the urethra during ejaculation, providing lubrication. The
Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas
deferens.
The PLISSIT (permission, limited information, specific suggestions, intensive therapy)
model of sexual assessment and intervention may be used to provide a framework for
nursing interventions. By beginning with the patients permission, the nurse establishes a
patient-centered focus.
Routine repeated DRE (preferably by the same examiner) is important, because early
cancer may be detected as a nodule within the gland or as an extensive hardening in the
posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not
suggestive of metastatic disease.
All prostatectomies carry a risk of impotence because of potential damage to the
pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do
not affect sexual functioning after prostatectomy.
The physician should be informed if there is significant leakage around a suprapubic
catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing
the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not
stop the leakage of urine around the tube.

Assessment and Management of Problems

Related to Male Reproduction Processes

The patients statements specifically address his perception of his body as it relates to his
identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely
appropriate. This patient is at risk for social isolation and loneliness, but theres no
indication in the scenario that these diagnoses are present. There is no indication of
spiritual element to the patients concerns.
Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also
creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully
compare input and output, and ensure that these are in balance. Parenteral nutrition is
unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid
status. Frequent bladder scanning is not required when a urinary catheter is in situ.
Patients may be required to endure a long course of therapy and will need encouragement
to maintain a positive attitude. It is certainly the patients ultimate decision to accept or
reject chemotherapy, but the nurse should focus on promoting a positive outlook. It
would be a violation of confidentiality to report the patients statement to members of his
support system and there is no obvious need for a social work referral.
Surgical removal of mature plaques is used to treat severe Peyronies disease. There is no
potential benefit to physical therapy and hydrocortisone injections are not normally used.
PDE-5 inhibitors would exacerbate the problem.
Pelvic floor muscles can promote the resumption of normal urinary function following
prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of
adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary
function.
Applying ice bags intermittently to the scrotum for several hours after surgery can reduce
swelling and relieve discomfort, and is preferable to the application of heat. The nurse
advises the patient to wear snug, cotton underwear or a scrotal support for added comfort
and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and
sexual activity can usually be resumed in 1 week.
Administering a medication that relaxes smooth muscles can help relieve bladder spasms.
Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most
cases, this problem can be relieved without the involvement of the urologist, who will
normally order medications on a PRN basis.
Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor
changes in penile circumference during sleep using various methods to determine
number, duration, rigidity, and circumference of penile erections; the results help identify
whether the erectile dysfunction is caused by physiologic and/or psychological factors. A
sperm count would be done if the patient was complaining of infertility. Ejaculation
capacity tests and engorgement tests are not applicable for assessment in this
circumstance.
Organic causes of ED include cardiovascular disease, endocrine disease (diabetes,
pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism),
cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery),
hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies,

Assessment and Management of Problems

Related to Male Reproduction Processes

parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area,
alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to
be psychogenic causes.
Patients with erectile dysfunction from psychogenic causes are referred to a health care
provider or therapist who specializes in sexual dysfunction. Because of the absence of an
organic cause, medications and penile implants are not first-line treatments. Physical
therapy is not normally effective in the treatment of ED.
Circumcision is usually indicated after the inflammation and edema subside. Needle
aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual
activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for
paraphimosis.