Disorders

of
Male
NURS 304 Adult Nursing 2
Reproductive
System
Lecturer:
K. Mackey

Structures of the Male Reproductive Tract

Assessment
Sexual function
Diseases e.g. diabetes, multiple scerosis, CVA, cardiac disease
Medications e.g antihypertensives, psychotrophic agents,
antihyperlipedemia
Alcohol use
stress

Urinary symptoms

Assessment

Urinary function and symptoms

Symptoms related to urinary obstruction

urinary frequency
Decreased force of stream
Double or triple voiding
Nocturia
Dysuria
Hematuria
hematospermia

Physical Assessment
Digital rectal exam
Testicular exam

Assessment
Digital rectal exam (DRE)
Used to screen for prostate CA
Recommended in men 40yrs and over
prostate gland is assessed

Inspect male genitalia

Note any abnormalites
Palpate for masses
Discharges, inflammation

Assesment
Scrotum
Palpated for nodules, masses, inflammation
Note abnormalities such as hydrocele, hernia, masses
Tumours of testes

Instruct pt. on TSE and purpose

Performing TSE
Best performed either in the shower or after a warm bath,
when the scrotal skin is relaxed.
Look in the mirror at the testicles
Observe size & shape of each testicle.
Hold the scrotum in the palms of the hands.
Examine one testicle at a time. Gently roll each testicle
(with slight pressure) between the thumb, middle and index
fingers.
Place the thumbs over the top of your testicle and gently
roll
Each testicle should be smooth, with no lumps or swellings.

TSE contd.
Locate and palpate the epididymis and spermatic cord
Check for any small irregularities, enlargements and:
An increase in firmness of a testicle
Pain or discomfort in a testicle or in the scrotum

An unusual difference between one testicle and the other.

A heavy feeling in the scrotum
A dull ache in the lower stomach, groin or scrotum.
Normal for one testis to be slightly larger than the other

Diagnostic Tests
Prostate specific antigen (PSA)
0.2 4.0 ng/ml
Annual testing

Ultrasonography (TRUS)
Prostate fluid or tissue analysis
Tests of male sexual function

Common Conditions of Male

Reproductive Organs
Crytorchidism
Orchitis
Epididymitis
Phimosis
Priaprism
Circumcision

Common Conditions of Male

Reproductive System

Hydrocele collection of fluid in testes

Varicocele abnormally dilated veins in the scrotum
Hypospadias shortened urethra, urethral opening
located on ventral side of penis (congenital anomaly)
Epispadias urethral opening is on dorsum of penis
peyronies disease build up of fibrous plaque in
corpus cavernosum
urethral stricture narrowing of urethra

Disorders of Male Sexual Function

Erectile dysfunction
The inability to achieve/sustain an erection
sufficient to accomplish intercourse
Psychogenic and organic causes
Organic causes include vascular, endocrine,
hematological, and neurologic disorders,
trauma, alcohol, medications, and drug abuse
Medications associated with erectile dysfunction
(pg. 1745; 49-1)

Erectile Dysfunction
Pharmacologic therapy
Oral medicationssildenafil (Viagra),
cialis, levitra
Side effects include headache,
flushing, dyspepsia
Use cautiously in pts. with retinopathy
Injected vasoactive agents
Surgical implants

Complications of erectile dysfunction

include priapism (persistent abnormal
erection)

Prostatitis
Inflammation of prostate gland caused by an
infectious agent
Clinical manifestations

Fever, chills
Dysuria
Frequency
Urgency
Perineal pain
Nocturia
Rectal or lower back pain

Prostatitis
Pathophysiology
Inflammation of the prostate gland cause by infectious
agents

E. coli is the most common

Microorganisms are usually carried to the prostate from

the urethra

Prostatitis
Diagnosis (May be acute or chronic)
History
Culture of prostate gland
Urine for C & S
Histological examination of the tissue
D.R.E.
Swollen, tender & firm prostate gland

Prostatic massage
Obtain prostatic fluid

Prostatitis
Management
Antibiotic therapy

broad-stectrum antibiotic
(rimethroprim sulfamethoxazole (Bactrim)
Cirpfloxacin (Cipro)
Analgesics for pain
Sitz bath (10-20mins)
Educate pt. on disease process
Stool softeners

Prosatitis
1. AVOID Foods and liquids that have diuretic actions or that
increase Prostatic secretion should be avoided
1. Alcohol
2. Coffee
3. Tea
4. Chocolate
5. Cola
6. Spices

2. Avoid intercourse
3. Avoid sitting for long periods

Prostatitis
Complications
Swelling of prostate gland
Urinary retention
Epididymitis
Bacteremia
pyelonephritis

Benign Prostatic Hypertrophy

Non malignant enlargement of the prostate gland.

Characterized by formation of large nodular lesions in the

periurethral region of the prostate.

Etiology
Unknown
Dihydrotestosterone (DHT) active metabolite in testosterone
contibutes to BPH
Free plasma testosterones enters prostatic cells where about
90% is converted to DHT

Predisposing factors

Men over the age of 50 years

Smoking
Heavy alcohol consumption
Diabtes, hypertension, heart disease
Race, ethnicity
Family history

Benign Prostatic Hypertrophy

Clinical Manifestations
Signs of urinary obstruction
Acute urinary retention
Frequency
Urgency
Nocturia
Abdominal straining with urination
Hesitancy in passing urine
Decrease in volume and force of urinary stream
Dribbling
urinary tract infections
Sensation that bladder is not completely emptied
General symptoms, fatigue, anorexia, pelvic discomfort

Renal failure can occur with chronic urinary retention

BPH: Pathophysiology

Pathophysiology not clearly understood

Hormonal contribution in men with elevated testosterone levels

Develops over long period
Hypertrophied lobe of prostate obstruct the prostatic urethra
This causes the bladder to become over distended, urinary retention
occurs with incomplete emptying of the bladder
Frequency of urination occurs with constant desire to empty the bladder
Frequency becomes worse at nights
Gradual dilation (hydroureter) of ureters and kidneys (hydronephrosis)
occur
UTI may result from urinary stasis,
Urine remaining in the urinary tract serves as a medium for infectious
organisms

BPH
Diagnosis
History
Digital rectal exam
Urine analysis
CBCs
Ultrasound scan (trans abdominal or rectal)
PSA
Serum creatinine levels

Medical Management: BPH

Treatment
Pharmacologicalpha-adrenergic blockers, alphaadrenergic antagonists, antiandrogen agents
Antiandrogen agents
Relax smooth muscle of bladder, relieving urinary
symptoms
Catherization if unable to void

Prostate surgery
TURP
surgical resection
Strinking of prostate

Prostate Cancer
Second most common cancer and the second
most common cause of cancer death in men
Risk factors:
increasing age
familial predisposition
African-American race

Early diagnosis is vital; health screening

Prostate Cancer
Clinical Manifestations

Frequency of urination
urgency
hesitancy in starting urination
recurrent UTI
dribbling
interruption of urinary flow
sensation that bladder has not emptied
decrease in volume and force of urine stream

Diagnosis
Digital rectal exam
PSA, Transrectal Ultrasound guided biopsy

Nursing Diagnoses
Anxiety
Acute pain preoperatively
Acute pain postoperatively
Deficient knowledge

Nursing ManagementPlanning
Major goals preoperatively:
adequate preparation and reduction of anxiety
Reduction of pain.

Major goals postoperatively:

maintenance of fluid volume balance
relief of pain and discomfort
ability to perform self-care activities
absence of complications

Interventions

Routine preoperative management

enema

Reduction of anxiety

Be sensitive to potentially embarrassing and culturally charged issues

Establish a professional, trusting relationship
Provide privacy
Allow patient to verbalize concerns
Provide and reinforce information

Provide patient teaching including explanations of anatomy and

function, diagnostic tests and surgery, and the surgical
experience.
Preparation of pt. for actual surgery

Management
Surgery
Transurethral resection of the prostate (TURP)

Chemotherapy
Radiation therapy

Prostate Cancer
Surgical Management
Radical prostatectomy: removal of the prostate, seminal
vesicles, tips of the vas deferens, surrounding fat, nerve and
blood vessels may also be removed.
Radiation therapy
If detected in the early stages radiation treatment can be used to destroy
tumor

hormonal therapy
Use of antiandrogen drugs to decrease growth of tumor

Chemotherapy
Use of ketoconazole to lower testosterone levels

Post operative

Pain management
V/S
Fluid balance management
Irrigation of bladder
Close monitoring of fluid intake, output
Amount of fluid used for irrigation
Irrigate according to Dr.s order

Ensure tubing is secured properly

Monitor urinary drainage and keep catheter patent

Drainage is red then pink within 24hrs

Cather care to prevent infection

Post operative care

Observation of dressing site
Observe abdomen for distension

Assessment of pain
Bladder spasms cause feelings of pressure and
fullness
urgency to void

bleeding from the urethra around the catheter.

Educate pt. not to pull on catheter/tubing
Advice re: feelings of urge to void is normal

Relief of Pain
Warm compresses or sitz baths to relieve spasms
Administer analgesics and antispasmodics as ordered
Encourage patient to walk, but to avoid sitting for
prolonged periods.
Prevent constipation
Ambulation begins 24hrs. post op
Wound care using strict asepsis

Three-Way System for Bladder Irrigation

Collaborative Problems/Potential
Complications
Hemorrhage and shock
Infection
DVT
Catheter obstruction
Sexual dysfunction

Rehabilitation and Home Care

Patient and family teaching for home care
including care of urinary drainage devices and
recognition and prevention of complications
Regain bladder continence
Information that regaining control is a gradual process (dribbling
may continue for up to 1 year depending upon type of surgery)
Perineal exercises

Avoidance of straining, heavy lifting, long car

trips (68 weeks)
Diet: encourage fluids and avoid coffee, alcohol,
and spicy foods
Assessment and referral of sexual issues

Testicular Cancer

Most common cancer in men ages 1540

Highly treatable and curable
Risk factors: undescended testicles, positive family history,
cancer of one testicle, Caucasian-American race
Manifestations: painless lump or mass in the testes
Early diagnosis: monthly testicular self-exam (TSE) and annual
testicular exam
Treatment: orchidectomy, retroperitoneal lymph node dissection
(open or laparoscopic), radiation therapy, chemotherapy

Testicular cancer
Tumor markers that may be elevated in testicular cancer:
Human chorionic gonadotropin
alpha fetoprotein.

Nursing Management
Assessment of physical and psychological status
Support of coping
Address issues of body image and sexuality
Encourage a positive attitude
Patient teaching
TSE and follow-up care

References
Salzano, C. (2008). Testicular Cancer
Bare, B., Cheever, K., Hinkle, J.L. & Smeltzer, S.C. (2008).
Brunner, & Suddaths textbook of medical-surgical nursing.
(11th Ed.). Philidelphia:
Lippincot Williams & Wilkins.