DISORDERS OF THE MALE REPRODUCTIVE SYSTEM

1. DISORDERS OF THE MALE REPRODUCTIVE SYSTEM

2. Male reproductivesystem. Organs of the urinary system are also shown.  

3. 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. 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. 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 • -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. 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. 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 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. 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

12. 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. 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. 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. 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. 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

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

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 NEOPLASMS • Benign Prostatic Hyperplasia (BPH) • Early symptoms: hesitancy, nocturia, eventually unable to completely empty bladder which could lead to infection.

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.

26. 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.

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.

28. MALIGNANT NEOPLASMS • Prostate Cancer: • 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

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.

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. MED-SURG MANAGEMENT • Pharmacological: • Hormonal agents: diethylstilbestrol, goserelin acetate, or leuprolide acetate • Systemic chemotherapy: not very effective

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

33. MALIGNANT NEOPLASMS • Testicular Cancer: Most common cancer in young men ages 15-35. 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.

34. 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.

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.

36. 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.

37. 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.

38. NURSING MANAGEMENT • Provide emotional support • Monitor vital signs and I&O • Elevate scrotum to prevent edema • Assess pain and administer analgesics as ordered.