Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes

1. Chapter 49Assessment and Management of Problems Related to Male Reproductive Processes

2. Male Reproductive System • Includes conditions that affect reproduction, sexuality, and urinary elimination • Patient may experience anxiety and embarrassment • Be sensitive to cultural and emotional issues related to sexuality and the genitals to accomplish effective assessment and communication • Provide for privacy and education

3. Structures of the Male Reproductive Tract

4. Assessment • Urinary function and symptoms • Sexual function and manifestations of sexual dysfunction • Symptoms related to urinary obstruction • Increased urinary frequency • Decreased force of stream • “Double” or “triple” voiding • Nocturia, dysuria, hematuria, and hematospermia • Medications, drug, and alcohol use • Presence of conditions that may affect sexual function (diabetes, cardiac disease, and multiple sclerosis)

5. PLISSIT • Model of sexual assessment and intervention • Permission • Limited Information • Specific Suggestions • Intensive Therapy

6. Physical Assessment • Digital rectal exam • Testicular exam

7. Examination of the Prostate

8. Diagnostic Tests • Prostate specific antigen (PSA) • Ultrasonography • Prostate fluid or tissue analysis • Tests of male sexual function

9. Disorders of Male Sexual Function • Erectile dysfunction • Psychogenic and organic causes • Organic causes include vascular, endocrine, hematological, and neurologic disorders, trauma, alcohol, medications, and drug abuse • Chart 49-1 lists classes of medications associated with erectile dysfunction • Ejaculation problems • Premature ejaculation • Retrograde ejaculation

10. Evaluation and Treatment of Erectile Dysfunction

11. Medical Management • Pharmacologic therapy • Oral medications: sildenafil (Viagra) • Side effects include headache, flushing, dyspepsia • Caution with retinopathy • Contraindicated with nitrate use • Injected vasoactive agents • Complications include priapism(persistent abnormal erection) • Urethral suppositories • Penile implants • Negative pressure devices • See Table 49-2

12. Conditions of the Prostate • Prostatitis: inflammation caused by an infectious agent • Treatment includes appropriate anti-infective agents and measures to alleviate pain and spasm • Benign prostatic hyperplasia (BPH, enlarged prostate) • Affects half of men over age 50 and 80% of men over age 80 • Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections • Treatment • Pharmacologic: alpha-adrenergic blockers, alpha- adrenergic antagonists, and antiandrogen agents • Catheterization if unable to void • Prostate surgery

13. Prostate Cancer • Second most common cancer and the second most common cause of cancer death in men • Risk factors include increasing age, familial predisposition, and African American race • Manifestations • Early disease has few/no symptoms • Symptoms include urinary obstruction, blood in urine or semen, and painful ejaculation • Symptoms of metastasis may be the first manifestations • Early diagnosis is vital; regular health screening is crucial • Treatment may include prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy

14. Prostate Surgery Procedures

15. Prostate Surgery Procedures (cont.)

16. Nursing Process—Assessment of the Patient Undergoing Prostatectomy • Assess how the underlying disorder (BPH or prostate cancer) has affected the patient’s lifestyle • Urinary and sexual function • Health history • Nutritional status • Activity level and abilities

17. Nursing Process—Diagnosis of the Patient Undergoing Prostatectomy • Anxiety • Acute pain preoperatively • Acute pain postoperatively • Deficient knowledge

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

19. Nursing Process—Planning the Care of the Patient Undergoing Prostatectomy • Major goals preoperatively include adequate preparation and reduction of anxiety and pain • Major goals postoperatively include maintenance of fluid volume balance, relief of pain and discomfort, ability to perform self-care activities, and absence of complications

20. Relief of Pain • Monitor urinary drainage and keep catheter patent • Assessment of pain • Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter • Medication and warm compresses or sitz baths relieve spasms • Administer analgesics and antispasmodics as needed • Encourage patient to walk but to avoid sitting for prolonged periods • Prevent constipation • Irrigate catheter as prescribed

21. Three-Way System for Bladder Irrigation

22. Interventions • Reduce anxiety • Be sensitive to potentially embarrassing and culturally charged issues • Establish a professional, trusting relationship • Provide privacy • Allow the 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

23. Rehabilitation and Home Care • Provide patient and family teaching for home care including care of urinary drainage devices and recognition and prevention of complications • Regain bladder continence • Regaining control is a gradual process (dribbling may continue for up to one year depending upon the type of surgery) • Perineal exercises • Avoid straining, heavy lifting, long car trips (for 6 to 8 wks) • Diet: encourage fluids and avoid coffee, alcohol, and spicy foods • Assess sexual issues and provide referrals as needed

24. Testicular Cancer • Most common cancer in men age 15 to 40 • 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, and chemotherapy

25. Testicular Self-Exam

26. Nursing Management • Assess physical and psychological status • Support coping ability • Address issues of body image and sexuality • Encourage a positive attitude • Provide patient teaching • Provide TSE and follow-up care

27. Conditions Affecting the Penis • Hypospadias and epispadias • Phimosis • Penile cancer • Bowen’s disease • Priapism • Peyronie’s disease • Urethral stricture • Circumcision