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Assessment and Management of Problems Related to Male Reproductive Processes

Assessment and Management of Problems Related to Male Reproductive Processes. Anatomy and Physiology. The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens).

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Assessment and Management of Problems Related to Male Reproductive Processes

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

  2. Anatomy and Physiology • The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens). • The prostate (an encapsulated gland that encircles the proximal portion of the urethra). • The penis.

  3. Common Diagnostic Tests for Reproductive System Disorders

  4. Inflammatory Diseases:Epididymitis • A sterile or nonsterile inflammation of the epididymis. • A sterile inflammation may be caused by direct injury or reflux or urine down the vas deferens. • Nonsterile inflammation may occur as a complication of gonorrhea, chlamydia, mumps, tuberculosis, prostatitis, or urethritis. • Symptoms include sudden, severe pain in the scrotum, scrotal swelling, fever, dysuria, and pyuria.

  5. Inflammatory Diseases: Orchitis • An inflammation of the testes that most often occurs as a complication of a bloodborne infection originating in the epididymis. • Causes include gonorrhea, trauma, surgical manipulation, and tuberculosis and mumps that occur after puberty. • Symptoms include sudden scrotal pain, scrotal edema, chills, fever, nausea, and vomiting.

  6. Inflammatory Diseases:Prostatitis • An inflammation of the prostate which is a common complication of urethritis caused by chlamydia or gonorrhea. • Symptoms include perineal pain, fever,dysuria, and urethral discharge.

  7. Nursing Interventions • Inflammatory Disorders: • Encourage bed rest • Monitor VS, esp. temp for fever • Monitor I & O • Assess pain • Sitz bath – provide comfort = PROSTATITIS • Provide ice pack to scrotum to decrease swelling • Elevate or provide scrotal support

  8. Inflammatory disorders • Interventions • Analgesic • Antibiotic • Procaine = anesthetic • Stool softeners • Digital massage – rectally – release infected fluid

  9. Benign Prostatic Hyperplasia • BPH is a progressive adenomatous enlargement of the prostate gland that occurs with aging. • More than 50% of men over the age of 50 and 75% of men over the age of 70 demonstrate some increase in the size of the prostate gland. • Although this disorder is not harmful, the urinary outlet obstruction is a problem. • Early symptoms include hesitancy, decreased force of stream, urinary frequency, and nocturia.

  10. Benign Prostatic Hyperplasia • Diagnosis: • PSA – prostate specific antigen = high • Rectal examination – most reliable • Ultrasound • Cystoscopy – visualization of bladder • IVP – Intravenous Pyelography – inject a dye through vein – visualize bladder, ureters, kidney – allergic to shellfish or iodine? • BUN – blood, urea, nitrogen – urine, blood – increase • Serum creatinine – Increased

  11. TURP • Transurethral Resection of the Prostate • Continuous irrigation = reduce or prevent clot formation = clogs urethra = urinary retention = kidney damage • Monitor I & O • 3-way f/c • Monitor fluid overload=water intoxication • Edema, mental status = agitation, lethargy • Monitor for distention - bladder

  12. Benign Prostatic Hyperplasia • Management • Stent • Balloon • Surgical • TURP • TULIP – Transurethal Ultrasound-guided Laser-induced prostatectomy • Less invasive • PROSTATECTOMY • Perineal prostectomy – incision through perineum • Suprapubic resection – lower abdomen – incision through the bladder – urethrotomy • Retropubic – lower abdomen – does not go through the bladder

  13. Benign Prostatic Hyperplasia • Pharmacological • Alpha blockers – relax the smooth muscles along urinary tract (Hytrin, Cardura) – p. 852 • S/E: dizziness – orthostatic hypotension • Belladonna & Opium suppository – reduce post-op bladder spasm • Narcotic analgesic – relieve p-op pain – Vicodin, Morphine, Codeine – S/E constipation • Proscar – androgen hormone inhibitor – may arrest prostate enlargement

  14. Benign Prostatic Hyperplasia • Nsg. Interventions • Increased fluids – monitor I & O • Maintain gravity drainage of F/C • Monitor blood clots and color = bright red = bleeding • Keep irrigation flowing, note clots • Monitor VS – pain level, temp – orally, NOT rectal • Avoid straining, provide stool softeners • Teach deep breathing, relaxation technique • Avoid straining • Observe bladder distention & spasms = ask for antispasmodic – stops spasms = pain, increase blood clots

  15. Malignant Neoplasms:Breast Cancer • Breast cancer in males is an uncommon disorder. Because it is so uncommon, it is all the more dangerous as it is not considered a threat. • Late diagnosis is quite common; therefore, males need to be educated in self-examination. • Signs and symptoms include breast lumps, pain, or discharge from nipple.

  16. Malignant Neoplasms:Breast Cancer • Management • Chemo, radiation, surgical removal • Subjective data assessment • pain,emotional & educational needs • Objective data assessment • Rating scale, drainage, VS –temp increase, BP, Pulse, Resp – increased d/t pain • Nursing management • P-op: elevate affected arm, not to apply pressure, B/P, drawing blood, IVs

  17. Malignant Neoplasms:Prostate Cancer • The second leading cause of cancer deaths in men. • Risk factors include: advancing age (over 55); first-degree relative with prostate cancer; African-American heritage; high level of serum testosterone. • Five-year survival rate is 89%.

  18. Prostate Cancer • S/S • Early tumor – no symptoms • Subjective • Back pain, same symptoms as BPH – hesitancy, decrease pressure, frequency, dysuria, urinary retention • Objective • Symptoms from metastasis • Lumps – inguinal • Enlarged lymph nodes • Blockage of urethra, and rectal dysfunction

  19. Diagnostic Test – Prostate CA • Rectal examination • PSA- prostate specific antigen – elevated • Prostatic smear – abnormal cells, dysplasia • Acid phosphatase – prostate – 100x higher than normal – PAP – prostatic acid phosphatase • Serum alkaline phosphatase – increased if bone metastasis • Bone scan – metastasis • MRI, CT scan

  20. Treatment – Prostate CA • Radiation, chemo, surgical removal • Radical perineal prostatectomy – removal of prostate, surrounding tissues, lymph nodes – inguinal area • Urethra is anastomosed to the bladder • Urostomy • Bilateral orchiectomy (removal of testes) • TURP • Estrogen therapy – inhibits serum testosterone = contradicts • Agonists of LH – estrogen • Radioactive seed implant – rectally

  21. Nsg interventions – Prostate CA • BPH interventions • Be supportive – expect feminization, more emotional, educate • Gynecomastia – enlargement of the breast • Control pain – terminally ill = hospice, palliative care

  22. Malignant Neoplasms:Testicular Cancer • Although it accounts for only 1% of all cancer in men, it is the most common cancer in young men between the ages of 15 and 35. • Essential for clients to learn TSE (testicular self-examination). – monthly • During shower • Five-year survival rate is 95%. • Management same as prostate cancer

  23. Assessment • Subjective data • Heaviness in scrotum • Weight loss • Scrotal pain • Emotional and educational needs • Anxiety or depression • Objective data • Palpation of abdomen and scrotum – enlarged • Gynecomastia – enlarged breasts • Mass in testes • Drainage, swelling, hemorrhage – post-op

  24. Malignant Neoplasms:Testicular Cancer

  25. Malignant Neoplasms:Penile Cancer • A rare cancer that has a high correlation with poor hygiene and delayed or no circumcision. • Males with a history of STDs are also predisposed to developing penile cancer. • Symptoms include a painless, nodular growth on the foreskin, fatigue, and weight loss

  26. Penile cancer • Surgery – primary treatment • Penectomy – removal of the penis • Urostomy – suprapubic or perineal • No catheterization

  27. Crytorchidism

  28. Hydrocele • Collection of amber fluid within the testes, tunica vaginalis, and spermatic cord • Painful • Swelling • Discomfort in sitting and walking • Treatment: aspiration (usually in children) • Inject a sclerosing solution – decrease the swelling • Hydrocelectomy – remoal of the sac • Nsg Interventions: • Preoperative and postoperative management • Scrotal support (elevation) • Supportive to parents/patient

  29. Hypospadias Classes of hypospadias by location of the meatus. • (A) Anterior, on the inferior surface of the glans penis. • (B) Coronal, in the balanopenile furrow. • (C) Distal, on the distal third of the shaft. • (D) Penoscrotal, at the base of the shaft in front of the scrotum. • (E) Scrotal, on the scrotum or between the genital swellings. • (F) Perineal, behind the scrotum or genital swellings. Abnormal placement of the urethral opening Tx: repair of the foreskin, surgery

  30. Spermatocele – herniation, protrusion -non-tender cyst, epididymis, rete testis Contains milky fluid and sperm

  31. Varicocele • Vein- dilation • Spermatic cord = Vas deferens • Occurs when incompetent or absent valves in the spermatic venous system permits blood to accumulate and increase hydrostatic pressure • Hyperthermia – decrease spermatogenesis = fertility • Bluish discoloration • Wormlike mass

  32. Torsion of the spermatic cord • Abnormal scrotal pain • Scrotal edema • Nausea & vomiting, sl. Fever • Treatment: • immediate surgery to untwist the cord, suturing of the testicle to the scrotum

  33. Impotence • The inability of an adult male to have an erection firm enough or to maintain it long enough to complete sexual intercourse. • Three types: functional (psychosocial factors); atonic (result of medications and disease) and anatomic (Peyronie’s disease, which causes development of nonelastic, fibrous tissue just beneath the penile skin).

  34. Peyronie’s disease • Fibrous plaque • Can not penetrate vagina • Atonic impotence • Antihypertensive, sedatives, antidepressants, tranquilizers, nicotine, drugs & alcohol • Diabetes, vascular neurological disorder • Functional • Decreased libido Sx – silicone cylinder flexible or inflexible Hydraulic implant, has pump

  35. Infertility • Causes of infertility in males include varicoceles, cryptorchidism, impaired sperm, insufficient number of sperm, and hormonal imbalance. • Tight-fitting underwear and use of hot tubs or saunas may decrease the sperm count. • Treatment includes counseling, medications, circulatory aids, and surgery.

  36. Contraception • Contraceptive options available to males include abstinence, coitus interruptus - withdrawal, condoms, or voluntary surgical sterilization (vasectomy) • Coitus – sexual intercourse

  37. Vasectomy • http://www.vasectomymedical.com/features/vasectomy-videos.html

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