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Reproductive System

Reproductive System. Disorders of the Male Reproductive Tract (2). Diagnostic Tests – Testicular Bx. Used to detect abnormal cells & presence of sperm Done by aspiration or via incision Post-bx care Scrotal support Ice pack Analgesic Warm sitz baths Notify MD for bleeding.

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Reproductive System

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  1. Reproductive System Disorders of the Male Reproductive Tract (2)

  2. Diagnostic Tests – Testicular Bx • Used to detect abnormal cells & presence of sperm • Done by aspiration or via incision • Post-bx care • Scrotal support • Ice pack • Analgesic • Warm sitz baths • Notify MD for bleeding

  3. Semen Analysis • Determines effectiveness of vasectomy • Detect semen on body or clothing of suspected rape victim • Rule out paternity • Collection of semen • Manual stimulation • Coitus interruptus • Use of a condom

  4. Prostatic Smears • Detect & identify microorganisms & tumor cells in the prostate • Massages prostate via rectum; then voids in a sterile container with preservative • Possible to detect some cases of cancer & TB of the prostate via prostate gland

  5. Cystoscopy • Used to detect bladder infections & tumors • Review GU chapter on this procedure

  6. PSA (Prostate Specific Antigen) • Highly sensitive blood test • PSA shows up in the blood in the presence of CA & BPH • Slight elevation needs further investigation • Normal value = 0 – 4 ng/dl

  7. ALP (Alkaline Phosphatase) • Used in diagnosing • BPH • Bone metastasis in prostate cancer • Other disease conditions

  8. ACP (Acid Phosphatase) • Group of enzymes present in semen & prostate gland • Used to detect cancer • Monitor response to therapy used for cancer • Blood test • 0.5 – 1.9 U/L

  9. II. Inflammatory Disorders – Prostatitis (Etiology) • Either acute or chronic • Bacterial infection of prostate gland • E. Coli, Klebsiella, Proteus, Pseudomonas • Usually from descending infection from kidneys

  10. Prostatitis (S/sx) • Sudden onset of chills, fever • Urgency & frequency of urination • Dysuria • Cloudy urine • Perineal fullness • Low back pain • arthralgia

  11. Prostatitis (S/sx) – (con’t) • Gland is tender, edematous & firm when palpated • How do you palpate the prostate gland? • What supplies are needed? • Sx are same but at a lesser degree with chronic condition

  12. Prostatitis (Dx Tests) • C & S of urethra – urine & prostatic fluid • How do you get prostatic fluid?

  13. Prostatitis (Medical Mgmt) • Antibiotic therapy • Periodic digital massage of the prostate • Heat via sitz baths

  14. Prostatitis (NI) • Full explanation of all therapies • Rx • Supportive care • Bed rest to relieve strain/pain of perineum & suprapubic area • Sitz bath – relieve pain • Stool softeners – prevent straining • Monitoring I&O • Follow-up care

  15. Prostatitis (Prognosis) • Recurrent episodes of acute prostatitis may cause fibrotic tissue formation. • If so, may be confused with CA as it causes hardening of prostate gland

  16. Epididymitis (Etiology) • Infection of cordlike excretory duct of the testes • Common infection • S. Aureus • Strep • N. Gonorrhea

  17. Epididymitis (Etiology) • Associated with • Urethral strictures • Cystitis • Prostatitis • Can occur after • Genital trauma • Urethral instrumentation (cystoscopy) • Prolonged sexual or physical activity

  18. Epididymitis (S/sx) • Severe, sudden scrotal pain that radiates along the spermatic cord • Scrotal edema that is sometimes extreme • “Duck walk” or “Waddling Gait” d/t sensitivity & pain walking elicits

  19. Epididymitis (S/sx) • Tender scrotal area • Pyuria • Chills • Fever

  20. Epididymitis (Dx Tests) • 1st am voiding for pyuria via MSCC • Epididymis is massaged by MD & expressed fluid is sent to lab • Scrotal exam is done • WBC is monitored for leukocytosis

  21. Epididymitis (Medical Mgmt) • Bed rest • Scrotal support & elevation • How do you elevate the scrotum? • Ice • Reduction of edema & pain • Antibiotic, prn • I&D, prn for abscess formation

  22. Epididymitis (NI) • Bed rest during acute phase • Testicular support • Scrotal support • Testicular elevation • Ice • During initial phase to hasten recovery • Education for compliance

  23. Epididymitis (Prognosis) • May be bilateral & recur • Bilateral can cause sterility • Untreated  necrosis of testicular tissue • Abscesses can form & septicemia can develop which can ultimately be fatal

  24. III. Structural Anomalies • Cryptorchidism • Failure of the testes to descend • Could become sterile if not descended • Spermatic Cord Torsion • Spermatic cord becomes twisted • Medical emergency • Sudden severe pain • Due to strenuous physical activity or sexual activity

  25. Structural Anomalies (con’t) – Phimosis – (Etiology) • Prepuce is too small to allow retraction over glans • May be congenital or d/t inflammation or disease • Doesn’t permit adequate hygeine

  26. Phimosis – (Medical Mgmt/NI) • Circumcision • Post-op care: • Petroleum gauze dressing over glans after surgery • Changed after every voiding • Observe for unusual bleeding or urine flow obstruction

  27. Structural Anomalies (con’t) – Hydrocele (Etiology;S/sx) • Accumulation of fluid between the membranes covering the testes & enclosing the testes • Scrotum enlarges as fluid accumulates • Pain if develops suddenly • Most occur in males > 21 • May develop from trauma, orchitis, epididymitis

  28. Hydrocele (Medical Mgmt) • Aspiration of fluid from the sac • Or • Surgical removal of the sac to avoid constriction of the circulation of the testes • Pain is relieved after fluid aspiration

  29. Hydrocele (NI/Prognosis) • Bed rest • Scrotal support • Elevation of scrotum How? • Ice packs to edematous areas • Frequent dressing changes very carefully to avoid skin impairment • Prognosis is good with treatment

  30. Structural Anomalies (con’t) – Varicocele • Scrotal veins become distended • Obstruction & malfunctioning cause veins to become engorged & elongated • Inadequate blood drainage occurs • Sx: • Pulling sensation • Dull ache • Scrotal edema

  31. Varicocele (con’t) • Tx • Surgical removal of obstruction • NI • Bed rest • Scrotal support • Ice • Analgesics

  32. Varicocele (con’t) • Prognosis • Often seen in men with low fertility/sperm count • Ligation of the spermatic vein improves sperm quality

  33. Structural Anomalies (con’t) – Hypospadias • Hypospadias • Birth anomaly in which the urethral opening is on the underside of the penis • Epispadias • Birth anomaly in which the urethral opening is on the top side of the penis or the dorsum

  34. Male Climacteric (Menopause)Etiology • Gradual • Occurs between 55 & 70 years • Gradual decrease in: • Testosterone levels • Semen production • Impact mostly psychological

  35. Male Climacteric (Menopause)S/sx • Mostly physiologic & occur as he ages • Erection requires more time • Erections not as full or firm • Prostate gland enlarges • Secretions diminish • Seminal fluid decreases

  36. Male Climacteric (Menopause)S/sx • Loss or thinning of hair • Head • Chest • Axillae • Pubis • Flushing & chilling

  37. Male Climacteric (Menopause)Assessment • Occurs when he is @ peak of career or retirement • Concludes his decreased sexual need as a loss of productivity & sexual power • Encourage him to vent feelings, including feelings of loss of self-worth

  38. Male Climacteric (Menopause)Dx Tests/NI/Education • Dx Tests • Complete physical to rule out structural & function anomalies • NI • Explain all procedures • Encourage verbalization of feelings • Education • Climacteric is normal • Seek counseling if stress increases

  39. V. Erection Disorders • Priapism • An abnormal, painful & continued erection of the penis due to disease or medication • Usually without sexual desire • Medical emergency – must seek medical attention immediately

  40. Erection Disorders – Impotence • Inability of an adult male to achieve erection • Causes • Functional – psychological • Anatomical – physical defect • Atonic – disturbed neuromuscular function

  41. Impotence (con’t) • Some Rx result in impotence • Anti-HTN • Anti-depressives • Anti-anxiety • Cardiac agents • ETOH • Some diseases result in impotence • DM • ESRD • COPD

  42. Impotence (con’t) • Pharmacological intervention • Viagra (contraindicated in hypotension) • Cialis (contraindicated in CV issues) • Testosterone (monitor for SE, take w/ food) • Surgical intervention • Penile implants • Inflatable • Rigid

  43. Cancer of Male Reproductive Tract – Testis • Higher in men with Cryptorchidism (undescended testes into scrotal sac) • Associated with • Testicular atrophy • Orchitis • Scrotal trauma

  44. Testis (con’t) • S/sx • Slow or rapid onset • Enlarged scrotum • Firm, painless smooth mass in testicular area • May c/o dull ache or heavy sensation in lower abdomen, perianal area or scrotum • Dx Tests • Med Mgmt

  45. Testis – (con’t) • Dx Tests • Palpation of testicular area • CA mass is firm & doesn’t transilluminate • US of testes if CA or painful/persistent testicular edema is suspected • Lab Tests • AFP (Alpha-fetoprotein) • HCG (Human Chorionic Gonadotropin) • CT of abdomen & pelvis • CXR

  46. Testis – (con’t) • Med Mgmt • Radical inguinal Orchiectomy – removal of involved testis, epididymis & portion of gonad’s lymph & blood supply • Remaining testis is enough to maintain sex characteristics • Decreased sperm count & mobility

  47. Testis – (con’t) • NI/Education • Early detection via TSE • Teach TSE beginning @ puberty (15 y/o) • Scrotum checked for color, contour & skin breaks • Left side hangs lower d/t longer spermatic cord • Normally firm, but somewhat resilient, smooth & mobile

  48. Testis – (con’t) • Prognosis • With early detection, surgery, chemotherapy & radiation therapy, 95% of patients obtain complete remission.

  49. VI. Cancer of Male Reproductive Tract – Penis • Generally rare • Those @ risk: • Over age of 50 • Uncircumcised • Low maintenance of good personal hygiene • Have STDs

  50. Penile Cancer • S/sx • Painless tumor • Wart-like growth or ulceration on the glans under the prepuce • Common for metastasis to the inguinal nodes & adjacent organs • Dx Test • Biopsy

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