THE GENITOURINARY SYSTEM

1. THE GENITOURINARY SYSTEM

3. GENITOURINARY SYSTEMStructural Disorders • Objectives: • To learn the common structural and functional disorders of the male reproductive system • To learn nursing management for these disorders • To learn about infertility and impotence • To describe various forms of contraceptives • To know nursing management, including pharmacology related to disorders.

4. STRUCTURAL DISORDERS • Hydrocele: benign, non-tender collection of clear, amber fluid within the space of the testes and the tunica vaginalis or along the spermatic cord. • Occurrence is in males > 21 years old • Cause unknown. May develop secondary to • trauma, orchitis or epididymitis

5. Clinical Manifestation • Scrotal swelling possible: can be painful if it develops suddenly. • Inflammation of the epididymis or testis or a lymphatic or venous obstruction can be the cause.

6. STRUCTURAL DISORDERS • Congenital hydrocele: occurs in newborn when the canal between the peritoneal cavity and the scrotum does not close completely during fetal development. • Aspiration of fluid is only temporary measure and can lead to secondary infection • Surgery is the treatment

7. Medical/Surgical Management • -Sometimes aspiration of the fluid is done which • increases the risk for infection. After aspiration, pain • is relieved and scrotum can be examined easier. • -Surgery is usually the treatment. Removal of the sac to • avoid constriction of the circulation of the testes.

8. Nursing Interventions • Post-op and post aspiration • - Maintain bed rest • - Scrotal support • - Ice to edematous areas • - Frequent dressing changes

13. STRUCTURAL DISORDERS • Spermatocele: benign nontender cyst of either the epididymis or the rete testis. • Contains milky fluid and sperm • Usually painless and requires no treatment • Varicocele: dilation of the veins of the scrotum; occurs when the venous system that drains the testicle lengthens and enlarges. • Absent or malfunctioning valves in spermatic venous system; permits blood to accumulate resulting in decreased hydrostatic pressure…..

15. Varicocele: symptoms may include bluish discoloration of the scrotal skin or palpation of a wormlike mass when male bears down…..condition seldom requires treatment. • Torsion of the spermatic cord: vascular pedicle of the testes twists, resulting in partial or complete venous occlusion. • Three types • Sx: abdominal/scrotal pain, scrotal, edema, N/V, fever

16. MED-SURG MANAGEMENT • Specific to the condition • Hydrocele • Spermatocele • Varicocele • Torsion

17. NURSING MANAGEMENT • Bed rest with scrotal support • Ice to area • Analgesics prn • Monitor vital signs, incisional drainage and dressing. Use strict asepsis when changing dressings.

18. STRUCTURAL DISORDERS • Phimosis: when the opening of the foreskin is so small that it cannot be pulled back over the glans; may interfere with urination. • Inguinal Hernia: most common type, occurs in groin area, frequently occur after activities (heavy lifting) that increase intraabdominal pressure; subsides with relaxation. • Pain located lower than abdominal hernia

19. FUNCTIONAL DISORDERS • Impotence: inability of an adult male to have an erection firm enough or to maintain it long enough to complete sexual intercourse. • Functional: psychological factors, aging, difficulty with relationships or communication • Atonic: result of medications, alcohol, cocaine and nicotine. Or diabetes, vascular and neurological disorders, renal disease.

20. FUNCTIONAL DISORDERS • Anatomic: Peyronie’s disease- the development of non-elastic, fibrous tissue just beneath the penile skin, leading to anatomic impotence.

22. MED-SURG MANAGEMENT • Medical • Determine whether lifestyle is a factor • Assessment may include nocturnal penile tumescence monitoring or DICC • Treatment based on assessment and findings: change in lifestyle, manage stress, lose weight, exercise. • External devices can be used (VCD)

23. MED-SURG MANAGEMENT • Surgical: revascularization and penile implants • Disadvantages: expense, post-op complications, especially post-op infection. • Pharmacological: Medications that produce erections are available: • Viagra (sildenafil citrate) • Oral transmitters or sublingual apomorphine

24. Nursing Interventions • -Post-op care post penile implant • -Patient/family teaching: • Use and care of the implant • Medication use, effects and side effects • -Nursing Diagnoses: Sexual dysfunction, ineffective • sexuality problems, disturbed body image, deficient • knowledge.

26. INFERTILITY • Approximately 1 in 6 couples experience infertility, the inability to produce offspring. • Primary infidelity • Secondary infidelity • Etiology: may be related to anatomic or endocrine problems • Detailed history and physical exams needed

27. 40% of infertility factors are female related • 40% are male related • 20% are a combination of multiple factors involving both partners • Infertility causes in female include: • -Blocked passages through the cervix or fallopian tubes • -Uterine or cervical abnormalities • -Cervix too narrow for sperm navigation • -Development of antibodies by woman’s system to • male’s sperm (kills sperm on contact in cervical • mucousa)

28. Infertility causes in males include- • -Varicoceles • -Cryptorchism • -Impaired sperm • -Insufficient number of sperm • -Hormonal imbalance • -Use of hot tubs or sauna (may decrease sperm)

29. INFERTILITY • Basic infertility workup may be started when couple unable to conceive after 6-12 months of unprotected intercourse. • Basal temperature chart • Endometrial biopsy • Semen analysis • Endocrine imbalance testing • Male-female interaction studies • Laparoscopy

30. MED-SURG MANAGEMENT • No one treatment for infertility problems • -Diagnostic Tests: Testing to rule out systemic disease • ( e. g. DM, neoplasms, hepatic and renal disease, etc.) • -genetic disorders • -Male infertility testing: semen analysis, sperm volume, • sperm motility and density • -Endocrine testing to check pituitary gonadotropins, and • testosterone production

31. MED-SURG • Pharmacology • Hormone imbalances or deficiencies: clomiphene citrate, menotrins, human chronic growth hormone, progesterone suppositories • -Clomiphene and Chorionic Gonadotropin

32. Medical: • Artificial insemination Surgical: - In vitro fertilization GIFT - ZIFT -Both procedures are expensive

33. Pharmacology • -Hormone imbalances or deficiencies: clooiphene • citrate, menotrins, human chronic growth • hormone, progesterone suppositories • -Clomiphen and Chrionic Gonadotropin • Clomid (clomiphene): synthetic nonsteroidal • compound; binds to estrogen receptors and causing • anterior pituitary to increase secretion of FSH and • LH. Used to induce ovulation in anovulatory • women.

34. MED-SURG • Pharmacology • HCG: extracted from human placentas; actions identical to those of pituitary LH; used to induce ovulation in anovulatory women. Also used to for treatment of prepubertal cryptorchism ( failure of the testes to descend into the scrotum)

35. MED-SURG • PHARMACOLOGY • Adverse reactions: • Clominophene: vasomotor flushes, abdominal discomfort, ovarian enlargement, blurred vision, N/V, nervousness. • HCG: headache, irritability, restlessness, fatigue, edema, precocious puberty (when given for cryptorchism)

36. MED-SURG • Pharmacology • Menotropins: purified preparations of the gonadotropins ( FSH and LH) extracted from the urine of postmenopausal women: used to induce ovulation and pregnancy in anovulatory women; also used with HCG to stimulate multiple follicles for in vitro fertilization. In men, use to induce the production of sperm

37. MED-SURG • Adverse Reactions: ovarian enlargement, hemoperitoneum (Blood in the peritoneum), abdominal discomfort, and febrile reactions. • Patient teaching considerations

38. Med-Surg • Health Promotion • Seek prompt medical attention for infections affecting the reproductive system • Wise choices for contraception and sexual practices

39. Family Planning • - A range of options for individuals wanting to • prevent or plan conception • - Birth control planning involves moral, • religious, cultural, and personal values. The • nurse should be sensitive to these factors when • discussing birth control with patients. • - Selection of birth control practices and • procedures should take into account the health • individual, effectiveness of the method, cost, • cost, ease of use, age, and parity (# of • pregnancies), preference of the couple and • willingness to comply with use.

40. CONTRACEPTION • Contraception: prevention of pregnancy • Natural method: • Rhythm method -Rhythm method is a abstaining from intercourse during woman’s fertile period of the month -Usually lasting 7 days; 3 days before ovulation and 3 days after

41. -Basal body temperature chart must be maintained • -Spinnbarkeit method monitors stretchiness of • cervical mucous to determine ovulation • -This type of mucous provides favorable • environment for sperm and its’ motility toward • the ova • - Immediately after ovulation, the mucous • becomes hostile to the sperm • - Home kits are available to take this test

42. Hormonal methods: • Oral contraceptives- works by suppressing • ovulation (“the pill”) • Depo-Provera • Lunelle • Mirena • Transdermal Patch • Vaginal ring -Some contain estrogen and progesterone; others contain only progestins -Clients may experience mild side effects in response to the pseudopregnancy state (nausea, breast tenderness, weight gain)

43. Nonhormonal methods: • -Intrauterine Device • -Barriers: cervical cap, diaphragm, condoms • -Vaginal ring • -Spermicides • Sterilization method: • -Permanent and very effective • -Tubal ligation • -Vasectomy

50. PHARMACOLOGY • Objectives: • Discuss medical uses, actions and adverse reactions to male and female hormones • Discuss pre-administration and ongoing assessments the nurse should perform with a person taking male or female hormones • Discuss adverse reactions and/or special considerations