1120 Male Reproductive

1. 1120 Male Reproductive By Diana Blum RN MSN Metropolitan Community College

3. Anatomy • Scrotum} thin pendulous sac that holds 2 testes in separate components (protects and insulates) • Testes} male reproductive organs. Suspended from spermatic cord. Secretes testosterone. Descend in last 2 mths gestation. • Prostate} produces thin milky alkaline liquid that enhances motility and fertility of the sperm. Contracts during ejaculation • Cowper’s gland} pea sized..just below prostate, secretes clear mucus into urethra • Urethra} empties urine from bladder and provides outlet for ejaculation • Epididymis} coiled tubule almost 20 ft long • Vas Deferens} tubes of secretory duct that store sperm, contribute semen, and propel fluid during ejaculation • Seminal vesicles} hollow twisted tubular secretory glands in posterior bladder. Produce 60% of semen

4. Physiology • Cryptorchidism} failure of testes to descend • may result in sterility • Emission} result of sympathetic stimulation leaving spinal cord at L1 and L2 • Ejaculation} expulsion of semen • See page 1128

5. Age Related Changes • Testerone continues throughout life but decreases after age 50 • Slower to rouse • Have longer refractory periods between erections

6. Assessment • Look for erectile dysfuntion • Assess injuries, diseases, surgeries, meds, allergies • Look for knowledge deficit about self exams • Assess family Hx • Assess diet, exercise, changes in habits, or skin, endocrine problems • exam} inspect and palpate

7. Definitions • Smegma} white thick odiferous secretion b/w glans and foreskin • Hydrocele} mass filled with serous fluid and glows red with light • Hematocele} mass filled with serous fluid. Looks like a shadow in light because no light passes through

8. Diagnostics • Semen analysis: too high or too low =infertility, look for thyroid, pituitary, adrenal, or testicular dysfunction • Tumor markers • X-ray • See page 1133-1134

9. Disorders • Prostatitis: inflamed prostate gland • S/S: swelling, warmth, tenderness, dysuria, frequency, hematuria, foul smelling urine, malaise • Tx: antibiotics, analgesics, sitz bath • Epididymitis: inflamed epididymis • Causes: infection, trauma, urine reflux • S/S: scrotal edema, n/v, chills, fever • Tx: bedrest, antibx, analgesics, antiinflamatory, scrotal support • Orchiditis: inflamed testes • Causes: trauma, mumps, pneumonia, TB • S/S: fever, tenderness, swelling of testes (can lead to sterility) • Tx: analgesics, antiyretics, bedrest, scrotal support, local heats

10. Disorders • BPH} enlargement of prostate • s/s: obstructive, irrative, decreased urine flow, urinary retention, post void dribbling, urgency, incontinence, frequency, dysuria, nocturia, hematuria • Tx: meds (proscar, flomax) , TURP • Nsg Dx: fear, impaired urinary elimination, ineffective therapeutic regimen • Interventions: space fluid throughout day, avoid ETOH and antihistamines, bladder scan, foley (p. 1137--1138)

11. Post-Op • Vs • Monitor blood in urine and clots seen • Strict I/O • CBI to prevent clots • Manually irrigate as ordered • Assess pain • Care plan page 1139

12. Peyronie’s DX • Development of plaque under skin of penis • Occurs b/w 45-70 years of age • result of an injury that caused inflammation • Leads to failure to fill and store • TX: topical or oral meds with vitamin E, chochicine, tamoxifen, etc

13. Erectile Dysfunction • Failure to initiate- inability to initiate erection • Cause: nerve damage, stress, anxiety, hormone problems • Tx: therapy, hormones, injections, implant • Failure to fill- erection develops slowly • Cause: arterial blockage • Tx: therapy, revascularization, implant • Failure to store- poorly maintained erection • Cause: stress, aging, injury • Tx: therapy injections, sildenafil (viagra), venous ligation, implant • BP meds interfere with erection • Viagra: vasodilator and is contraindicated with those on nitrates and hypotension

14. Priapism • Prolonged erection not related to desire • Causes: sickle cell crisis, injury, neoplasms, or certain meds (see page 1147) • May be painful, may obstruct urine, may cause hydronephrosis

15. Phimosis • Edema that prevents retraction of the foreskin • Causes: poor hygiene, inflammation • Tx: antimicrobials, and proper cleansing • Uncircumsized med need to retract foreskin for proper cleaning

16. Infertility • Caused by: infection, cryptorchidism, variocele, testicular torsion, vasectomy • Testicular torsion: when testicle is mobile and spermatic cord twists… requires surgery • Variocele: lengthening and enlargement of scrotal portion that drains..caused by valve problems in the spermatic venous system • Cryptorchidism: any testis located somewhere other than scrotum • Must be corrected in first 18 months of life to improve infertility • Men with undescended testicles have 10-30 times more incidence of testicular cancer

17. Vasectomy • Surgical removal of a portion of the vas deferons • Birth control must be used until lab determines that no sperm are present • Analysis will be started after 15 ejaculations post surgery

18. Testicular/Prostate Cancer • Testicular • 3 risk factors: cryptorchidism, white race, previous history • Nsg Dx: anxiety, acute pain, impaired urinary retention, risk for injury, constipation, low self esteem, knowledge deficit • Prostate • Tx: routine PSA level checks, radiation, hormone therapy, surgery, chemo