Male Genitourinary Disorders

1. Male Genitourinary Disorders Chapter 40 Patty Maloney MSN/Ed,RN

2. Male Reproductive System • Normal Anatomy & Physiology includes: • 2 testicles • Ductal System: epididymis, ductus deferens, and ejaculatory ducts • Accessory Glands: seminal vesicles, prostate gland, and bulbourethral or cowper’s glands • External Genitals:urethra and penis

3. Male Reproductive System

4. Male Reproductive System:Prostate • Sits at base of bladder • Wraps around upper part of urethra • Purpose: provide secretions for semen, aid in ejaculation • Does not secrete hormones

5. The Male Reproductive System • The male reproductive organs are shared with the urinary tract. • Disorders of one system often effects the other system. • A male patient who has a disorder or dysfunction of the reproductive tract is often treated by a urologist.

6. Changes that occur with aging • Prostate enlargement may occur with risk of urethral obstruction. • Decrease in sperm production, but fertility remains intact. • After the age of 60, cycle of sexual response lenghtens. • Sexual activity in the older man is closely related to his sexual activity in younger years.

7. Reversible Contraception • Involves the use of spremicidal creams, gels, or foams applied before intercourse to kill sperm in the vagina. • These are more effective when used with a condom. • Latex condoms provide some protectio against sexually transmitted infections (STIs).

8. Permanent Contraception • Vasectomy-sterilization of the male. • Surgical procedure performed on the vas deferens for the purpose of interrupting the continuity of the duct. • Considered permanent but occasionally a vasectomy with microsurgery.

9. Vasectomy • Performed on an outpatient basis. • Local anesthesia is used. • Incision made into the scrotal sac on each side and vas is lifted out. • Instruct patient to use ice applications and acetaminophen or ibuprofen for scrotal pain and swelling for the first 12 to 24 hours post-op. • 2 negative sperm counts are needed for patient to be considered infertile.

10. Male Genitourinary Disorders Prostate Disorders: • Prostatitis- inflammation of the prostate gland can occur anytime after puberty chronic, acute or a single episode • Three types: 1. Acute bacterial 2. Chronic bacterial 3. Nonbacterial

11. Digital Rectal Exam • Physician inserts a lubricated, gloved finger into the rectum to evaluate the size and consistency of the prostate and to detect any nodules. • Should be done yearly after the age of 50.

12. Diagnostic Testing • Semen analysis-patient provides a semen specimen, which is analyzed for volume and for sperm count motility. • Testicular self-exam (TSE)-encouraged regularly for early detection of cancer. • Prostate-specific antigen (PSA) level-blood test, level above 10 may be indicative of cancer.

13. Diagnostic Testing • Prostate tissue analysis(biopsy)-sample tissue or fluid is aspirated and samples sent for pathology. • Testosterone level-need to obtain a morning sample because testosterone levels are highest in the morning. High levels may indicate a testicular tumor.

14. Disorders of the Male Reproductive System • Erectile Dysfunction (ED)- also known as impotence. • Inability to achieve or maintain an erection that is firm enough for sexual intercourse more than 25% of the time. • ED has both psychological and organic causes.

15. Erectile Dysfunction • Treatment: Depends on the cause. • Medical conditions are treated, hormone therapy, vascular surgery may be indicated for blood flow obstruction. • Primary intervention for ED id reversing the problem.

16. Erectile Dysfunction Treatment • Erectile dysfunction drugs such as, Viagra, Cialis. (Should not be taken with heart problems) • Penile implants. • Priapism-persistent abnormal erection that can develop into a medical emergency.

17. Disorders of the Male Reproductive System • Infertility: • Approximately 25% to 30% of infertility causes may be due to male factors. • Testicular disorders are the most frequent cause of male infertility. • Drugs, infections, systemic disorders can cause testicular failure. • Semen analysis and sperm count is performed.

18. Hydrocele • A larger than normal amount of fluid between the testis and the tunica vaginalis within the scrotum. • The fluid accumulation may be caused by infection. • Hydrocele causes enlargement of the scrotum, usually painless but the weight and bulk of the fluid can cause discomfort.

19. Hydrocele

20. Testicular Torsion • Twisting of the testing and the spermatic cord. • Commonly caused by elevated hormone levels in young men or the result of scrotal trauma. • S/S include sudden acute scrotal pain and absence of cermasteric reflex (retraction of the testicles when the inner thigh is stroked)

21. Testicular Torsion • Diagnosis is made by ultrasound. • Treatment is emergency surgery to remove the testicle.

22. Peyronie’s Disease • Condition in which a plaque of nonelasticfiberous tissue develops in the tunica portion of the penis. • The penis will curve upward when an erection occurs. • Erection may be painful. • Treatment is conservative, may be treated with injections to dissolve plaque.

23. Benign Prostatic Hyperplasia Signs/Symptoms: • Symptoms related to obstruction include: • Decrease in size or force of urinary stream • Difficulty starting a stream • Dribbling after urination is thought to be completed • Urinary retention • Feeling that the bladder is not empty • Interrupted stream-(urine stops mid stream and then starts again)

24. Benign Prostatic Hyperplasia • Narrowing causes an obstruction and may lead to urinary retention and eventually distention of the kidney with urine (hydronephrosis) • No known cause other than normal aging • Men over 50, more commonly in men over 70

25. Benign Prostatic Hyperplasia Complications: • Hydronephrosis - urine back-up into kidneys • Renal insufficiency • Urosepsis

26. Benign Prostatic Hyperplasia Diagnostic Tests: • Medical history is important • Digital rectal exam (DRE) • Urinalysis • BUN & creatinine • (PSA) - prostate-specific antigen level - this will be elevated (normal = less than 4.0) • Urodynamic flow studies - assesses urine flow rate • Transrectal ultrasound, cystoscopy

27. Benign Prostatic Hyperplasia Treatment: • Antibiotics for UTI • Indwelling or intermittent catheter • Encourage Fluids • Alpha-adrenergic antagonists - used to relax smooth muscle of the prostate, Ex. Flomax, Hytrin and Cardura

28. Benign Prostatic Hyperplasia Surgical Treatment: • (TURP)-Transurethral resection - most used to relieve obstruction caused by an enlarged prostate • (TUIP)-Transurethral incision of the prostate, incision into the gland to relieve the obstruction • (TULIP)-Transurethral ultrasound-guided lasar-induced prostatectomy used to relieve obstruction

29. Benign Prostatic Hyperplasia Surgical Treatment: • Radical Prostatectomy - removal of the entire prostate gland when the gland is very large, is causing obstruction, or is cancerous

30. Benign Prostatic Hyperplasia • (TURP)-Transurethral Resection of the Prostate • Patient is anesthetized and surgery is performed with a scope • Resectoscope inserted into the urethra and prostate gland is “chipped away” a piece at a time • Chips are flushed out using an irrigating solution and are sent to lab for analysis • Gland is not completely removed but peeled back like an orange

31. Benign Prostatic Hyperplasia Post-OP: • Bleeding is common • Foley catheter is left in place • Balloon is overinflated with 30-60mL of sterile water and tightly secured to leg • Creates tamponade to compress the prostate and stop the bleeding • (CBI)-continuous bladder irrigation is usually kept running for the first 24 hours

32. Benign Prostatic Hyperplasia Complications: • Clot formation • Bladder spasms • Infection • Hemorrhage • Erectile dysfunction

33. Benign Prostatic Hyperplasia Nursing Interventions: • Closely monitor urinary output, amount, color and presence of clots hourly for first 24 hrs • Encourage patient to drink 2500mL per day unless contraindicated • Monitor for acute pain and bladder spasms and administer analgesics as ordered

34. Cancer of the Prostate • Second most common cause of cancer death in US in men over 60 years of age • Usually slow growing and does not cause a major threat to health or life • Prostate cancer rates are highest in African American men

35. Cancer of the Prostate Risk Factors: • Age - usually in men over 65 • High levels of testosterone • High fat diet • Immediate family history • Occupational exposure to cadmium (e.g. welding, alkaline battery manufacturing)

36. Cancer of the Prostate Signs/Symptoms: • Rare to have symptoms in early stage Later symptoms: • Urinary obstruction • Hematuria • Urinary retention Advanced symptoms (metastatic stage): • Bone pain in back or hip • Anemia, weight loss, weakness

37. Cancer of the Prostate Complications: • Difficulty urinating • Bladder or kidney infection • Pain • Bone fractures • Weight loss • Depression • Death if treatment is unsuccessful

38. Cancer of the Prostate Diagnosis: • (DRE)-Digital Rectal Exam, examiner may find a hard lump or hardened lobe • (PSA)-Prostate Specific Antigen-levels will be elevated • (PAP)-Prostatic Acid Phosphatase-will be elevated, this test is indicative of cancer spreading out of the capsule

39. Cancer of the Prostate Treatment - Early Stages: • Testosterone-supressing medications, e.g. Lupron, Zoladex • TURP or radical prostatectomy • Combination of medication and radiation

40. Cancer of the Prostate Treatment - Later Stages: • Radical prostatectomy, radiation or implantation of radioactive seeds into the prostate • Bilateral Orchiectomy - surgical removal of the testicles, (relieves symptoms by blocking testosterone) Estrogen Therapy • Chemotherapy to help relieve symptoms from spread of cancer

41. Cancer of the Prostate Treatment: • Radical Prostatectomy-reserved for patients with cancer of the prostate or when the gland is too large to resect with a TURP • Post-op - the patient will return with large indwelling catheter in the urethra or may have a suprapubic catheter

42. Cancer of the Prostate Nursing Implications: • Assess catheter for patency and s/s of bleeding • Assess level of pain and medicate as ordered • Assess incision for drainage or s/s of infection • Notify physician of any abnormals • Instruct men over the age of 40 to have a yearly DRE of the prostate, men over 50 - PSA

43. Penile Disorders Phimosis - condition in which foreskin of uncircumcised male becomes so tight that it is impossible to clean the area underneath • Smegma -a cottage cheese-like secretion made by the glands of the foreskin, becomes trapped under the foreskin, becomes an excellent place for the growth of bacteria and yeast (infections)

44. Penile Disorders Treatment: • Antibiotics • Warm soaks to area • Physician may need to cut a slit in foreskin to relieve pressure and treat infection • Full circumcision if problem continues • Problem is preventable by instructing males who are not circumcised to pull the foreskin back carefully and wash with soap and water

45. Penile Disorders Paraphimosis- occurs when the uncircumcised foreskin is pulled back during bathing or intercourse and not immediately replaced in a forward position • Result is constriction of the dorsal veins which leads to edema and pain • Requires immediate medical attention to prevent circulation problems or gangrene

46. Penile Disorders Cancer of the Penis - has been found in men who have not been circumcised as babies or have acquired the human papillomavirus (HPV) • Tumor looks like a small, round, raised wart • One type of cancer that may be spread to the sex partner (HPV – linked with cervical cancer in female)

47. Penile Disorders Treatment: • Circumcision • Laser removal of the growth • Cutting away all or part of the penis • Radiation • Chemotherapy • Finding and treating any wart-like tumor in it’s earliest stages is an important part of patient education

48. Cancer of the Testes • Most common solid tumor in men 15 to 40 years of age • Peaks between 20 and 34 years of age • Etiology unknown • Risk factors-family history, mothers use of DES (estrogen preparation once used to prevent spontaneous abortion while pregnant), white race

49. Cancer of the Testes Prevention: **Monthly self-testicular exam ! Signs/Symptoms: • Early warning signs = small painless lump on the side or front of the testes • Swollen scrotum that feels heavy

50. Cancer of the Testes Late Symptoms: • Back pain • Shortness of breath • Difficulty swallowing • Breast enlargement • Changes in vision or mental status indicate metastasis