1120 Male Reproductive

By Diana Blum RN MSN Metropolitan Community College

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

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

Age Related Changes

• Testerone continues throughout life but decreases after age 50

• Slower to rouse • Have longer refractory periods between erections

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

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

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

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

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)

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

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

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

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

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

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

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

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