Chapter055

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 55: Caring for Clients with Disorders of the Male Reproductive

System


Structural AbnormalitiesStructural Abnormalities

• Cryptorchidism

– Testes undescended; Empty scrotum; Lie in inguinal canal, abdominal cavity

– Unknown cause; Asymptomatic

– Impact on sperm production, fertility

– Risk for testicular cancer

– Treatment: Androgen therapy; Orchiopexy

– Nursing management


QuestionQuestion

Is the following statement true or false?

Cryptorchidism is evidenced by painful swelling of the scrotum.


AnswerAnswer

False.

Cryptorchidism is asymptomatic. It is evidenced by an empty scrotum and the testes lie in inguinal canal, or abdominal cavity.


Structural AbnormalitiesStructural Abnormalities• Torsion of the Spermatic Cord

– Twisted spermatic cord; Artery kinked; Compromised blood flow to testicle

– Spermatic cords congenitally unsupported

• Assessment Findings: Signs and Symptoms

– Sudden, sharp testicular pain; Local swelling; Nausea, vomiting, chills, and fever

• Diagnostic Findings: Physical Examination

• Treatment: Immediate Surgery

• Nursing Management


Structural AbnormalitiesStructural Abnormalities

• Phimosis, Paraphimosis

– Occur among uncircumcised males, opening of the foreskin is constricted

– Signs and symptoms

• Pain with erection and intercourse

• Difficulty cleaning under foreskin

• Painful swelling of glans

• Edema; Urinary retention

– Treatment: Circumcision; Hygiene


Structural AbnormalitiesStructural Abnormalities• Hydrocele, Spermatocele, and Varicocele

– Swelling of the scrotum

– Hydrocele and spermatocele: No treatment

– Varicocele: Surgically repaired; Cause of male infertility


Infectious, Inflammatory ConditionsInfectious, Inflammatory Conditions• Prostatitis: Inflammation of the Prostate Gland

– Escherichia coli; Microbes that cause STDs; Psychosexual problem

• Signs and Symptoms

– Glandular swelling; Tenderness; Perineal pain

– Unusual sensation prior to/after ejaculation

– Low back pain; Fever; Dysuria; Urethral discharge

• Treatment: Antibiotic therapy; Analgesics; Sitz baths



QuestionQuestionIs the following statement true or false?

Prostatitis has several causes.


AnswerAnswerTrue.

Prostatitis is inflammation of the prostate gland caused by E. coli, STD microbes, psychosexual problems, etc.


Infectious, Inflammatory ConditionsInfectious, Inflammatory Conditions• Epididymitis, Orchitis: May occur alone or

simultaneously; Uni- or bilateral epididymitis

• Causes: Infectious agent causing prostatitis; Infection in body; Noninfectious epididymitis (long-term indwelling catheter, genitourinary procedures)

– Orchitis: Viral mumps after puberty

• Signs and Symptoms: Pain, swelling in inguinal area, scrotum; Fever; Chills

• Treatment: Bed rest; Scrotal elevation; Local cold applications; Analgesics/Anti-inflammatory agents; Antibiotic therapy; Epididymectomy



Erection Disorders: Erectile DysfunctionErection Disorders: Erectile Dysfunction

• Pathophysiology and Etiology: Ineffective

– Neurologic stimulation

– Arterial blood flow

– Trapping of venous blood

• Physical and psychological origins


– Difficulty in achieving or maintaining an erection

– Insufficient rigidity


Erection Disorders: Erectile DysfunctionErection Disorders: Erectile Dysfunction• Diagnostic Findings

– Nocturnal penile tumescence and rigidity test

– Vascular ultrasound studies

• Medical, Surgical Management

– Change in drugs that cause impotence

– Drug therapy; Treatments to facilitate penile engorgement

– Vascular surgery; Penile implants



Erection Disorders: PriapismErection Disorders: Priapism• Priapism: Persistent erection without sexual

stimulation

– Etiology: Vascular problem; Medical condition; Side effect of medication

– Symptoms: Discomfort; Interference with arterial blood flow and urinary elimination; Tissue damage

– Treatment: Vasoconstrictive medications; Draining trapped blood; Emergency surgery

– Emotional support


Erection Disorders: Benign Prostatic Hyperplasia Erection Disorders: Benign Prostatic Hyperplasia

• Pathophysiology, Etiology: Increased number of cells in prostate

– Resulting in decreased diameter of the prostatic section of the urethra


– Gradual onset; Difficulty urinating, emptying bladder; Nocturia; Urgency

• Diagnostic Findings

– DRE; Cystoscopy; IVP; Blood chemistry tests

– PSA; Transrectal ultrasound


Erection Disorders: Benign Prostatic Hyperplasia Erection Disorders: Benign Prostatic Hyperplasia


– Monitoring with DREs

– Drug therapy

– Alternative therapy

– Surgical procedures

• TURP; TUIP

• TULIP; TUNA

• Prostatectomy



Prostate CancerProstate Cancer

• Pathophysiology, Etiology

– Increased testosterone; High-fat diet; Family history

– Occurs in periphery of the gland; GU symptoms; Untreated cells spread by bloodstream and lymphatics


– Frequent urination; Nocturia; Dysuria; Hematuria; Hemospermia; Erectile dysfunction; Back pain, pain down leg—metastasis


Prostate CancerProstate Cancer• Diagnostic Findings: Rectal examination; PSA;

Transrectal ultrasound; Radiographs; MRI; CT; IVP; Elevated serum acid phosphatase


– Annual screening @ 50 y.o.

• At age 45: African Americans; 1st degree family history < 65 y.o.

– Treatment: Observation, surgery, radiation, hormone therapy, or combination

– Surgery: Suprapubic prostatectomy; Radical prostatectomy; Bilateral orchidectomy; Potential complications


QuestionQuestionIs the following statement true or false?

Prostatic screening should begin for all men at age 60.


AnswerAnswerFalse.

Annual prostatic screening should begin for men with a 10-year life expectancy at age 50. Screenings should begin at age 45 for African Americans and men who have immediate relatives with a history of prostatic cancer before 65 years of age.


Prostate CancerProstate Cancer

• Medical, Surgical Management (Cont’d)

– Radiation therapy: Used alone or with other therapies; Side effects

– Hormone therapy

• Men with D stage carcinoma; Antiandrogenic or estrogenic drugs; Feminizing side effects



Testicle CancerTesticle Cancer• Pathophysiology and Etiology

– Cryptorchidism

– Early degeneration of cells in undescended testis or testes; Abnormal cellular changes

– Seminomas; Nonseminomas


– Scrotal swelling; Hard, nontender nodule; Abdominal pain; General weakness; Testicular aching

• Diagnostic Findings: Tumor markers; IVP; Lymphangiography; CT; MRI


Testicle CancerTesticle Cancer• Medical, Surgical Management: Treatment depends

on the stage of the disease

– Autologous bone marrow transplantation; Sperm banking

– Surgery: Radical inguinal orchiectomy; Spermatic cord ligation; Radical retroperitoneal lymph node dissection

– Chemotherapy; Radiation



Penis CancerPenis Cancer• Rare; Occurs more often in uncircumcised men

• Probable progress: Chronic irritation; Precancerous skin lesion; Malignancy

• Diagnosis

– Biopsy; CT; MRI

• Treatment

– Tumor excision; Chemotherapy

– External or interstitial radiation therapy

– Amputation


Elective SterilizationElective Sterilization• Vasectomy: Ligation of vas deferens

– Minor surgical procedure

– Permanent sterilization

• Interruption of the pathway that transports sperm

– Procedure has no effect on erection or ejaculation



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