Download - Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes

Copyright © 2008 Lippincott Williams & Wilkins.

Chapter 49

Assessment and Management of Problems Related to Male

Reproductive Processes

Chapter 49

Assessment and Management of Problems Related to Male

Reproductive Processes


Male Reproductive SystemMale Reproductive System

• Includes conditions that affect reproduction, sexuality, and urinary elimination

• Patient may experience anxiety and embarrassment

• Be sensitive to cultural and emotional issues related to sexuality and the genitals to accomplish effective assessment and communication

• Provide for privacy and education


Structures of the Male Reproductive Tract Structures of the Male Reproductive Tract


AssessmentAssessment

• Urinary function and symptoms

• Sexual function and manifestations of sexual dysfunction

• Symptoms related to urinary obstruction

– Increased urinary frequency

– Decreased force of stream

– “Double” or “triple” voiding

– Nocturia, dysuria, hematuria, and hematospermia

• Medications, drug, and alcohol use

• Presence of conditions that may affect sexual function (diabetes, cardiac disease, and multiple sclerosis)


PLISSITPLISSIT

• Model of sexual assessment and intervention

– Permission

– Limited Information

– Specific Suggestions

– Intensive Therapy


Physical AssessmentPhysical Assessment

• Digital rectal exam

• Testicular exam


Examination of the ProstateExamination of the Prostate


Diagnostic TestsDiagnostic Tests

• Prostate specific antigen (PSA)

• Ultrasonography

• Prostate fluid or tissue analysis

• Tests of male sexual function


Disorders of Male Sexual FunctionDisorders of Male Sexual Function

• Erectile dysfunction

– Psychogenic and organic causes

– Organic causes include vascular, endocrine, hematological, and neurologic disorders, trauma, alcohol, medications, and drug abuse

– Chart 49-1 lists classes of medications associated with erectile dysfunction

• Ejaculation problems

– Premature ejaculation

– Retrograde ejaculation


Evaluation and Treatment of Erectile DysfunctionEvaluation and Treatment of Erectile Dysfunction


Medical ManagementMedical Management

• Pharmacologic therapy– Oral medications: sildenafil (Viagra)

Side effects include headache, flushing, dyspepsia Caution with retinopathy Contraindicated with nitrate use

– Injected vasoactive agents

• Complications include priapism (persistent abnormal erection)

– Urethral suppositories• Penile implants• Negative pressure devices • See Table 49-2


Conditions of the ProstateConditions of the Prostate• Prostatitis: inflammation caused by an infectious agent

– Treatment includes appropriate anti-infective agents and measures to alleviate pain and spasm

• Benign prostatic hyperplasia (BPH, enlarged prostate)

– Affects half of men over age 50 and 80% of men over age 80

– Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections

– Treatment

• Pharmacologic: alpha-adrenergic blockers, alpha- adrenergic antagonists, and antiandrogen agents

• Catheterization if unable to void• Prostate surgery


Prostate CancerProstate Cancer• Second most common cancer and the second most

common cause of cancer death in men

• Risk factors include increasing age, familial predisposition, and African American race

• Manifestations– Early disease has few/no symptoms

– Symptoms include urinary obstruction, blood in urine or semen, and painful ejaculation

– Symptoms of metastasis may be the first manifestations

• Early diagnosis is vital; regular health screening is crucial• Treatment may include prostatectomy, radiation therapy,

hormonal therapy, and/or chemotherapy


Prostate Surgery ProceduresProstate Surgery Procedures


Prostate Surgery Procedures (cont.)Prostate Surgery Procedures (cont.)


Nursing Process—Assessment of the Patient Undergoing Prostatectomy

Nursing Process—Assessment of the Patient Undergoing Prostatectomy

• Assess how the underlying disorder (BPH or prostate cancer) has affected the patient’s lifestyle

• Urinary and sexual function

• Health history

• Nutritional status

• Activity level and abilities


Nursing Process—Diagnosis of the Patient Undergoing Prostatectomy

Nursing Process—Diagnosis of the Patient Undergoing Prostatectomy

• Anxiety

• Acute pain preoperatively

• Acute pain postoperatively

• Deficient knowledge


Collaborative Problems/Potential Complications

Collaborative Problems/Potential Complications

• Hemorrhage and shock

• Infection

• DVT

• Catheter obstruction

• Sexual dysfunction


Nursing Process—Planning the Care of the Patient Undergoing Prostatectomy

Nursing Process—Planning the Care of the Patient Undergoing Prostatectomy

• Major goals preoperatively include adequate preparation and reduction of anxiety and pain

• Major goals postoperatively include maintenance of fluid volume balance, relief of pain and discomfort, ability to perform self-care activities, and absence of complications


Relief of Pain Relief of Pain

• Monitor urinary drainage and keep catheter patent• Assessment of pain

– Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter

• Medication and warm compresses or sitz baths relieve spasms

• Administer analgesics and antispasmodics as needed

• Encourage patient to walk but to avoid sitting for prolonged periods

• Prevent constipation• Irrigate catheter as prescribed


Three-Way System for Bladder IrrigationThree-Way System for Bladder Irrigation


InterventionsInterventions

• Reduce anxiety

– Be sensitive to potentially embarrassing and culturally charged issues

– Establish a professional, trusting relationship

– Provide privacy

– Allow the patient to verbalize concerns

– Provide and reinforce information

• Provide patient teaching including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience


Rehabilitation and Home CareRehabilitation and Home Care

• Provide patient and family teaching for home care including care of urinary drainage devices and recognition and prevention of complications

• Regain bladder continence

– Regaining control is a gradual process (dribbling may continue for up to one year depending upon the type of surgery)

– Perineal exercises

• Avoid straining, heavy lifting, long car trips (for 6 to 8 wks)

• Diet: encourage fluids and avoid coffee, alcohol, and spicy foods

• Assess sexual issues and provide referrals as needed


Testicular CancerTesticular Cancer

• Most common cancer in men age 15 to 40

• Highly treatable and curable

• Risk factors: undescended testicles, positive family history, cancer of one testicle, Caucasian American race

• Manifestations: painless lump or mass in the testes

• Early diagnosis: monthly testicular self-exam (TSE) and annual testicular exam

• Treatment: orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy


Testicular Self-ExamTesticular Self-Exam


Nursing Management Nursing Management

• Assess physical and psychological status

• Support coping ability

• Address issues of body image and sexuality

• Encourage a positive attitude

• Provide patient teaching

• Provide TSE and follow-up care


Conditions Affecting the PenisConditions Affecting the Penis

• Hypospadias and epispadias

• Phimosis

• Penile cancer

– Bowen’s disease

• Priapism

• Peyronie’s disease

• Urethral stricture

• Circumcision