Chapter 49

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Chapter 49

Assessment and Management of Problems Related to Male Reproductive

Processes

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Anatomy and Physiology The scrotum (two parts;

each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens).

The prostate (an encapsulated gland that encircles the proximal portion of the urethra).

The penis.

Assessment

Health History and Clinical Manifestations Physical Assessment

Digital Rectal Examination Testicular Examination testicular self-examination (TSE)

Diagnostic Evaluation Prostate-Specific Antigen Test Prostate Fluid or Tissue Analysis

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Inflammatory Diseases:

Epididymitis an infection of the epididymis,

which usually descends from an infected prostate or urinary tract.

Symptoms include unilateral pain and soreness in the inguinal canal, sudden, severe pain in the scrotum, scrotal swelling, fever, pyuria, bacteriuria, dysuria, and pyuria.

Epididymitis/ treatment If it is caused by a chlamydial infection, the

patient and his wife must be treated with antibiotics.

observe for abscess formation epididymectomy (excision of the epididymis

from the testis) may be performed for patients who have chronic, painful conditions

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Nursing Management bed rest and scrotal support to prevent traction on

the spermatic cord and to relieve pain. Intermittent cold compresses to ease the pain. Sitz baths may help resolve the inflammation. Analgesic for pain relief as prescribed. Instructs patient to avoid straining, lifting, and

sexual stimulation until the infection is under control.

He needs to know that it may take 4 weeks or longer for the epididymis to return to normal.

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Inflammatory Diseases:

Orchitis An inflammation of the testes that most often occurs as a complication of a bloodborne infection originating in the epididymis.

Causes include gonorrhea, trauma, surgical manipulation, and tuberculosis and mumps that occur after puberty.

Symptoms include sudden scrotal pain, scrotal edema, chills, fever, nausea, and vomiting.

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Inflammatory Diseases:

Prostatitis

An inflammation of the prostate which is a common complication of urethritis caused by chlamydia or gonorrhea.

Symptoms include perineal pain, fever,dysuria, and urethral discharge.

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Nursing Interventions Inflammatory Disorders:

Encourage bed rest Monitor VS, esp. temp for fever Monitor I & O Assess pain Sitz bath – provide comfort = PROSTATITIS Provide ice pack to scrotum to decrease

swelling Elevate or provide scrotal support

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Inflammatory disorders Interventions

Analgesic Antibiotic Procaine = anesthetic Stool softeners Digital massage – rectally – to release infected

fluid

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Benign Prostatic Hyperplasia BPH is a progressive

adenomatous enlargement of the prostate gland that occurs with aging.

More than 50% of men over the age of 50 and 80% of men ≥ 80 demonstrate some increase in the size of the prostate gland.

Risk factors: smoking, heavy alcohol consumption, hypertension, heart disease, and diabetes

Early symptoms include hesitancy, decreased force of stream, urinary frequency, and nocturia. Then frequent UTIs

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Benign Prostatic Hyperplasia Diagnosis:

Rectal examination – most reliable Urine analysis Ultrasound SerumBUN & creatinine to evaluate kidney function

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TURP•Transurethral Resection of the Prostate

•Continuous irrigation = reduce or prevent clot formation = clogs urethra = urinary retention = kidney damage

•Monitor I & O

•3-way f/c

•Monitor for distention - bladder

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Benign Prostatic Hyperplasia Management

Foley’s catheter (stylet needed, inserted by urologist) Surgical

TURP PROSTATECTOMY Perineal prostectomy – incision through perineum Suprapubic resection – lower abdomen – incision through the

bladder – urethrotomy Retropubic – lower abdomen – does not go through the bladder

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Benign Prostatic Hyperplasia Pharmacological

Alpha blockers – relax the smooth muscles along urinary tract

Narcotic analgesic – relieve post-op pain – Morphine, Codeine

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Benign Prostatic Hyperplasia Nursing Interventions

Increased fluids – monitor I & O Maintain gravity drainage of F/C Monitor blood clots and color = bright red = bleeding Keep irrigation flowing, note clots Monitor VS – pain level, temp – orally, NOT rectal Avoid straining, provide stool softeners Teach deep breathing, relaxation technique Observe bladder distention & spasms = ask for

antispasmodic – stops spasms = pain, increase blood clots

Malignant Neoplasms:

Prostate Cancer The second leading cause of cancer deaths in men.

Risk factors include: advancing age (over 55, more than 70% of cases diagnoses at age ≥ 65 ); first-degree relative with prostate cancer; African-American heritage; high level of serum testosterone.

Five-year survival rate is 98%.

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Prostate Cancer S/S

Early tumor – no symptoms Subjective

• Back pain, same symptoms as BPH – hesitancy, decrease pressure, frequency, dysuria, urinary retention, painful ejaculation.

Objective• Symptoms from metastasis

• ? Blood in urine or semen. • Lumps – inguinal• Enlarged lymph nodes• Blockage of urethra, and rectal dysfunction

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Diagnostic Test – Prostate CA Digital Rectal Examination PSA- prostate specific antigen – elevated Bone scan to detect metastasis MRI, CT scan

Complications Sexual dysfunction (gets worse with treatment)

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Treatment – Prostate CA Radiation, chemo, surgical removal

Complete surgical removal of the prostate, seminal vesicles, tips of the vas deferens, and often the surrounding fat, nerves, and blood vessels

Bilateral orchiectomy (removal of testes) TURP Estrogen therapy – inhibits serum testosterone =

contradicts Agonists of LH – estrogen Radioactive seed implant – rectally

Nursing process Anxiety related to concern and lack of

knowledge about the diagnosis, treatment plan, and prognosis Reduced stress and improved ability to cope

Urinary retention related to urethral obstruction secondary to prostatic enlargement or tumor and loss of bladder tone due to prolonged distention/retention Improved pattern of urinary elimination

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Deficient knowledge related to the diagnosis of: cancer, urinary difficulties, and treatment modalities Understanding of the diagnosis and ability to

care for self Imbalanced nutrition: less than body

requirements related to decreased oral intake because of anorexia, nausea, and vomiting caused by cancer or its treatment Maintain optimal nutritional status

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Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy, radiation therapy, surgery Ability to resume/enjoy modified sexual

functioning Pain related to progression of disease and

treatment modalities Relief of pain

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Impaired physical mobility and activity intolerance related to tissue hypoxia, malnutrition, and exhaustion and to spinal cord or nerve compression from metastases Improved physical mobility

Collaborative Problems: Hemorrhage, infection, bladder neck obstruction Goal: Absence of complications

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Nsg interventions – Prostate CA BPH interventions Be supportive – expect feminization, more

emotional, educate Gynecomastia – enlargement of the breast Control pain – terminally ill = hospice,

palliative care

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Malignant Neoplasms:

Testicular Cancer Although it accounts for only 1% of all cancer

in men, it is the most common cancer in young men between the ages of 15 and 40.

Essential for clients to learn TSE (testicular self-examination). – monthly During shower

Five-year survival rate is 95%. Management same as prostate cancer

Risk Factors Undescended testicles (cryptorchidism), A family history of testicular cancer, Cancer of one testicle, Ethnicity: more common in white Caucasian

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Assessment Subjective data

Heaviness in scrotum Weight loss Scrotal pain Anxiety or depression

Objective data Palpation of abdomen and scrotum – enlarged Mass or lump on the testicle and usually painless

Medical Management The testis is removed by orchiectomy

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Crytorchidism

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Hydrocele•Collection of amber fluid within the testes, tunica vaginalis, and spermatic cord

•Painful

•Swelling

•Discomfort in sitting and walking

•Treatment: aspiration (usually in children)

•Hydrocelectomy – removal of the sac

•Nsg Interventions:

•Preoperative and postoperative management

•Scrotal support (elevation)

•Supportive to parents/patient

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Varicocele-Vein- dilation

-Spermatic cord = Vas deferens

-Occurs when incompetent or absent valves in the spermatic venous system permits blood to accumulate and increase hydrostatic pressure

-Hyperthermia – decrease spermatogenesis = fertility

-Bluish discoloration

-Wormlike mass