Transcript Male Genitourinary Disorders - Wilkes

Janet Frascella MSN,Ed,RN
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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
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Sits at base of bladder
Wraps around upper part of urethra
Purpose: provide secretions for semen, aid in
ejaculation
Does not secrete hormones
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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.
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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
lengthens.
Sexual activity in the older man is closely
related to his sexual activity in younger years.
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Involves the use of spermicidal 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 protection
against sexually transmitted infections (STIs).
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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.
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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.
Prostate Disorders:
 Prostatitis- inflammation of the prostate gland
can occur anytime after puberty
chronic, acute or a single episode
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Three types:
1. Acute bacterial
2. Chronic bacterial
3. Nonbacterial
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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.
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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.
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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.
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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.
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Treatment: Depends on the cause.
Medical conditions are treated, hormone
therapy, vascular surgery may be indicated
for blood flow obstruction.
Primary intervention for ED is reversing the
problem.
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Erectile dysfunction drugs such as, Viagra,
Cialis. (Should not be taken with cardiac
problems)
Penile implants.
Priapism-persistent abnormal erection that
can develop into a medical emergency.
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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.
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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.
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Twisting of the testes 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)
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Diagnosis is made by ultrasound.
Treatment is emergency surgery to remove
the testicle.
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Condition in which a plaque of nonelastic
fiberous 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.
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)
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Narrowing causes an obstruction and may
lead to urinary retention and eventually
distention of the kidney with urine
(hydronephrosis)
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No known cause other than normal aging
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Men over 50, more commonly in men over 70
Complications:
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Hydronephrosis - urine back-up into kidneys
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Renal insufficiency
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Urosepsis
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
Treatment:
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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
Surgical Treatment:
 (TURP)-Transurethral resection - most used to
relieve obstruction caused by an enlarged
prostate
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(TUIP)-Transurethral incision of the prostate,
incision into the gland to relieve the obstruction
(TULIP)-Transurethral ultrasound-guided lasarinduced prostatectomy used to relieve
obstruction
Surgical Treatment:
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Radical Prostatectomy - removal of the entire
prostate gland when the gland is very large,
is causing obstruction, or is cancerous
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(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
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
Complications:
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Clot formation
Bladder spasms
Infection
Hemorrhage
Erectile dysfunction
Nursing Interventions:
 Closely monitor urinary output, amount, color
and presence of clots hourly for first 24 hrs
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Encourage patient to drink 2500mL per day
unless contraindicated
Monitor for acute pain and bladder spasms
and administer analgesics as ordered
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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
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)
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
Complications:
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Difficulty urinating
Bladder or kidney infection
Pain
Bone fractures
Weight loss
Depression
Death if treatment is unsuccessful
Diagnosis:
 (DRE)-Digital Rectal Exam, examiner may find
a hard lump or hardened lobe
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(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
Treatment - Early Stages:
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Testosterone-suppressing medications, e.g.
Lupron, Zoladex
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TURP or radical prostatectomy
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Combination of medication and radiation
Treatment - Later Stages:
 Radical prostatectomy, radiation or
implantation of radioactive seeds into the
prostate
 Bilateral Orchiectomy - surgical removal of
thetesticles, (relieves symptoms by blocking
testosterone)
Estrogen Therapy
 Chemotherapy to help relieve symptoms from
spread of cancer
Treatment:
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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
Nursing Implications:
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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 abnormal findings
Instruct men over the age of 40 to have a
yearly DRE of the prostate, men over 50 - PSA
Phimosis - condition in which foreskin of
uncircumcised male becomes so tight that it
is impossible to clean the area underneath
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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)
Treatment:
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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
Paraphimosis - occurs when the uncircumcised
foreskin is pulled back during bathing or
intercourse and not immediately replaced in a
forward position
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Result is constriction of the dorsal veins
which leads to edema and pain
Requires immediate medical attention to
prevent circulation problems or gangrene
Cancer of the Penis - has been found in men
who have not been circumcised as babies or
have acquired the human papillomavirus
(HPV)
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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)
Treatment:
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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
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Most common solid tumor in men 15 to 40 years
of age
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Peaks between 20 and 34 years of age
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Etiology unknown
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Risk factors-family history, mothers use of DES
(estrogen preparation once used to prevent
spontaneous abortion while pregnant), white
race
Prevention:
**Monthly self-testicular exam !
Signs/Symptoms:
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Early warning signs = small painless lump on
the side or front of the testes
Swollen scrotum that feels heavy
Late Symptoms:
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Back pain
Shortness of breath
Difficulty swallowing
Breast enlargement
Changes in vision or mental status indicate
metastasis
Complications:
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Emotional complications - fear of cancer and
death
Loss of masculine body image and sexual
function
Dealing with pain
Metastasis to lungs, abdomen, lymph nodes
Diagnostic Tests:
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Ultrasound of the testes
Chest x-ray to look for spread to lungs
Scan of lymph nodes, liver, brain and bones
Blood is drawn for tumor markers (some
tumors secrete chemicals, labs are drawn to
see if levels are elevated)
Exploration, biopsy and removal of the testes
are done to decide the stage of the tumor
Staging of Testicular Tumors:
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Stage I - tumor only in the testes
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Stage II - tumor spread to groin lymph nodes
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Stage III - tumor spread past lymph nodes
usually to the lungs (or other organ)
Treatment:
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Depends on the stage of the cancer
All treatment begins with complete removal
of cancerous testes, spermatic cord, and local
lymph nodes
Stage I-radiation to groin and lymph nodes
Stage II-chemotherapy
Stage III-both radiation and chemotherapy
Nursing Interventions:
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Emotional support
If patient does not have children, encourage
to make deposit in sperm bank
Helping patient deal with pain and side
effects of chemotherapy/radiation