NURS 245 Ch. 43: Disorders of the Male Reproductive System

anatomy of the male reproductive system

-Testes.

-Duct system:

• Epididymis.

• Ductus deferens.

• Urethra.

- Accessory organs:

• Seminal vesicle.

• Prostate gland.

• Bulbourethral gland.

-External genitalia:

• Penis.

• Scrotum.

Follicle-stimulating hormone (FSH)

initiates spermatogenesis

Luteinizing hormone (LH)

stimulates testosterone production

testosterone

maturation of sperm, sex characteristics, protein metabolism, muscle development

epispadias

congenital defect in which urethral opening on ventral or upper surface of penis

hypospadias

congenital defect in which urethral opening is on dorsal surface of the penis which can result in incontinence or infection

how do you treat congenital abnormalities?

congenital reconstruction

cryptorchidism

the testes fail to descend into the scrotum properly

ectopic testis - the testis are positioned outside of the scrotum that can cause degeneration of seminiferous tubules and impair spermatogenesis. testicular cancer risk is increased

hydrocele

occurs when excessive fluid collects in the space between the layers of the tunica vaginalis of the scrotum

varicocele

dilated vein in the spermatic cord - lack of valves allows backflow in the veins which causes pressure and dilation. blood flow to testes is impaired along with spermatogenesis - causes decreased fertility and is seen most commonly on the left side in men 15-35

torsion of the testes

testes rotate on the spermatic cord, compressing arteries and veins - causes ischemia or infarction. most cases occur in adolescence and must be treated like an emergency. can be spontaneous or due to injury

epididypitis

inflammation of the epididymis from a bacteria infection... STIs associated with urethritis and non-STIs are associated with UTIs and prostatitis

orchitis

infection of the testes that can be precipitated by a primary infection in GU and can spread to testes through bloodstream or lymphatics such as with the mumps virus.

how is epididymitis diagnosed?

lab findings reveal elevated WBC count.. urinalysis and urine culture, urethral specimen, midstream specimen, gram-staining, doppler ultrasound to reveal blood flow patterns to testes

prostatitis

infection of inflammation of the prostate gland

acute bacterial prostatitis

gland is tender and swollen, urine and secretions contain bacteria

nonbacterial prostatitis

urine and secretions contain large numbers of leukocytes

chronic bacterial prostatitis

gland only slightly enlarged, dysuria, frequency, urgency

asymptomatic inflammatory prostatitis

painless inflammation of the prostate gland where there is no evidence of infection

etiology of prostatitis

acute bacterial by E. coli, Pseudomonas proteus, Strep faecalis.. chronic is associated with many E. coli infections. occurs in young men with UTIs, old men with hypertrophy, STDs, catheterization, bacteremia

signs and symptoms of prostatitis

acute and chronic forms both manifested by dysuria, urinary frequency and urgency. decreased stream, acute fever and chills, lower back pain, leukocytosis, abdomen discomfort, systemic signs, anorexia, muscle aches

treatment of postatitis

antibacterial drugs like ciprofloxacin or antiinflammatory drugs and prophylactic antibacterial agents

hernia

some males still have an opening were testes descended from the abdominal cavity, which makes these males more prone to inguinal hernias

benign prostatic hypertrophy

occurs in half of older men.. compression of urethra and urinary obstruction.. estrogen-testosterone imbalance. no coma. typically a nonmalignant enlargement that is characterized by the formation of large, discrete lesions in periurethral region

other notes on benign prostatic hypertrophy

enlarged gland palpated on digital rectal exam, leads to frequent infections, continued obstruction will cause distended bladder, dilated ureters, hydronephrosis, renal failure.

signs and symptoms of BPH

obstructed flow, hesitancy in flow starting, dribbling, decreased flow strength, increased frequency and urgency, nocturia, dysuria w infection

treatment of BPH signs and symptoms

drugs like dutasteride to slow enlargement, smooth muscle relaxers like tamsulosin, surgery, combination of finasteride and doxazosin to reduce progression of hypertrophy

prostate cancer

most common cancer in older men.. third leading cause in death and 1/6 are affected. most are adenocarcinomas arising near surface of the gland. many are androgen-dependent

risk factors for prostate cancer

>40 in black men... frequency increased in black men. family history.. fatal prostate cancer linked with smoking and higher BMI

prostate cancer is both invasive and metastatic

some forms are highly aggressive and some aren't. 5-10% are caused by inherited mutations. other causes are high androgen levels, increased insulin-like growth factor, history of recurrent prostatitis.

signs and symptoms of prostate cancer

hard nodule felt on periphery of gland, hesitancy in urination, decreased urine stream, frequent urination, recurrent UTI

grading of prostate tumor

T1: asymptomatic and discovered in histologic exam

T2: tumors are palpable on digital exam but confined to prostate gland

T3: tumors extend beyond prostate

T4: tumors pushed beyond prostate to involve adjacent structures

Dx of prostate cancer

prostate specific antigen, prostatic acid phosphatase, ultrasonography, biopsy, bone scans

treatment of prostate cancer

surgery, radiation, orchiectomy and antitestosterone drugs, chemotherapy

testes cancer

most cancers of the testes are malignent... most common solid tumor cancer in young men with increasing cases. testicular self-exam is needed for detection early

origination of testicular cancer

originate from one type of cell or mixed cells from various sources. teratoma has a mixture of different germ cells, some malignant tumors secrete hCG or AFP which are markers for diagnosis

spreading pattern of testicular cancer

appear in common iliac and paraaortic lymph nodes, then to the mediastinal and supraclavicular lymph nodes, then through the blood the lungs, liver, bone and brain

TNM classification

stage 1: tumor confined to testes, epididymis or spermatic cord

stage 2: tumor spreads to retroperitoneal lymph nodes below the diaphragm

stage 3: metastases outside the retroperitoneal nodes or above the diaphragm

risk factors of testicular cancer

heredity (Chromosome 12), cryptorchidism, exposure to herbicides and other environmental agents

signs and symptoms of testicular cancer

tumors are hard, painless, and usually unilateral. testes may feel enlarged or heavy, scrotum and pelvis may have dull pain, hydrocele and epididymitis can develop.. if tumor secretes hormones then gynecomastia occurs

diagnosis of testicular cancer

usually no biopsy.. tumor markers of hCG and AFP, ultrasound, computed tomography, lymphangiography

treatment of testicular cancer

surgery, radiation therapy, chemotherapy.. client may donate sperm to ensure future fertility