Male Reproductive System: Anatomy, Conditions, and Treatments

What does the epididymis do?

Stores and matures sperm.

Trace the path of sperm from production to exit.

Testes → epididymis → vas deferens → urethra → out through the penis.

Where is the prostate, and why does its location matter?

It surrounds the urethra just below the bladder — so when it enlarges it compresses the urethra and blocks urine flow.

Define prostatitis.

Inflammation of the prostate gland.

Define epididymitis.

Inflammation of the epididymis.

Define phimosis.

Foreskin that CANNOT be retracted back over the glans.

Define paraphimosis.

Retracted foreskin that CANNOT return forward over the glans (glans swells — emergency).

Define prostatectomy.

Surgical removal of all or part of the prostate.

Define erectile dysfunction (ED).

Inability to achieve or maintain an erection.

Define infertility.

Inability to conceive after 12 months of unprotected sex.

What are the 4 types of prostatitis?

I acute bacterial, II chronic bacterial, III chronic prostatitis / pelvic pain syndrome, IV asymptomatic inflammatory.

Signs & symptoms of prostatitis?

Pelvic, perineal, penile, or ejaculatory pain; voiding problems; sexual dysfunction; fever/chills if severe.

How is prostatitis diagnosed?

Symptoms + labs; cultures of urine and prostatic secretions before AND after prostatic massage; CT or transrectal ultrasound.

Treatment of bacterial vs. nonbacterial prostatitis?

Bacterial → antibiotics; nonbacterial → alpha blockers + NSAIDs. Both: sitz baths, rest, fluids; avoid spicy food, caffeine, alcohol.

Key nursing care for prostatitis?

Stool softeners (constipation is very painful); NO urethral catheter with urethral inflammation (use suprapubic); prostate massage/ejaculation drains secretions.

Causes of epididymitis?

Infection, trauma, or reflux of urine through the vas deferens.

Signs of epididymitis?

Painful scrotal edema, nausea/vomiting, chills, fever.

Treatment of epididymitis?

Bed rest, ice packs, sitz baths, analgesics, antibiotics, NSAIDs, scrotal support; treat the partner if STI-related.

What is orchitis and a classic cause?

Inflammation of one or both testes; classically caused by mumps (also pneumonia, TB).

Why does orchitis matter clinically?

It can reduce fertility (true sterility is uncommon).

What is BPH?

Benign (non-cancer) enlargement of the prostate that compresses the urethra and obstructs urine flow.

BPH voiding symptoms?

Hesitancy, weak stream, straining, prolonged voiding.

BPH storage symptoms?

Frequency, urgency, nocturia, urge incontinence, small volumes.

BPH postmicturition symptoms?

Postvoid dribbling and a feeling of incomplete emptying.

What worsens BPH symptoms?

Alcohol, caffeine, sweeteners; and diuretics, decongestants, antihistamines.

How is BPH diagnosed?

Symptoms, digital rectal exam, urinalysis, voiding diary; plus PSA, residual urine, cystoscopy/transrectal US to rule out other causes.

5-alpha-reductase inhibitors: drugs and action?

Finasteride, dutasteride — SHRINK the prostate (works slowly). Memory: '-steride Shrinks.'

Alpha-1 blockers: drugs and action?

Tamsulosin, doxazosin — RELAX the bladder neck (fast relief; watch for dizziness/low BP). Memory: '-osin loosens.'

Is saw palmetto recommended for BPH?

No — it is not recommended.

Standard surgical treatment for BPH?

TURP (transurethral resection of the prostate) — removed via the urethra, no external incision; continuous bladder irrigation afterward.

BPH conservative fluid teaching?

1500-2000 mL/day, restrict ~2 h before bed; avoid caffeine/alcohol; bladder training.

Three priority nursing problems in BPH?

Urinary obstruction, fear, and self-care.

BPH self-care teaching?

Avoid OTC antihistamines/pseudoephedrine (cause retention); avoid caffeine and alcohol.

A BPH patient can't void — what must you never do?

Never force a catheter.

Early signs of bleeding after prostatectomy?

Restlessness and a rising heart rate.

Expected urine color after prostatectomy?

Light pink within 24 hours. Bright-red blood or clots = report immediately (hemorrhage).

Purpose of continuous bladder irrigation (CBI)?

Prevents clots from forming.

Urine flow stops and the bladder is distended after prostatectomy — what do you do?

Stop the irrigation, manually irrigate, and notify the surgeon.

What is retrograde ejaculation?

Semen enters the bladder and is voided later with urine — harmless but causes sterility.

Is ED common after TURP?

No — reassure the patient it is not common.

Prostatectomy discharge teaching?

No heavy lifting, driving, or sex ~6 weeks; drink 1.5-2 quarts fluid/day; stool softeners + fiber to prevent straining.

Managing bladder spasms after prostatectomy?

Keep the catheter draining freely; antispasmodics (oxybutynin, belladonna & opium suppositories); analgesics.

Teaching for incontinence after catheter removal?

Kegel (perineal) exercises 10-20 times per hour.

Risk factors for prostate cancer?

Age over 50, African origin (~2x in Black men), family history, high-fat diet.

How is prostate cancer diagnosed and confirmed?

DRE, transrectal ultrasound, and PSA; biopsy confirms; staging with CT, MRI, bone scan.

Why is PSA screening controversial?

PSA rises with cancer but also with many other conditions — so screening is a shared decision.

How does androgen deprivation therapy (ADT) work?

Lowers testosterone: LHRH agonists (leuprolide, goserelin), androgen blockers (flutamide, bicalutamide), or orchiectomy.

Side effects and monitoring of ADT?

Hot flashes and ED; effective ~1-3 years; a rising PSA signals recurrence.

What does a radical prostatectomy remove?

Prostate, capsule, seminal vesicles, and vas sections; nerve-sparing technique may preserve erections.

Three requirements for an erection?

Intact nerves, enough blood inflow, and a leak-proof trap to maintain it.

Most common cause of ED?

Diabetes.

ED can be the FIRST sign of what condition?

Diabetes — explore general and family health history.

Drug classes that contribute to ED?

Antidepressants, blood-pressure drugs, antihistamines, and certain hair-loss treatments.

PDE5 inhibitors — examples and timing?

Sildenafil (Viagra), tadalafil (Cialis), vardenafil, avanafil; taken 20-60 minutes before sex.

PDE5 inhibitors are ABSOLUTELY contraindicated with what?

Nitrates — the combination causes life-threatening hypotension.

What is Peyronie disease?

A hard fibrous plaque that bends the penis (usually upward) during erection; can be painful and interfere with sex.

What is priapism, and which type is an emergency?

A prolonged, painful erection unrelated to arousal; ISCHEMIC priapism is a medical emergency.

Priapism treatment?

Aspirate blood or inject phenylephrine; surgery if needed.

Conditions/drugs linked to priapism?

Sickle cell crisis, leukemia, trauma; cocaine, PDE5 inhibitors, papaverine.

Phimosis vs. paraphimosis — which is the emergency?

Paraphimosis (foreskin stuck retracted, glans swells) — surgical emergency if it can't be reduced.

Structural causes of male infertility?

Cryptorchidism, testicular torsion, and varicocele.

What is cryptorchidism, and its cancer risk?

Undescended testicle; abdominal warmth damages sperm; 10-30x higher risk of testicular cancer.

When is cryptorchidism corrected?

Between the 1st and 2nd birthday; untreated bilateral cases lead to sterility.

What is testicular torsion and why is it urgent?

The spermatic cord twists and cuts off blood flow — emergency surgery; necrosis if blood flow is lost over ~4 hours.

What is a varicocele?

Dilated scrotal veins from faulty valves, usually on the LEFT; a factor in about half of male infertility.

Vasectomy — what's cut and what's unaffected?

A deferens; erection, ejaculation, and intercourse are unaffected.

Vasectomy contraception teaching?

Use other birth control until semen shows NO sperm (~15 ejaculations later); consider it permanent.

Penile cancer risk factors?

Not circumcised early (especially with phimosis), HPV/HIV, smoking.

Testicular cancer — peak age and classic sign?

Young men ages 15-35; a PAINLESS lump or enlargement of one testicle.

Testicular cancer tumor markers?

Alpha-fetoprotein (AFP) and hCG (plus ultrasound).

What should be offered BEFORE testicular cancer treatment?

Sperm banking — treatment may affect fertility.

Testicular self-exam (TSE) — when and how?

Monthly, after a warm bath/shower when the scrotum is relaxed; roll each testicle gently between thumb and fingers of both hands.

What does a normal testicle feel like on TSE?

Egg-shaped, firm but not hard, smooth, no lumps; the left usually hangs lower.

What do the ovaries produce?

Eggs (ova) and hormones — estrogen and progesterone.

Where does fertilization usually occur?

In the fallopian tubes.

Define dysmenorrhea.

Painful menstruation / menstrual cramps.

Define dyspareunia.

Painful sexual intercourse.

Define dysplasia.

Abnormal cell changes that may precede cancer.

Define hysterectomy.

Surgical removal of the uterus.

Define salpingo-oophorectomy.

Removal of a fallopian tube and ovary.

Define retroversion.

Backward tilt of the uterus.

What are the 4 phases of the menstrual cycle?

Menstruation, follicular, ovulation, luteal.

Roles of FSH vs. LH?

FSH grows the follicles (follicular phase); the LH surge triggers ovulation.

What does the corpus luteum do?

After ovulation it produces progesterone to prepare and maintain the uterus for pregnancy.

Key fertile-window facts?

The egg survives 12-24 h; sperm survive up to 5 days; ovulation mucus is clear and stretchy ('egg-white').

Define metrorrhagia.

Bleeding or spotting BETWEEN periods (metro = mid-cycle).

Define menorrhagia.

Profuse or prolonged bleeding DURING menstruation (meno = more).

Define amenorrhea.

Absence of menses (a = without).

With amenorrhea, what must you rule out first?

Pregnancy.

Menorrhagia cause treated with D&C (or hysterectomy if past childbearing)?

Endometrial hyperplasia.

Normal menstruation values?

Cycle 21-40 days, flow 2-8 days, 40-100 mL of blood.

Candida vaginitis — discharge and treatment?

Thick, white, clumpy 'cottage cheese' discharge (normal pH); treat with fluconazole or intravaginal azoles.

Trichomonas vaginitis — discharge and treatment?

Frothy, yellow-green, foul-smelling discharge ('strawberry cervix,' elevated pH); treat with metronidazole.

Bacterial vaginosis — discharge and treatment?

Thin, off-white, fishy-smelling discharge (clue cells, positive whiff test); treat with metronidazole or clindamycin.

Key teaching with metronidazole?

NO alcohol during and for 48 h after (disulfiram-like reaction); dark urine is normal.

Key concern with clindamycin?

Risk of C. difficile diarrhea — monitor for severe diarrhea.

Bartholin gland abscess — common organism and treatment?

E. coli (often from wiping back-to-front); treat with sitz baths, incision & drainage (I&D), antibiotics.

Top causes of cervicitis, and its danger?

Chlamydia and gonorrhea; can ascend to cause PID or infertility.

Mastitis — most common organism and who gets it?

S. aureus; a lactating woman; the nipple is the entry point; usually affects ONE breast.

Mastitis treatment — what should the patient keep doing?

Keep EMPTYING the breast (can usually keep breastfeeding); antibiotics safe in milk, cold compresses, rest, NSAIDs.