Week 5 Male Reproductive Voiceover PPT

MALE REPRODUCTIVE SYSTEM

Overview

• Presenter: Dr. Claire Loden, DNP, FNP-C

• Related Chapters:

  • Chapter 49: Management of Patients with Urinary Disorders

  • Chapter 53: Assessment and Management of Patients with Male Reproductive Disorders

Page 2: Inspirational Quote

• Fall in love with Jesus

• Quote: "The Lord is my shepherd; I shall not want." - Psalm 23:1

Page 3: Learning Objectives

• Understand the disease process, nursing considerations, and interventions.

• Identify appropriate treatment methods and pharmacotherapy interventions.

• Identify appropriate patient education discussion points for each disease process.

Page 4: Lecture Topics

• Acute Prostatitis

• Benign Prostatic Hypertrophy (BPH)

• Prostate Cancer

• Testicular Cancer

• Orchitis

• Epididymitis

• Testicular Torsion

• Erectile Dysfunction

• Priapism

• Bladder Cancer

Page 5: Review of Male Anatomy

• Key Structures:

  • Symphysis pubis

  • Vas deferens

  • Corpus cavernosum

  • Urinary bladder

  • Ampulla

  • Seminal vesicle

  • Ejaculatory duct

  • Prostate gland

  • Bulbourethral gland

  • Anus

  • Perineum

  • Penis

  • Urethra

  • Glans penis

  • Prepuce

  • Urethral meatus

  • Scrotum

  • Epididymis

Page 6: Acute Prostatitis

• Definition: Painful inflammation of the prostate.

• Key Highlights:

  • Most frequent urologic diagnosis in men < 50 years old

  • Commonly caused by E. Coli

  • Symptoms include abdominal, ejaculatory, rectal, and perineal pain.

Page 7: Symptoms of Acute Prostatitis

• Common Symptoms:

  • Sudden fever

  • Discomfort

  • Burning/urgency

  • Frequent urination

  • Pain with ejaculation

  • Referred pain in genitalia, perineum, lower back, or suprapubic areas.

Page 8: Diagnosis and Treatment of Acute Prostatitis

• Diagnosis:

  • Urinalysis (UA) & culture (CS)

  • Transrectal ultrasound (to rule out abscess, cysts, or seminal vesicle obstruction).

• Treatment:

  • Antibiotics: Ciprofloxacin or Bactrim

  • NSAIDs to alleviate bladder spasms

  • Catheterization as needed.

• Patient Education:

  • Signs and symptoms (S/s) and treatment.

Page 9: Benign Prostatic Hypertrophy (BPH)

• Overview:

  • Common disease in aging men

  • Slow enlargement of the prostate due to hypertrophy and hyperplasia, compressing the urethra.

Page 10: Assessment Findings in BPH

• Storage Symptoms:

  • Frequency

  • Urgency

  • Nocturia

  • Incontinence

• Voiding Symptoms:

  • Weak stream

  • Dribbling

  • Dysuria

  • Straining

• Uncommon Symptoms:

  • Fever with dysuria

  • Urinary retention

Page 11: Diagnosis of BPH

• Diagnostic Tests:

  • UA: normal in uncomplicated BPH

    • Pyuria indicates UTI

    • Hematuria may suggest cancer

  • PSA: elevated levels indicate potential issues and can aid in discussing treatment.

  • Volume charting: record frequency and volume of voiding for three days.

Page 12: Nursing Interventions for BPH

• Medications:

  • First line treatment: focus on avoiding retention, shrinking the gland, and relaxing smooth muscle

• Catheterization: Temporary urinary or straight catheterization if needed.

Page 13: Patient Education for BPH

• Behavioral Modifications:

  • Reduce fluids at night.

  • Limit caffeine and alcohol

  • Avoid or adjust timing of diuretics/medications that may increase urinary retention.

Page 14: Pharmacology - Alpha-Blockers

• Examples:

  • Tamsulosin & Terazosin: smooth muscle relaxers.

  • Initial therapy for most patients, effective within days.

  • "First-dose effect": Increased risk of falls, fractures, and head trauma.

  • Medications must be titrated; know drug class, MOA, and side effects.

Page 15: Pharmacotherapy - 5-Alpha Reductase Inhibitors

• Examples:

  • Finasteride & Dutasteride

  • Effectively reduce prostate size and symptoms related to acute urinary retention.

  • PSA decreases by 50% but may obscure prostate cancer diagnosis.

  • Monitor for potential side effects like sexual dysfunction in 5-10% of patients.

Page 16: BPH Surgical & Invasive Procedures

• Transurethral Resection of the Prostate (TURP):

  • Insert scope via urethra; standard procedure for prostate sizes < 80g.

  • Excellent resolution of LUTS, but increases risk of bleeding and ejaculatory dysfunction.

Other Procedures

• Urethral stents for narrowing areas.

• Prostatectomy: removal of the inner portion of the prostate.

Page 17: BPH Surgical Management

• Most Common Surgical Procedure: Transurethral resection of the prostate (TURP).

Page 18: Post-op Considerations for TURP

• Monitor for hemorrhage and perform continuous bladder irrigation.

• Assess for TURP syndrome (transurethral resection syndrome).

• Provide instructions for discharge and manage bladder spasms.

Page 19: TURP Syndrome

• Definition: Excessive fluid load causing electrolyte shifts and associated symptoms due to absorption of irrigation fluid.

• Can lead to complications such as hyponatremia and hypervolemia.

Page 20: Discharge Instructions Post-TURP

• Avoid straining for bowel movements for 6 weeks (use stool softener).

• Maintain catheter hygiene and recognize abnormal signs.

• Engage in Kegel exercises for bladder control, avoid lifting > 5lbs for 6 weeks.

• Resume sexual activity in 3-4 weeks; report any abnormal symptoms to the healthcare provider.

Page 21: Continuous Bladder Irrigation (CBI)

• Purpose: Flush blood clots or debris from the bladder post-surgery.

• Utilizes a triple-lumen catheter and maintains continuous output; urine should appear pink to clear.

Page 22: Indications for CBI

• Post TURP and bladder surgery; can also be used for chemotherapy applications and to dissolve bladder stones.

Page 23: Nursing Management of CBI

• Monitor and titrate to maintain appropriate urine clarity; intervene if obstructions occur (notify MD if unable to relieve).

Page 24: Prostate Cancer Overview

• Characteristics: Slow-growing malignancy, most commonly adenocarcinomas.

• Typically arises from the outer area of the prostate and can metastasize to lymphatic and vascular systems.

Page 25: Causes of Prostate Cancer

• Risk Factors:

  • Age

  • Exposure to heavy metals

  • Smoking

  • High-fat diet

  • Obesity

  • African American descent

  • Family history

  • Sexually transmitted infections (STIs).

Page 26: Screening for Prostate Cancer

• Methods:

  • PSA levels (initial exam at age 40); >4 requires follow-up.

  • DRE performed alongside baseline PSA to detect nodules or abnormalities.

Page 27: Diagnosis of Prostate Cancer

• Diagnostic Tools:

  • PSA testing, DRE, transrectal ultrasound (TRUS) for biopsy.

Page 28: Prostate Cancer Assessment

• Early Symptoms: Often asymptomatic but may present with hard nodules or painless hematuria in advanced disease.

• Late Symptoms: Weight loss, urinary obstruction, and bone pain.

Page 29: Staging of Prostate Cancer

• Stages:

  • Stage I: Localized tumor

  • Stage II: Tumor extended

  • Stage III: Local metastasis

  • Stage IV: Distant metastasis.

Page 30: Treatment Options for Prostate Cancer

• Options:

  • Active surveillance, hormone therapy, chemotherapy, radiation (internal/external), proton therapy, prostatectomy.

Page 31: Active Surveillance

• Close monitoring; treatment only if disease advances.

• Regular PSA and DRE requirement for ongoing assessment.

Page 32: Chemotherapy for Prostate Cancer

• Utilized when hormone therapy fails; not curative, but may improve survival rates in non-androgen-dependent cancers.

Page 33: Radiation Therapy – External

• Administered to shrink tumors and reduce metastasis, typically in short sessions over several weeks.

Page 34: Radiation Therapy – Internal

• Method: Radioactive seed implants into the prostate; minimal radiation exposure outside of the gland in the immediate aftermath.

Page 35: Radiation Therapy - Internal Continued

• Patient Care: Monitor for complications like rectal inflammation, bleeding, and urinary issues; safeguard against exposure to vulnerable populations.

Page 36: Proton Therapy

• Offers fewer side effects, is painless, and leaves surrounding tissues unharmed.

• High survival rates at four years.

Page 37: Prostatectomy

• Types of Approaches: Suprapubic, retropubic, and perineal.

• Surgical removal of the prostate tissue for treatment.

Page 38: Clinical Judgment Question

• Mr. Rodriguez: Identifying symptoms related to benign prostatic hyperplasia, including:

  • B. Incomplete emptying

  • D. Hesitancy

  • E. Intermittent urinary stream

Page 39: Nursing Care Post-Prostatectomy

• Preoperative: Bowels preparation and clear liquid diet.

• Postoperative Monitoring: Check for urine leaks, hemorrhage, and infection.

Page 40: Men's Health - Male Reproductive Problems

• Critical health concerns regarding male reproductive disorders.

Page 41: Testicular Cancer

• Self-Examination: Monthly testicular self-exam recommended

• Types: Germinal and nongerminal cancers.

• Symptoms: Painless enlargement, heaviness, inguinal pain, metastasis signs (back ache, weight loss).

Page 42: Testicular Self-Examination

• Guidelines for self-examinations: check after showering, roll between fingers, look for lumps, and consult a doctor for abnormalities.

Page 43: Orchitis

• Definition: Inflammation of one or both testicles; can be caused by various organisms.

• Symptoms: Pain, fever, nausea/vomiting.

Page 44: Diagnosis and Treatment of Orchitis

• Diagnosis: STI screening, UA, ultrasound to rule out torsion.

• Treatment: Antibiotics (if bacterial), rest, scrotal support.

Page 45: Epididymitis

• Symptoms: Pain and swelling in the back of the testicle, possible enlarged testes.

• Diagnostic tests include UA, CBC, and STI testing.

Page 46: Treatment for Epididymitis

• Management: Targeted antibiotics based on organism identification, bed rest, and scrotal elevation.

Page 47: Testicular Torsion

• Definition: Twisting of the spermatic cord, leading to acute pain and blood flow loss to the testicle.

• Diagnosis: Typically history of trauma, confirmed via ultrasound.

Page 48: Treatment of Testicular Torsion

• Surgical Intervention: Urgent untwist of the testicle and suture cord to prevent re-torsion and preserve fertility.

Page 49: Warning Signs for Testicular Issues

• Important symptoms include sudden testicular pain, swelling, and redness, requiring immediate medical attention.

Page 50: Erectile Dysfunction - Impotence

• Definition: Inability to achieve or maintain an erection adequate for sexual intercourse, affecting a significant portion of men aged 40-70.

Page 51: Causes of Erectile Dysfunction

• Psychogenic Factors: Include anxiety, depression, and relationship issues.

• Organic Factors: Include cardiovascular diseases, diabetes, and certain medications.

Page 52: Diagnosis and Treatment of Erectile Dysfunction

• Diagnosis: History and physicals, sleep studies.

• Treatment Options: Medications (e.g., sildenafil, alprostadil) and mechanical devices.

Page 53: Priapism

• Definition: Prolonged erection lasting 4-6 hours; can lead to severe complications if untreated.

• Treatment: Oral medications, aspiration, and potentially surgery.

Page 54: Bladder Cancer

• Overview: Arises from various sources, predominantly affects men.

• Risk Factors: Smoking, chemical exposure, and radiation.

Page 55: Signs of Bladder Cancer

• Primary Symptom: Visible, painless hematuria; other symptoms include urgency, frequency, and potential pain.

Page 56: Diagnostic Testing for Bladder Cancer

• Cystoscopy: Key tool for visual inspection and biopsy of suspicious lesions.

Page 57: Treatment Options for Bladder Cancer

• Methods Include: Radiation therapy, chemotherapy, urinary diversion, and cystectomy as necessary.

Page 58: Chemical and Surgical Treatments

• Intravesical Chemotherapy: Concentrated treatment instilled into the bladder.

• Surgical Interventions: Include transurethral resections and cystectomies.

Page 59: Postoperative Management

• Key Focus Areas: Monitor urine output, vital signs, stoma assessment, and hydration management post-surgery.

Page 60: Percutaneous Nephrostomy

• Indications: Used for kidney obstructions from tumors or calculi.

• Consists of inserting a nephrostomy tube to relieve obstruction.