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.