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Chapter 40 Care of Males With Reproductive Disorders

Medical-Surgical Nursing: Concepts and Practice, 6th edition by Holly K. Stromberg, RN, BSN, MSN, PHN Alumnus CCRN

Learning Objectives

  1. Common Disorders
        - Discuss common disorders associated with the male reproductive system and nursing interventions for each.

  2. Male Infertility
        - Examine causes and treatments of male infertility.

  3. Diagnostic Tests
        - Name the most common diagnostic tests and examinations associated with the male reproductive system.

Learning Objectives (Continued)

  1. Surgical Approaches
        - Discuss surgical approaches to address male reproductive disorders.

  2. Benign vs. Malignant Disorders
        - Compare benign and malignant disorders of the male reproductive system.

Clinical Practice

  1. Nursing Process
        - Use the nursing process in the care of a male with a reproductive disorder.

  2. Interventions
        - Implement interventions for patients with common disorders of the male reproductive system.

Erectile Dysfunction

  • Definition: Impotence refers to the inability to consistently achieve or maintain an erection that is firm enough for sexual intercourse.

  • Treatment Options:
        - Phosphodiesterase (PDE-5) inhibitors taken about 1 hour before intercourse.
        - Complementary and alternative therapies.
        - Sexual therapy.
        - Penile implants.
        - Negative pressure devices (vacuum constrictive devices).

Changes Noted in Male Reproductive System

  • Age-related changes include:
        - More pendulous scrotum.
        - Enlarged prostate.
        - Decreased testosterone levels.
        - Decreased ejaculate volume and prolonged arousal time.

Sildenafil (Viagra)

  • Contraindications: Use is contraindicated in patients taking nitrates, with hypertension, or those with retinopathy.

  • Administration: Taken 30 minutes to 4 hours before sexual stimulation.

  • Possible Side Effects:
        - Color vision disturbances.
        - Blurred vision and photophobia.
        - Hypotension.
        - Priapism (persistent erection).

  • Usage Recommendation: Should not be taken more than once per day or contrary to the healthcare provider's prescription.

Tadalafil (Cialis)

  • Risks: Can cause priapism, which is a persistent erection that may become a urologic emergency due to potential thrombosis of penile vessels.

  • Advisory: Patients should avoid drinking grapefruit juice while taking this medication, as it can increase drug retention in the body.

Ejaculation Disorders

  • Premature Ejaculation: Occurs when the ejaculation reflex is not controlled, resulting in premature release of semen before desired.

  • Retrograde Ejaculation: Occurs when semen travels toward the bladder rather than exiting through the penis.

Infertility

  • Definition: Infertility is defined as the failure of a couple to achieve pregnancy after at least 1 year of active, unprotected intercourse.

  • Common Causes:
        - Testicular disorders are the most common organic cause of male infertility.
        - Other factors include drugs, infections, systemic diseases, and congenital disorders, which can result in testicular failure.

Hydrocele

  • Description: Accumulation of a larger-than-normal amount of fluid in the space between the testis and tunica vaginalis in the scrotum.

  • Treatment Options:
        - Aspiration or surgical incision and drainage of the sac.
        - Application of a pressure dressing and possibly a drain post-operation.
        - Post-treatment education: Patient should wear an athletic supporter for several weeks.

Varicocele

  • Definition: Dilation and clumping of the tributary vessels of the spermatic vein.

  • Occurrence: Typically occurs on the left side due to retrograde blood flow from the left renal vein.

  • Nursing Considerations: Measures to help the patient cope with associated fatigue, weakness, and fever.

Testicular Torsion

  • Description: Twisting of the testes and spermatic cord.

  • Signs and Symptoms:
        - Sudden acute scrotal pain.
        - Absence of the cremasteric reflex.

  • Emergency Treatment:
        - Surgical procedure to prevent testicular ischemia and necrosis, which may involve securing the testicle or removal if necessary.

  • Triggering Factors: Often occurs after trauma and may also result in nausea and vomiting.

Priapism

  • Definition: A prolonged erection of the penis that is large, hard, and painful, unrelated to sexual desire or activity.

  • Causes: May be neurologic, vascular, or due to medications designed to enhance sexual performance.

  • Treatment Options: Conservative measures to promote vessel dilation and relieve pressure.

Peyronie Disease

  • Definition: A condition characterized by a plaque of nonelastic fibrous tissue developing in the tunica portion of the dorsal corpus cavernosa of the penis.

  • Consequence: Leads to a loss of elasticity and results in the inability to achieve a uniform erection.

  • Conservative Treatment: Local injections to dissolve the plaque.

Diagnostic Tests for the Male Reproductive System

  1. Digital Rectal Examination (DRE)

  2. Semen Analysis

  3. Testicular Self-Examination (TSE)

  4. Prostate-Specific Antigen (PSA) level

  5. Transrectal Ultrasound

  6. Urography

  7. Uroflowmetry

Additional Diagnostic Tests

  1. Prostate Tissue Analysis (Biopsy)

  2. Cystoscopy

  3. Urethral Smears

  4. Luteinizing Hormone (LH) Level

  5. Prolactin Level

  6. Follicle-Stimulating Hormone (FSH) Level

  7. Testosterone Level

Benign Prostatic Hyperplasia (BPH) - Etiology and Pathophysiology

  • Description: BPH involves enlargement of the prostate gland leading to an extension into the bladder neck, causing obstruction of urine flow.

  • Symptoms:
        - No symptoms until growth presses against urethra.
        - Difficulty urinating, evidenced by decreased stream strength, hesitancy, and dribbling after voiding.

BPH Complications

  • BPH can cause urinary stasis resulting in UTIs, as retained urine provides a medium for organism growth.

  • Possible complications include:
        - Gradual dilation of the ureter (hydroureter) and kidneys (hydronephrosis).
        - Nitrogen products accumulation leading to azotemia and potential renal failure if urinary obstruction is not addressed.

BPH - Diagnosis and Treatment

  • Diagnosis:
        - DRE.
        - Pressure flow studies.
        - Postvoiding ultrasound or catheterization.

  • Treatment Options:
        - Drug therapy.
        - Surgical intervention as required.

BPH - Bladder Irrigation Postoperative Care

  • Post-operative care post-BPH surgery requires continuous bladder irrigation for approximately 2 to 3 days.

  • Hospitalization: Patients typically require several days of hospital care.

  • Urinary Observation: Bloody urine that appears red, pink, or watermelon colored is expected during the initial period post-operation.

Surgical Interventions for Male Urogenital Problems

  1. Transurethral Microwave Thermotherapy (TUMT)

  2. Transurethral Needle Ablation (TUNA)

  3. High-Intensity Focused Ultrasound (HIFU)

  4. Open Prostatectomy

  5. Suprapubic Prostatectomy

  6. Retropubic Prostatectomy

  7. Perineal Prostatectomy

  8. Transurethral Resection of Prostate (TURP)

  9. Transurethral Incision of the Prostate (TUIP)

  10. Laser Prostatectomy

  11. Transurethral Electrovaporization of the Prostate (TUVP)

  12. Transurethral Photoselective Vaporization of the Prostate (PVP)

  13. Urethral Stent

  14. Laparoscopic Radical Prostatectomy

TURP

  • Complication Management: Abdominal pain and distension may indicate a clot occluding the catheter.

  • Nursing Intervention: Additional irrigation (20 to 30 mL of normal saline) may be needed to dislodge the clot.

Post Prostatectomy Care

  • Signs of Infection: Cloudy, foul-smelling urine, chills, fever, and purulent drainage from the surgical wound.

  • Bleeding: Blood-tinged urine is normal for the first few days, while continuous catheter irrigation may be indicated for patients at risk of bleeding.

  • Fluid Balance: Monitor for decreased turgor, indicating fluid deficit; IV therapy may be necessary.

Suprapubic Prostatectomy Care

  • After a suprapubic prostatectomy, the patient will have both a suprapubic and urethral catheter.

  • Following removal of the urethral catheter:
        - Clamping of the suprapubic catheter, followed by a voiding attempt.
        - Residual urine measurement performed afterward by unclamping the suprapubic catheter.
        - Suprapubic catheter removal occurs when residual urine is 60 mL or less.

Inflammations and Infections of the Male Reproductive Tract

  1. Epididymitis: Inflammation of the epididymis, often due to infection (such as urinary tract infections).

  2. Orchitis: Inflammation of the testicle(s), potentially caused by local/systemic infections or trauma.

  3. Prostatitis Types:
        - Type I: Acute bacterial prostatitis.
        - Type II: Chronic bacterial prostatitis.
        - Type III: Nonbacterial prostatitis (chronic pelvic pain syndrome).

Cancer of the Male Reproductive Tract

  • Types include:
        - Penile cancer.
        - Testicular cancer.
        - Prostate cancer:
            - Clinical symptoms include possible finding through prostate-specific antigen (PSA) screening tests.
            - Treatment and nursing care options vary according to diagnosis and disease progression.