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Chapter 40: Care of Males With Reproductive Disorders

Learning Objectives

Theory 1

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

  2. Examine causes and treatment of male infertility.

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

Theory 2

  1. Discuss surgical approaches to address male reproductive disorders.

  2. Compare benign and malignant disorders of the male reproductive system.

Clinical Practice

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

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

Erectile Dysfunction

  • Definition: Also known as impotence, erectile dysfunction (ED) is defined as the inability to consistently achieve or maintain an erection firm enough for sexual intercourse.

Treatment Options

  • Phosphodiesterase (PDE-5) inhibitors: These medications are usually taken about 1 hour before intercourse.

  • Complementary and alternative therapies: May include herbal or nutritional supplements, although these should be approached cautiously.

  • Sexual therapy: Counseling may help address emotional or psychological issues related to ED.

  • Penile implants: Surgical option for those who do not respond to other treatments.

  • Negative pressure devices: Utilizes vacuum constrictive devices to promote blood flow to the penis.

Changes Noted in Aging Males

  • Age-related changes in the male reproductive system can include:

    • A more pendulous scrotum

    • Enlarged prostate gland

    • Decreased testosterone levels

    • Decrease in ejaculate volume over time

    • Increased time required for arousal.

Sildenafil (Viagra)

  • Contraindications: Not recommended for patients taking nitrates, those with hypertension, or patients with retinopathy.

  • Dosage: Typically taken between ½ to 4 hours prior to sexual stimulation; specific instructions on timing must be provided.

  • Adverse effects: May cause color vision disturbances, blurred vision, photophobia, hypotension, and priapism.

  • Usage: Should not be taken more than once per day unless directed by a healthcare provider.

Tadalafil (Cialis)

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

  • Precautions: Patients should avoid consuming grapefruit juice while taking this medication to prevent increased retention in the body.

Ejaculation Disorders

  • Premature ejaculation: Defined as ejaculation that occurs sooner than desired, which may result from a lack of control over the ejaculation reflex.

  • Retrograde ejaculation: Condition where semen travels towards the bladder instead of exiting through the penis during ejaculation.

Infertility

  • Defined as the failure of a couple to achieve a pregnancy after at least 1 year of active, unprotected intercourse.

  • Common Causes: Testicular disorders are the most prevalent organic cause of male infertility. Additionally, other factors may include drugs, infections, systemic diseases, and congenital disorders which can impair testicular function.

Hydrocele

  • Defined as an accumulation of a larger-than-normal amount of fluid in the tunica vaginalis surrounding the testis within the scrotum.

  • Treatment options:

    • Aspiration

    • Surgical incision and drainage of the sac

    • Postoperative care includes a pressure dressing and a drain, with instructions for the patient to wear an athletic supporter for several weeks following treatment.

Varicocele

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

  • Common location: Typically occurs on the left side of the scrotum due to retrograde blood flow from the left renal vein.

  • Nursing care: Assist the patient in managing symptoms such as fatigue, weakness, and fever.

Testicular Torsion

  • Condition characterized by the twisting of the testes and spermatic cord.

  • Signs: Sudden acute scrotal pain and absence of the cremasteric reflex are primary indicators. Special attention must be given to prevent testicular ischemia and necrosis.

  • Immediate intervention: Emergency surgery may be required to secure the testicle or remove it if necessary.

  • Often occurs post-trauma and is associated with nausea and vomiting.

Priapism

  • Defined as a prolonged penile erection that is not related to sexual desire or activity.

  • Causes: Can be neurologic, vascular, or medication-induced.

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

Peyronie Disease

  • Condition in which a fibrous plaque of nonelastic tissue forms in the tunica of the dorsal corpus cavernosa, leading to an inability to achieve a uniform erection.

  • Conservative treatments: May include local injections aimed at dissolving the plaque.

Diagnostic Tests for the Male Reproductive System

Common Tests Include:

  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

  8. Prostate tissue analysis (biopsy)

  9. Cystoscopy

  10. Urethral smears

  11. Luteinizing hormone (LH) level

  12. Prolactin level

  13. Follicle-stimulating hormone (FSH) level

  14. Testosterone level

Benign Prostatic Hyperplasia (BPH)

Pathophysiology

  • BPH is characterized by the enlargement of the prostate gland, which extends into the bladder neck, leading to obstruction of urine flow.

Signs and Symptoms

  • Symptoms typically arise when the growth becomes significant enough to press against the urethra, including:

    • Difficulty urinating

    • Reduced strength of urine stream

    • Urinary hesitancy

    • Dribbling after voiding.

Complications

  • Urinary Tract Infections (UTIs): Result from urinary stasis due to retained urine providing a medium for organism growth.

  • Hydroureter and hydronephrosis: Gradual dilation of the ureters and kidneys due to obstruction can lead to renal failure (azotemia) if not managed.

Diagnosis of BPH

  • Methods include:

    • DRE

    • Pressure flow studies

    • Postvoiding ultrasound or catheterization.

Treatment

  • Drug therapy: Medications can manage symptoms and reduce enlargement.

  • Surgery: Surgical options are available for severe cases.

BPH - Postoperative Considerations

  • Bladder irrigation: Continuous bladder irrigation is typically required for 2 to 3 days following surgical interventions, with the patient remaining hospitalized.

  • Urine color: Bloody urine may present as red, pink, or watermelon-colored during the initial postoperative period, indicating common postoperative events.

Surgical Interventions for Male Urogenital Problems

Types of Surgical Procedures

  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 the 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

Post Prostatectomy Care

Signs of Infection

  • Surgical site infection signs may include:

    • Cloudy or foul-smelling urine

    • Chills and fever

    • Purulent drainage from the surgical wound.

Blood-tinged Urine

  • It is common to experience blood-tinged urine within the first few days post-surgery. Postoperative irrigation may be indicated for patients with higher bleeding risks.

Fluid Management

  • Decreased turgor indicates a potential fluid deficit; intravenous therapy may be necessary to maintain fluid balance.

Suprapubic Catheter Considerations

  • Following a suprapubic prostatectomy, patients will have both a suprapubic and urethral catheter. After removal of the urethral catheter, residual urine is measured, and if residual volume is 60 mL or less after attempts to void, the suprapubic catheter can be removed.

Inflammations and Infections of the Male Reproductive Tract

Common Conditions

  1. Epididymitis: Inflammation of the epididymis, often caused by infections from the prostate or urinary tract.

  2. Orchitis: Inflammation of one or both testicles, potentially from local or systemic infection or trauma.

  3. Prostatitis: Types of prostatitis include:

    • Type I: Acute bacterial prostatitis

    • Type II: Chronic bacterial prostatitis

    • Type III: Nonbacterial prostatitis or chronic pelvic pain syndrome.

Cancer of the Male Reproductive Tract

  • Common cancers include:

    • Penile cancer

    • Testicular cancer

    • Prostate cancer.

  • Clinical symptoms and a PSA screening test are essential tools in diagnosis and determining appropriate treatment and nursing care.