AH

In-Depth Notes on Male Reproductive Health

Male Reproductive Problems and Related Concepts

Learning Outcomes

  • Nursing Process Application
    • Benign Prostatic Hyperplasia (BPH): Apply the nursing process for patient care.
    • Continuous Bladder Irrigation (CBI): Evaluate nursing responsibilities in related care.
    • Prostate and Testicular Cancer: Apply the nursing process during diagnostic and treatment phases.
    • Teaching Plan Development: Formulate plans for early detection of testicular cancer.
    • Nursing Judgments: Make informed decisions regarding nursing interventions that aid adaptation in affected adults.
    • Communication: Effectively share relevant patient status and goal progress data with adult clients.

Male Reproductive System Overview

  • Functions:
    • Sperm production and transportation
    • Sperm deposition in female reproductive tract
    • Hormone secretion
  • Primary Reproductive Organs: Testes
  • Secondary Reproductive Organs:
    • Ducts: Epididymis, ductus deferens, ejaculatory duct, urethra
    • Sex glands: Prostate gland, Cowper’s glands, seminal vesicles
    • External Genitalia: Scrotum, penis

Assessment of Male Reproductive Health

  • Key Areas:
    • Urinary Function: Assess urinary symptoms, general health changes.
    • Sexual Function: Assess changes in sexual activity, sexual dysfunction manifestations.
    • Urinary Obstruction Symptoms:
    • Increased urinary frequency
    • Decreased force of stream
    • Double or triple voiding
    • Nocturia, dysuria, hematuria, hematospermia
    • Underlying Conditions: Assess for diabetes, cardiac disease, multiple sclerosis impact on sexual function.

The 5 Ps of Taking a Sexual History

  1. Partners: Current sexual partner(s) and past partners.
  2. Practices: Types of sexual activities engaged in.
  3. Protection from STIs: Usage of protection and types.
  4. Past History of STIs: Previous STIs and treatments.
  5. Prevention of Pregnancy: Current methods to prevent pregnancy.

Physical Assessment Techniques

  • Digital Rectal Exam (DRE):
    • Assess prostate for size, symmetry, shape, consistency, tenderness, and nodules.
    • Recommended for men over 50; sooner for high-risk men.
  • Testicular Exam:
    • Palpate testicles and penis for abnormalities or masses.
    • Instruct on testicular self-examination (TSE).

Changes Due to Aging

  • Testosterone Levels: Gradual decline leads to physical and sexual changes.
  • Prostate Enlargement: Increased risk of BPH.
  • Erectile Dysfunction: Potential occurrence due to varying causes—including psychological and organic factors.

Diagnostic Tests

  • Prostate-Specific Antigen (PSA): Normal values are less than 4 ng/mL; used to assess prostate cancer risk.
  • Ultrasonography: Especially for abnormal DRE or PSA results.
  • Prostate Fluid Analysis: Obtained via prostatectomy or TRUS.

Erectile Dysfunction (ED) Overview

  • Definition: Inability to achieve or maintain an erection (impotence).
  • Assessment: Includes physical and neurological exams, medication review.
  • Causes: Can be psychological (anxiety, depression) or organic (due to vascular or endocrine issues).
  • Management: Options include pharmacological treatments (e.g., sildenafil), counseling, or surgical interventions.

Prostatitis Types

  • Acute Bacterial (Type I): Sudden onset symptoms with common agent E. coli.
  • Chronic Bacterial (Type II): Typically asymptomatic.
  • Chronic Pelvic Pain Syndrome (Type III): Symptoms without bacteria in urine.
  • Asymptomatic Inflammatory (Type IV): Diagnosed incidentally with elevated PSA.

Benign Prostatic Hyperplasia (BPH)

  • Definition: Noncancerous prostate enlargement; common in aging men.
  • Prevalence: Symptoms in 50% by age 50; 70% by age 60-69.
  • Symptoms: Urinary obstruction, retention, UTIs; includes dysuria and nocturia.
  • Diagnosis: Via DRE and patient history.

Management Strategies for BPH

  • Medical Treatment:
    • Alpha-adrenergic blockers (e.g., tamsulosin).
    • Reducing symptoms and spasms.
  • Surgical Treatment:
    • TURP: Removal of inner prostate tissue considered the gold standard.

Continuous Bladder Irrigation (CBI) Protocol

  • Monitoring: Assess for bleeding/clots, catheter patency, and bladder spasms.
  • Patient Education: Teach Kegel exercises post-catheter removal and discharge instructions.

Prostate Cancer Insights

  • Prevalence: Second most common cancer; significant risk factors include age and family history.
  • Symptoms: Often asymptomatic; diagnosis through DRE, PSA, and TRUS biopsy.
  • Management: Based on tumor grading; includes surgery, radiation, hormone therapy.

Testicular Cancer

  • Characteristics: Common among 15-40 age group; highly treatable.
  • Risk Factors: Undescended testicles and family history notable.
  • Management: Often includes orchiectomy and lymph node dissection as necessary.

Conditions Affecting the Penis

  • Hypospadias and Epispadias: Surgical repair required.
  • Priapism: Persistent erection may require medical intervention.

Vasectomy Details

  • Procedure: Outpatient, local anesthesia; aims for male sterilization.
  • Post-Procedure Considerations: Requires interim contraception until confirmed no sperm present in semen.
  • Psychological Effects: Address potential impacts on masculinity and sexual self-esteem.