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71 Cards in this Set
- Front
- Back
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What is the function of the testes?
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spermatogenesis and testosterone production
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Describe the prostate gland
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lies just below the neck of the bladder, surrounds the urethra, tranversed by ejaculatory duct, a continuation of vas deferens, empties secretions into urethra during ejaculation, providing lubrication
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What age related changes occur in the male reproductive system?
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prostate enlarges, prostrate secretions decrease, decline in testesterone and progesterone, slower sexual response, urinary incontinence, BPH- signs of lower UTI obstruction, erectile dysfunction
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What assessments should be done with regards to male reproductive health?
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urinary function and symptoms, prostatism (obstruction, frequency, dec stream), dysuria, hematuria, hematospermia, sexual function
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What is the PLISSIT model of sexual assessment?
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P- ask permission to discuss sexual functioning
LI- limited info may be provided SS- offer specific suggestions for interventions IT- recommend intensive therapy with specialist |
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What are the 2 physical assessments for male reproductive health?
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digital rectual exam (>40, looking at size, shape, consistency of prostate)
testicular examination (hernia, hydrocele, tumor, inflamm, nodules, discharge) |
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Describe PSA
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prostate specific antigen, increases with cancer, normal is 0.2-4.0, abn >4.0
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Describe transrectal ultrasouns
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used when PSA is high and/or DRE abn is detected, may guide needle biopsy
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Describe erectile dysfunction
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impotence, inability to achieve or maintaine erection sufficient enough to accomplish intercourse
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What can cause erectile dysfunction?
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anxiety, fatigue, depressure, occlusive vascular disease, endocrine disease, cirrhosis, chronic renal failure, GU conditions, neurological disorders, trauma, alcohol, meds
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What medications can cause erectile dysfunction?
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antiadrenergics, antihypertensives, anticholinergics, phenothiazines, antiseizure, antifungals, antipsychotic, antispasmodic, beta blockers, sedatives, calcium channel blockers, carbonic anhydrase inhibitors, H2 antagonists, NSAIDs, thiazide diuretics, antidepress
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What are the treatments for erectile dysfunction?
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vascular surgery, oral meds (viagra, smooth muscle relaxants), injection of vasoactive agents (smooth muscle relaxants), penile implants, negative pressure devices, penile suppository
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What are side effects of PDE-5 meds (viagra)?
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headache, flushing, dyspepsia, hypotension, diabetic retinopathy,
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Describe pharmacologic treatment of ED?
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take 30 mins to 6 hours before, must be sexually stimulated to produce erection, usually take once per day, do not take if taking nitro, uncontrolled BP, CAD, MI in last 6 months, kidney or liver dysfx
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What are 2 common disorders of ejaculation?
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premature ejaculation, retrograde ejaculation (semen travels toward bladder)
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What GU tract infections can men get?
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cystitis (from e. coli infection in vagina), bateriuria, urethritis, herpes, syphilis, chancroid, granuloma inguinale, warts, HPV, hepatitis, proctitis, AIDS, trichomoniasis, etc.
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What about the use of spermicides with nonoxynol 9?
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do not protect against HIV and may increase transmission
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What is prostatitis?
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-inflammation of the prostate gland caused by infectious agent
-org carried to prostate from urethra |
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What are the classifications of prostatitis?
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acute bacterial, type I
chronic bacterial, type II chronic prostatitis/chronic pelvic pain syndrome, type III asymptomatic inflamm prostatitis, type IV |
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What are the s/s of prostatitis?
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fever, chills, perineal, rectal, low back pain, dysuria, frequency, urgency, nocturia
chronic UTI, urethral discharge, urinary retention, swelling of prostate gland, epididymitis, bacteremia, pyelonephritis |
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What is the treatment for prostatitis?
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antibiodics, bed rest, analgesics, sitz baths, stool softeners, alpha-adrenergic blockers to promote relaxation of bladder and prostate, ejaculation
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What is benign prostatic hyperplasia?
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prostate gland enlarges (hypertrophied lobes), extending upward into the bladder and obstruct the outflow of urine (obstruct vesical neck or prostatic urethra)
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What are the consequences of BPH?
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hydroureters (gradual dilation of ureters, hydronephrosis, UTI
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What are s/s of BPH?
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frequency, nocturia, urgency, hesitancy, abdominal straining, interruption of stream, dribbling, not completely empting, urinary retention, UTIs, renal failure, fatigue, anorexia, N/V epigastic discomfort
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What diagnostic tests are done for BPH?
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DRE, urinalysis, urodynamic studies, CBC, renal fx test
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How is BPH treated?
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alpha-adrenergic blockers, 5-alpha reductase inhibitors (Proscar-relax the smooth muscles of bladder neck and prostate), antiandrogen agents, saw palmetto, microwave thermotherapy (destroys prostate), transurethral needle ablation (destroys prostate tissue), resection of prostate, transurethrial incision of prostate, ballon dilation, transurethral laser resection
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What are risk factors for prostate cancer?
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African American, age, familial predisposition, BRCA 2 mutation, excessive amounts of red meat or dairy high in fat
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What are the s/s of prostate cancer?
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few at first, urinary obstruction later, blood in urine, painful ejaculation, if metastases- backache, hip pain, perineal rectal discomfort,anemia, weight loss, weakness, nausea, oliguria
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How is prostate cancer diagnosed?
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DRE, PSA, TRUS with biopsy, bone scan, CT, x-ray, urography, lymphangiography
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What surgical management is used for prostate cancer?
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radical prostatectomy- complete removal of prostate, seminal vesicles, vas deferans, fat, nerves, and blood vessels
*impotence follows |
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What radiation therapy is used for prostate cancer?
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teletherapy-external beam radiation
brachytherapy-implantation of interstitial radioactive seeds under anesthesia (side effects, inflam of rectum, bowel, bladder, pain) |
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What hormonal therapy is used for prostate cancer?
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dec in testosterone causes prostatic epithelium--orchectomy (removal of testes), nonsteroidal antiandrogen bicalutamide, estrogen therapy (DES), luteinizing hormone releasing hormone agonist (suppresses testicular androgen), antiandrogen agents
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What are some of the side effects of hormal therapy?
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thromboembolism, pulmonary embolism, MI, stroke, gynecomastia, decreased sexual fx, impotence
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What are other therapies for prostate cancer?
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chemo, cryosurgery (used for those who cannot tolerate surgery or recurrent cancer--freeze tissue directly), supportive therapy (pain management, blood transfusions, etc)
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What complications of TURP can occur?
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TUR (tranurethral resection syndrome--neuro, cardio and electrolyte imbalance from absorption of solution used to irrigate surgical site--hypnatremia, hypovolemia--lethary, confusion, hypotension, tachycardia, N/V, collapse, headache, muscle spasm, SZ), retrograde ejaculation, rarely ED
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When is prostate surgery indicated?
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For those with BPH, prostate cancer, and should be done before acute urinary retention develops and damages upper urinary tract and collecting system
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Describe the transurethral resection of the prostate
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TURP, endoscopy goes through urethra into prostate, gland is removed with electrical cutting loop, may need to be repeated b/c tissue may grow back
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What interventions are used for TUR?
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D/C irrigation, admin diurectics, replace bladder irrigation with NS, I/O, VS, LOC, asses lungs, heart for pulmonary edema, HF
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What are you monitoring for post TURP?
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hemorrhaging, symptoms of urethral stricture--dysuria, straining, weak urinary system)
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Describe suprapubic prostatectomy
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removal of prostate through abdominal incision and through bladder, monitor for incision infection, hemorrhage and shock
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Describe perineal prostatectomy?
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removal through incisionin perineum
high risk for infectio, incontinence, impotence, rectal injury |
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Describe retropubic prostectomy?
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low abdonimal incision with removal of prostate without entering bladder
monitor for infection and hemorrhage |
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Describe transurethral incision of the prostate
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treatment for BPH, pass through urethra, incisions (1 or 2) are made to reduce prostate pressure on urethra and reduce urethral constriction
monitor for hemmorrhage |
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Describe laparoscopic radical prostatectomy
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less invasive, easier to see removal
monitor for urethral stricture (straining, weak urinary stream), hemorrhage, shock, bowel fx change, aseptic care around tubes |
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What the complications of prostatectomy?
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hemorrhage, clot formation, catheriter obstruction, sexual dysfunction, retrograde ejaculation
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What are postop nursing interventions for prostatectomy?
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irrigation is used to prevent blood clot obstruction so fluid retention must be watched for, I/O strictly monitored, electrolyte imbalances, inc BP, confusion, resp distress, ambulation, catheter may need intermittented irrigation 50 mL at a time, do not sit for long periods of time (inc abd pressure), stool softeners, keep catheter patient, sitz baths, antispasmodics, analgesics, ambulation
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Describe hemmorrhaging in prostatectomy
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hyperplastic prostate is highly vascular, arterial hemorrhaging requires surgical intervention, venous bleeding can be controlled by traction (balloon or tape pressure)
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Patient teaching for prostatectomy
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I/O, infection, bleeding, thrombosis, kegals, avoid straining/sitting long time/strenous exercise/spicy food/coffee/alcohol/dehydration
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Describe orchitis
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inflammation of testes caused by bacterial, viral, spirochetal, parasitic, traumatic, chemical or unknown factor (can be caused by mumps)
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What are the s/s and treatment for orchitis?
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-scrotal pain, edema
-antibacterial/antiviral/antifungal, ice packs, anti-inflamm, rest, elevation of scrotum |
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Describe epididymitis
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infection of the epididymis usually from infected prostate or urinary tract
(often gnorrhea) -infection passes through urethra to ejaculatory ducts to vas deferens to epididymus |
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What are the s/s of epididymitis and the treatment?
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unilateral pain, soreness, swelling in groin and scrotum, urine may contain pus and bacteria, chills and fever, nausea, urinary frequency, urgency, dysuria
-antibiotics, analgesics, epididymectomy if recurrent, bed rest, scrotal elevation, ice |
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Describe the 3 classifications of testicular cancer
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1. germinal tumors-dev from sperm producing cells of testes, localized, grow quickly
2. nongerminal tumors-hormone producing stromal tumors 3. secondary- metastasized from other organ, lymphoma is most common cause |
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What are the risk factors for testicular cancer?
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cryptorchidism- undescended testicles, family hx, cancer of one testicle, caucasian, occupational hazards, DES prenatal exposure
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What are the s/s of testicular cancer?
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mass or lump, painless enlargement, heaviness in scrotum/inguinal area or lower abd pain, weight loss, general weakness
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What are diagnositic methods for testicular cancer?
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testicular self examination, human chorionic gonadotropin and alpha-fetoprotein tumor makers, IV urography, lymphangiography, CT scan, chest x-ray (common metasistis is lungs), MRI, PET
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What is the treatment for testicular cancer?
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orchiectomy (teste removal), with or without retroperitoneal lymph node dissection, radiation, chemo
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What are the long term effects of testicular cancer treatments?
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infertility (may not cause also), kidney damage, hearing problems, gonadal damage, neuro changes, cancer, may effect libido
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Describe hydrocele
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collection of fluid om timoca vaginalis or spermatic cord of testes, acute from epididymis/local injury/systemic infection, or chronic which is unknown
-therapy usually not required, but surgery may be done |
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Descrive varicocele
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abnormal dilation of veins for the pampiniform venous plexus in the scrotum, assoc with infertility
-no treatment of ligation of external spermatic vein in inguinal area |
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Describe vasectomy
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male sterilization, ligation and transection of vas deferens
complications include-scrotal ecchymoses, swelling, infection, vasitis, epididymitis, hematomas, spermatic granuloma *fertility remains until all sperm have been ejactulated --4 weeks to 36 ejaculations |
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Describe hypospadias
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urethral opening is a groove on the underside of the penis
-plastic surgery required |
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Describe epispadias
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urethral opening is on the dorsum
-plastic surgery required |
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Describe phimosis
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foreskin constricts and cannot be retracted over glans
-causes inflammation, adhensions, fibrosis, encrusted, calculi -circumcision is performed |
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Describe paraphimosis
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foreskin is retracted behind the glans and because of narrowness and subsequent edema cannot go back
-circumcisions is performed |
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Describe cancer of the penis
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painless wartlike growth or ulcer, Bowen's disease is a form of squamos cell carcinoma, melanomas, basal cell carcinomas
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What are risk factors for penis cancer?
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HPV, smoking, smegma (oily secretions from skin, dead skin cells, bacteria under foreskin, phimosis, psoriasis, age >55, AIDS
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How is penis cancer treated?
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surgery, simple excision, electrodesiccation, curettage, cryosurgery, Moh's surgery, laser surgery, circumcision, penectomy (partial and total), chemo
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Describe Peyronie's disease
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buildup of fibrous plaques in the sheath of the corpus cavernosum, causes painful curvature on erection, surgery may be necessary
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Describe urethral stricture
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urethra is narrowed, either congential or scar/injury, dilation of urethra or urethrotomy is treatment
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Describe circumcision
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excision of foreskin or prepuse of glans penis
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