The Male Reproductive System
• Infections of the male GU tract
• STD’s
• Most common in young, sexually active men
• STD’S include:
– Urethritis – gonococcus & nongonococcal
– Genital ulcers – genital herpes, primary syphilis, chancroid, granulomainguinale
– Genital warts
– Scabies
– Pediculosis pubis
– Hepatitis
– Aids
• Treatment of STD’s must be targeted toward client as well as partner(s) & sometimes an unborn child
• Must assess sexual history
• Identify partners at risk
• Partners of men with STD’s must be: examined & treated, as well as counseled to prevent reinfection and complications and spread of STD
The Male Reproductive System
• Sexual abstinence during treatment & recovery is advised.
• Use condoms and spermicides with nonoxynol 9 for at least 6 months after completion of TX to decrease transmission of human papilloma-virus (HPV) & HIV.
• Patients with 1 STD may have another. Its important to examine for other STD’s.
The Male Reproductive System
• Prostate problems
• Prostatitis – inflammation of the prostate gland caused by infection (bacteria, fungi, mycoplasa) or other problems (urethral stricture or prostate hyperplasia)
• Symptoms – perineal discomfort, Burning, Urgency, Frequency and Pain with or after ejaculation
The Male Reproductive System
• Acute bacterial prostatitis may present symptoms of:
• Fever & chills; Perineal, rectal or low back pain; Dysuria; Frequency; Urgency; Nocturia ; Some patients have no symptoms
• Chronic bacterial prostatitis is a major cause of relapsing urinary tract infection in men. Symptoms are mild:
– Frequency.
– Dysuria.
– Urethral discharge.
The Male Reproductive System
• Complications of prostatitis
– Swelling of the prostate gland
– Urinary retention
– Epididymitis
– Bacteremia
– Pyelonephritis
• Assessment for prostatitis
• History
• Culture of prostate fluid or tissue
• Histological exam
• Segmental urine culture – after cleaning, pt voids 10-15 ml into sterile container (urethral urine) than continues to void 50 – 70ml into 2nd container (bladder urine)
• Prostatic massage done to obtain prostatic fluid for 3rd container
The Male Reproductive System
• Prostatitis – medical treatment
• Avoid abscess formation and septicemia
• Broad spectrum antibiotic give for 10 – 14 days
• May need IV antibiotics
• Bed rest; Sitz baths
• Analgesics; Antispasmodics and bladder sedatives
• Stool softeners
The Male Reproductive System
• Chronic prostatitis.
• Difficult to TX as most antibiotics diffuse poorly into the prostatic fluid.
• May need continuous low dose antibiotic therapy.
• UTI may recur.
• Teach patient about s/sx of UTI.
• Sitz baths.
• Stool softener.
• Evaluation of sexual partner to reduce cross-infection.
• Fluids are to treat thirst but are not “forced” to maintain effective medication level in the urine.
• Avoid food & fluids that have diuretic effect or increase prostatic secretions such as alcohol, coffee, chocolate, cola & spices.
• Avoid sitting for long periods.
• Medical follow-up needed for 6 months to 1 yr because prostatitis can recur.
The Male Reproductive System
• BPH - Benign prostatic Hyperplasia (enlarged prostate).
• Prostate glands can enlarge especially after age 50. It pushes into bladder obstructing outflow of urine.
• It is the 2nd most common surgical intervention in men older that 60 yrs.
• Assessment for benign prostatic hyperplasia
– Large, rubbery non-tender prostate
– Increased frequency
– Nocturia, Urgency
– Hesitancy in starting urination
– Abdominal straining with urination
– Decrease in volume & force of urinary stream
– Dribbling
– Recurrent UTI’s
• Renal failure can eventually occur with urinary retention from BPH
• Pt may also experience: Fatigue; Anorexia; N/V; Epigastric discomfort
• DRE & other studies are done to assess degree of enlargement
• Urinalysis
• Renal function
The Male Reproductive System
Medical management of BPH:
• TX depends on cause, severity and condition of patient
• May need catheterization with stylet by urologist
• Alpha1-adrenergic receptor blockers – relax smooth muscle of bladder neck & prostate.
• Antiandrogen agents (Proscar) – prevents the conversion of testosterone to dihydrotesterone. Glandular activity is suppressed and prostate decreases in size.
– Side effects include gynecomastia, erectile dysfunction & flushing.
• Resection of prostate with lasers.
• Transuretheral needle ablation using low frequency radio waves produces heat which destroys prostate tissue while sparing urethra, nerves, muscle & membranes.
• Microwave thermo therapy applies heat to prostatic tissue. Water cooling system helps minimize damage to urethra.
The Male Reproductive System
• Cancer of the prostate.
• Second most common cancer in men.
• Second cause of cancer deaths in American men.
• 1 in 5 men in US will develop cancer of prostate.
Cancer of the Prostate (cont’)
• Manifestations few symptoms in early stages.
• Urinary obstruction in later stage is a common complaint.
– Difficulty and frequency of urination.
– Urinary retention.
– Decreased size and force of urinary stream.
• Metastasizes to bone and lymph nodes with symptoms of
– Backache; Hip pain; Perineal & rectal discomfort
– Anemia; Weight loss; Weakness; N/V; oliguria
Assessment: Cancer of the Prostate
• If detected early cure rate is high.
• Every man over age 40 should have a DRE yearly.
• DX confirmed by histologic exam of prostatic tissue.
• PSA level is proportional to total prostatic mass. Also used to monitor response to TX.
• Transrectal ultrasound used if elevated PSA and abnormal DRE.
• Bone scans x-rays.
• Sexual complications.
• Commonly experience sexual dysfunction before diagnosis made.
• Treatments also interfere with sexual function.
Medical management.
• Based on stage of disease and pt’s age & symptoms.
• Staging pg 1308 B&S.
Surgical management.
• Radical prostatectomy (removal of prostate & seminal vesicles) is the standard TX for prostatic cancer thought to be curable.
• This results in sexual impotence & sometimes urinary incontinence.
Radiation therapy.
• May be curative.
– Teletherapy: 5days/wk for 6 – 7 weeks.
– Interstitial seed implantation – 80 – 100 seeds placed with ultrasound.
• Pt goes home.
• Instructed to avoid close contact with pregnant women and infants.
• Use condom for 2 weeks after implantation during intercourse.
• Side effects of radiation therapy include inflammation of rectum, bowel, & bladder.
Cancer of the Prostate
• Hormonal therapy
– Orchiectomy (removal of testes)
– Medications
Cancer of the Prostate
• Orchiectomy – lowers plasma levels of testosterone since 93% originates in testes.
• This results in prostate atrophy.
• Does not have usual side effects of hormone therapy but does have significant emotional impact.
• Estrogen therapy.
• Diethylstilbestrol (DES) inhibits gonadotropins interfering with androgenic activity.
• Relieves symptoms of advanced cancer.
• Reduces size of tumor.
• Many side effects including decreased libido, decreased sperm production & gynecomastia.
• Newer hormonal therapies coming into use.
• Cryotherapy used to ablate prostate cancer in patients not able to tolerate surgery or have recurrence of cancer.
• Chemotherapy also used.
Cancer of the Prostate
• The Goal is to keep the urethra opening patent by resection or suprapubic catheter.
• Should be performed before damage occurs to the urinary tractor cancer progresses.
• TURP.
• Suprapubic prostatectomy.
Cancer of the Prostate
• TURP – most common approach
• Uses endoscopy
• Overnight hospital stay
• Strictures more frequent
• Infrequent erectile dysfunction
• May cause retrograde ejaculation
The Prostate
• Complications of prostatectomy: Hemorrhage; Clot formation
• Catheter obstruction and Sexual dysfunction - Sexual activity can be resumed in 6 – 8 weeks.
Prostatectomy
• A vasectomy may be done to prevent infection from spreading from prostatic urethra thru the vas into epididymis.
• Nursing care for Prostatectomy
• Pain control; Irrigation of bladder with 50 cc NS - Be sure return is what is put into the catheter.
• B & O suppositories.
• Ambulate; Don’t sit for long periods.