Male reproductive system:

*penis function :deliever sperm and eliminate urine, inside the penis there is two corpus
capbinosa and one corpus spongenosum which in case is the uretha. For an erection to occur
they both have to engored with blood, vasoconstriction maintain the erection. Sexual
simulation stop or orgasm or ejaculation achieve cause vasodilartion to occur and allthe blood
drains out of the penis and erection subsides.
*erectile reflex
testis : the function is spermatogenesis, the simnefoerous tuble produces sperm, the intersital
cell that is found between the simnerfous tubles produce the male sex hormone testorestrone
epididymis: carry the sperm from the efferent tuble to the vas difference ejaculatory
ductruns through the prostate muscle in the ejeculator duct remains close at all time
unless they are ejectlating , they are close to prevent urine from entering.
Prostate gland: produce prostatic fluid help sperm survive , is thin milky and alkaline ph.
Cowpers gland : secrets muscous intot he base of the penis , also help moves the sperm down
vas deferens
Change with aging
*decrease testoseterone production: decrease libo, atropy of testies, decrease sperm
production 60-80
*prostate gland enlarges : enlarge with age and secretion deminishes
* decrease seminal fluid: decrease and fluid becomes less viscious
*slow and weaker physiologic reaction: longer for erection to occur, doesnt lessen their sexual
satifaction
BenignProstaticHyperplasia(BPH)
*Enlarged,firm,smoothprostategland
*Commonurologicproblem:50%ofmenhavebphare50yearold90%are80yearold
*Prostatehyperplasiadoesnotleadtoprostatecancer:bphdevelopintheinnerpartoftheprostatewhilecancer
developintheouterpartoftheprostate.Prostateenlargementstartstopushintotheurethraandcompressitsohardly
anyurinecanemptyoutofthebladdercausespartialorcompleteobstructiondependingonlocation
BPH
PossiblecausesExcessivedihydrotestosterone(excessivegrowthofprostatetissue)testosterone(canleadto
higherportionofestrogenwhichpromotesprostatecellgrowth
Riskfactors
Aging
alcohol
Obesity
smoking
Physicalactivity
diabetes
FamilyHxofBPH1stdegreerelatives
BPHManifestations
Onset:gradual2typesofsymptoms
Obstructive(decreasecaliboreofinforceofurinarystrength,intermiteendrippling,urinearyretention
Irritative(dysuria,noturia,incontinence)
BPHComplications
Acuteurinaryretention(suddeninabilitytourinate,cathetherisinserttourine)
UTI(leadtosepsis&balddercalculi=abx)
Renalfailure(ifuntreatedpyelonephritis,hydronephrosisandbladderdamage).Hydronephrosisiswhenthereisa
distentionofthepelvisandcaliciofthekidneycantflowthroughtheurethertothebladder
BPHDiagnosticStudies
H&P
Digitalrectalexam
(DRE)(determinesizeandsymeteryofprostate)

UrinalysisandC&S
Prostatespecific
antigen(PSA)(rulesoutprostatecancer)
Serumcreatinine(rulerenalinsufficeny)
Postvoidresidual(decreasedegreeofurineflowobstruction)
Transrectalultrasound(accuratelyassesprostatefrombphandprostateca,biopsyistakenduringitperformwhen
thereisabnormalDREandelevatedPSAlevel)
Uroflowmetry(measuretheurinevoidedpersec,determinstheextendofurethralblockage)
Cystoscopy(visualizedbladderintheurethra,donepreopt,ifitsscheduleforprostatectomycystoscopyisdonefirst)
BPHGoalsofcollaborativecare
1.Restorebladderdrainage
2.Relievepatientssymptoms
3.Prevent/treatcomplicationsofBPH
BPHTreatmentsConservative
Treatmentsbasedonsxsnotprostatesize
Mildsxs
Watchfulwaiting
Diet(decreaseetoh,spicy,caffeine,fluidatnight,artificialsweenter)
Drugs(avoiddecongestionandanticolingeric,alphaadrrngericagnositcancausesmoothmusclecontraction)
Voidontimedschedule
BPHTreatmentsConservative
*Exhibitingsxsofobstruction
*Drugs
5reductaseinhibitorsfinasteride(Proscar)(reducethesizeoftheprostateglandbysuppressingandrogen50%
successrate6monthstobeeffectively,SE:decreaselibido,ejaculate,ED
adrenergicreceptorblockers
terazosin(Hytrin),tamsulosin(Flomax)[promotesmoothmusclerelaxation,allowurethratoexpandintotheprostate,
doesnottreathyperplasiaworkswith23wks,SE:orthrohypo,dizziness]
sawpalmetto[improveurinarysxs,outflowoftheurine,doesnotreducesizeofprostate,longterm]
BPHTreatmentsInvasive
Outpatientprocedures
TransurethralMicrowaveThermotherapy:inserttransfurethralprobeemitsmicrovwaeuptothetempof113Fkills
offprostatetissue,recutalprobisinserttotherectumtomeasuretherecutaltissueifthetempreach110itcause
damageforrectaltissue.
TransurethralNeedleAblation:tinyneedleareinsertedintotheprostateviacycstoscopylowwaveradialfrequency
areemitedkillofftheporstatetissue,complicationisuti,urinaryretention,dysuria.Foleyinsertedpostprocedure.
LaserProstatectomy:useultrasoundtoinsertfiberinstrument,cutandcoagulatesandvaporizedtheprostatetissueits
voidedoutwithurine
IntraprostaticUrethralStentsInpatientprocedure:stentinsertedintotheprostatetissue,complicationischronicpain
andinfection
TransurethralResectionOfTheProstate(TURP)viainpatient:cutalltheprostatetissues,thetissuethatwascutgets
urinatedout.larger3waycatherwasinsertedandCBIisinplacefor24hourstoflushprostatictissueandclots.The
urineneedstoberosadcolorw/ocloths
ComplicationofTURP
*TURPcomplications
Bleeding
*ExpectedUrinecolorpostop:rosecoloredwithoutclots
BPHNursingGoals
Preop
Restoreurinarydrainagepriortosurgery:usingacudaecathertoemptyoutthebladder,lidocaineisusetodilatethe
urethraascatetheristhreadin
TreatanyUTI:abx
Educate:mayhavesomeretrogradeejaculation:reduceorabscenseejeculant
Postopnocomplications
restorationofurinarycontrol
completebladderemptying

BPHHealthPromotion
Men>50y/o
Annualphysicalwithdigitalrectalexam
Limitalcohol,caffeine:actasdiureticincreasedistention
Limitcough&coldmeds:Sudafedbcworsenthebphsxs,alphaadrengericagonistcausesmoothmusclecontraction
preventthebladderneckfromrelaxingsourinecanflowout
Bladdertraining:void23hrs,preventuti,stasis
Maintainregularhydration:limitamtb4bedtime
satisfyingsexualexperience

ProstateCancer
Malignanttumor
Affects1in5men
2ndleadingcauseofcancerdeath
75%over65y/ocanalsooccurinyoungmen
Pathophysiology
Androgendependentcarcinoma
Mostslowgrowingconfinedtotheglandformanyyears
,littleornosxsduringphysicalexam,somearemore
aggressivethanothers
Tumorsinouteraspectofprostate
Spreadsbydirectextensiontothesiminualvasicles
urethramucosa,bladderwall,externalspincter,lateron
canspreadtothelymphnode,veinintheprostatecan
spreadtothecatopelvicbone,headofthefemor,liver
andlungs.
ProstateCancerRiskfactors
Age>65y/o
Ethnicity:AfricanAmericanhighmortalityrate
FamilyHx1stdegreerelative
Diet:redmeathighfatdiaryproductintake,decrease
fiber,occupationalexposure,bphisnotariskfactorfor
prostateca
Occupationalexposuretochemicals
ClinicalManifestations
Earlystages:asymptomatic
ExhibitingsxsDysuriahesitancyfrequency
DribblinghematuriaretentionUrgencyNocturia
InterruptionofurinarystreamInabilitytovoid
MetastasisPainwillspreadtothelumbarsacraldown
tothelegandthehips
DiagnosticTests
Annualdigitalrectalexam(DRE):+forprostateCA,
itwillfeelhard,asymmetrical,larger,areaofinduration
andnoduel
Annualprostatespecificantigen(PSA):glycoprotein
producebyprostate,smallelevationdoesnotindicate
anythingsuchasafterlongbikeride,indwellingcatheter,
cycstoscopy,prostatebiopsy,levelcanbedecreasedueto
drugsprosgae,feminstriai.somemenhavenormallevel
buttheyhaveca.DREisaccurate,PSAisusetomonitor

cancertxt
prostaticacidphosphatase(PAP)extracapsular
spreadofthecancer
Biopsy:doneduringtransrectualultrasound
CTscan,MRI:locationandextendofthecancerspread
ProstateCancerTreatments
Conservative:watchfulwaiting,dontdoanythinguntil
sxsareveryuncomfortable,withtxtislessthan10years.
OnlyforSTAGEALEVELTUMOR.PSA+DRE=annual
basesofcancerspread
Surgery:radicalprostatectomy,cryotherapy
Radiationtherapy:externalbeamradiationandbeam
therapy
Drugtherapy:hormones,orcheiecomty,chemo
ProstateCancerTreatmentsSurgery
Radicalprostatectomy&retroperitoneallymphnode
dissection(stageC)isveryeffectiveptlivealongtime
afterwards,ifdoneonstagedistorelievetheobstruction
forurinaryflow.Postoptpthavetroubleurinating
indwellingcathisinserted.Iftheyhaveperniealincision
donethereisriskforinfectionfromstool.Complicationis
ED=Viagra,urinaryincontinence=kegelexerise
Nervesparingprocedure(StageB):prostateremove
complelety,erectilefunctionworks
Cryotherapy:frezzescacellbyinjecting
nitrogen,complicationdamagetourethra,urethral
cutaneousfistula,urinaryinconteience
RadiationTherapy
Externalbeamradiation(StagesA,B,C)outpt
procedure,everdayfor5dayfor48wks,skincanbedry
red,irriated,painful,abdcramp,dysuria,noturia,ED,
bonemarrowsuppression,fatigue
Brachytherapy(StagesA,B)outptprocedureonceas
outpt,needlesareinserteddirectlyintotheprostated
glandguidedwithtransrectalultrasoundradialactive
seedsareimplanted.Complication:ED,urinary
irriative/obstructiveproblem
Drugtherapy
Hormonaltherapy(androgendeprivationtherapy
ADT)Usedasadjuncttherapy:decreaseamtof
androgenlevel,itpromotestumorgrowth,usebefore
surgeryandradiationshirinktumorsizepriortosurgeical
orradiationtherapycanbecomeresisitanttoadtifitsuse
forseveralyrs.Increasepsalevelindicatedthattheadtis
nolongereffective.complication:osteoprosisi,bone
mineralloss
Luteinizinghormonereleasinghormone(LHRH)
agonists&antagonists

LHRHagonistsoverstimulatesthepituitaryto
produceLH,LHstimulatesproductionofthe
aldestornincreasegrowthofprostategland,Lh
increaseandoverstimulatedthepituitary
LHRHantagonistsblocksLHreceptors
Estrogen
Orchiectomy(StageD)
Bisphosponatedrugs
Chemotherapy

ProstateCancerHealthPromotion
Annualprostatescreening(PSA,DRE)50yrsand
up/youngandhaveriskfactororAAorHXofprostate
cancer
ProstateCApatientgoals
Activelyparticipate&followtreatmentplan
Managepain
Managebladder&bowelfunctions
Managepossiblesexualdysfunction

PrepuceProblems
Phimosis
Cannotretractforeskin
Paraphimosis
Cannotpullforeskinoverhead

Priapism
Painfulerection>6hours
Medicalemergency
Causedby

thrombosis,leukemia,sicklecellanemia,
DM,spinelesions,neoplasmsof
brain/spinalcord,injectionofvasoactive
medicationsintocorporacavernosa,
cocaine,viagra,trazodone
Treatment
Sedatives
smoothmusclerelaxants
Aspiration&irrigation
creationofashunt
Complications
peniletissuenecrosis,hydronephrosis,
inabilitytoachieveanormalerection

Epididymitis
epididymisinflammation
UnilateralAge<35
Etiology
Treatment
Hydrocele
Nontender,fluidfilledmass
Dx:transillumination
Treatment:noneunlessuncomfortable
Spermatocele
Firm,cystlikemass
Painless
Dx:transillumination
Causeunknown
Treatment:Surgicalremoval
Selfexamoftestis
Varicocele
Dilationofveinsthatdraintestes

Cause:unknown
Associatedwithinfertility
TesticularTorsion
Twistingofspermaticcord
Age<20
Surgicalemergency
ClinicalManifestations
Diagnostictests

Cremastericreflex

Nuclearscan
Dopplerultrasound
TesticularCancer
Rare<1%
MostcommontypeofmaleCAinyoungmen
:occursinrighttesticles,undisendedtestitcles
developfromembroticcells
Age1534
FamilyHx
Ethnicity

Whites(esp.Scandinaviandescent)
RiskFactors
Orchitis
HIV
MaternalexposuretoDES
TesticularCAincontralateraltestis
Clinicalmanifestations

Onsetsloworrapid

Painlesslumpwithedema,heaviness

Dullacheorheavysensationinabd,or
lowerscortum

Acutepain(initial10%pts)

Backpain,cough,dyspnea,hemoptysis,
dysphagia,alteredvision,ALOC,
papilledema,seizures
Diagonostic Tests
Palpate scrotal contents: if its firm doesnt
traniluminate its probably cancerous
Ultrasound : testicular edema
CXR
CTscanabd,pelvis:detectmetasizesis
Lab:fetoprotein,LDH,humanchorionic
gonadotropin
Treatments
Orchiectomy or radical(remove affected
testies, spermaticord, lypmph node)
orchiectomy , in the early stage they
remove the retroperitoneal lymph node
they are the common sites for metasizesis
Pre-op
Explain procedure, discuss sperm bank,
erectile dysfunction
-Assess psychological status
Post orchiectomy

Radiation or chemotherapy
Health Promotion
Testicular self exam

 Monthly exam during shower/bath: when

temp is warm the testies will lower
inspect each testis with both hands: roll
testies between the thumb and first and
third finger round smooth like hardboil egg.
Epeidiemisis should not feel smooth. Its ok
to have different size testicles
Vasectomy
Bilateral surgical ligation of vas deferens
local anesthesia
Contraception: wear condom cath after
the procedure up to 6 wks and 10
ejeculation to make sure sperm that is
distal to the surgical site has empty out of
the surgical site
Complications psychological erectile
dysfunction
Erectile Dysfunction
unable to attain or maintain erect penis during sexual performance
Occurs at any age : if occur to young ppl its substance abuse, middle age= medical condition,
older ppl=taking too long for erection to occur.
Etiology

Physiologic: DM, vascular disease, trauma, chronic illness, ca

Psychologic:depression, low self estem, confident, overall sense of wellbeing

Diagnostic Tests
H&P
sexual Hx
Serum glucose, lipid panel, testosterone,
prolactin, thyroid hormone levels, PSA
Nocturnal penile tumescence & rigidity
test : measure circumference of penis
during sleep hours , its normal for penis to
become erected during sleep. Rigidty test
is abnormal is systemic if its normal its
pyschologic
Vascular studies: blood flow in and out of
the penis

Penile arteriography

Duplex doppler ultrasound

Treatments
first-line oral drug therapy, vacuum
constriction device, sex therapy
second-line
vasoactive drugs
third-line
surgical implantation
Nursing Management
Provide sensitivity, emotional support
Encourage counseling
Educate routine health assessments
Infertility

 Inability to conceive after 1 year

33% male infertility
Etiology:

Pretesticular (endocrine) :med or

surgery

Testicular : most common cause,

such as mumps , stds , infection

Posttesticular
Diagnostic Tests
H&P Semen analysis
Lab: Testosterone, serum LH, FSH levels
Treatments
Drugs
Conservative lifestyle changes
in vitro fertilization
Surgery