Reproductive disorders 2009

Chapter 47 : 

Chapter 47 Male Reproductive Disorders

Disorders of the Male Reproductive System : 

Disorders of the Male Reproductive System Infection and inflammation Erectile dysfunction Peyronie’s disease Priapism Phimosis Infertility Penile cancer

Bacterial Prostatitis : 

Bacterial Prostatitis Often occurs with urethritis or an infection of the lower urinary tract Fever, chills, dysuria, urethral discharge, and boggy, tender prostate Urethral discharge with white blood cells in the prostatic secretions Chronic bacterial prostatitis

Nonbacterial/Chronic Pelvic Pain Syndrome : 

Nonbacterial/Chronic Pelvic Pain Syndrome Can occur after viral illness or may be associated with sexually transmitted diseases Other causes: autoimmune, neuromuscular etiologies, allergy-mediated reactions, psychosexual problems Prostatodynia or pelvic floor pain Treatment

Epididymitis : 

Epididymitis Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma Treatment: bedrest with scrotum elevated on a towel, scrotal support when ambulating Comfort measures Epididymectomy

Orchitis (Mumps) : 

Orchitis (Mumps) Acute testicular inflammation resulting from trauma or infection Treatment: bedrest with scrotal elevation, application of ice, and administration of analgesics and antibiotics Mumps orchitis

Benign Prostatic Hyperplasia : 

Benign Prostatic Hyperplasia Glandular units in the prostate that undergo an increase in the number of cells resulting in enlargement of the prostate gland Hyperirritable bladder, urgency and frequency, hypertrophied bladder wall muscles, cellules and diverticula, hydroureter, hydronephrosis, and overflow urinary incontinence

Assessment : 

Assessment Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction Lower urinary tract symptoms Hesitancy, intermittency, reduced force and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling Hematuria

Laboratory Assessment : 

Laboratory Assessment Urinalysis Complete blood count Blood urea nitrogen and creatinine levels Prostate-specific antigen

Drug Therapy : 

Drug Therapy Finasteride to shrink the prostate gland and improve urinary flow Terazosin hydrochloride Doxazosin mesylate Tamsulosin hydrochloride Estrogens and androgens

Surgical Procedures : 

Surgical Procedures Transurethral resection of the prostate Suprapubic prostatectomy Retropubic prostatectomy Perineal prostatectomy

Erectile Dysfunction : 

Erectile Dysfunction Inability to achieve or maintain an erection for sexual intercourse Organic erectile dysfunction Functional erectile dysfunction Assessment Medical, social, sexual history Complete physical examination Duplex Doppler ultrasonography test

Interventions : 

Interventions Drug therapy includes sildenafil (Viagra), Testosterone. Avoid alcohol before sexual intercourse. Common side effects include headaches, facial flushing, diarrhea. Men who take nitrates should not take these drugs in addition.

Vacuum Devices : 

Vacuum Devices Cylinder fits over the penis and sits firmly against the body. Vacuum is created to draw blood into the penis to maintain an erection. Rubber ring (tension band) is placed around the base of the penis to maintain the erection; cylinder is removed.

Intraurethral Applications : 

Intraurethral Applications Prostglandin E is a self-administered suppository that is placed in the urethra with an applicator. Erection occurs in about 10 minutes and lasts 30 to 60 minutes. Burning of the urethra occurs after application.

Prosthesis : 

Prosthesis Penile implants are used when other modalities fail. Implants are semirigid, malleable, or hydraulic inflatable and multicomponent or one-piece instruments. Reservoir is placed in scrotum. Major disadvantage are devices failure and infection.

Priapism : 

Priapism Uncontrolled and long-maintained erection without sexual desire; causes the penis to become large and painful Can occur from: Thrombosis of veins of corpora cavernosa Leukemia Sickle cell disease (Continued)

Priapism (Continued) : 

Priapism (Continued) Diabetes mellitus Malignancies Abnormal reflex Some drug effects Recreational drugs Prolonged sexual activity

Collaborative Management : 

Collaborative Management Urologic emergency Goal of intervention: to improve the venous drainage of the corpora cavernosa Meperidine Warm enemas Urinary or suprapubic catheterization Large-bore needle or surgical intervention

Phimosis and Paraphimosis : 

Phimosis and Paraphimosis Constricted prepuce that cannot be retracted over the glans; prepuce remains down around the tip of the penis Emergency requiring immediate treatment Circumcision Warm bath to allow dressing to loosen Barbiturate sleeping medications

Cryptorchidism : 

Cryptorchidism Results when the testicles fail to descend; mainly a pediatric problem Injections of B-HCG luteinizing hormone-releasing hormone or testosterone optional to promote descent of the testicles Orchidopexy surgical procedure optional

Varicocele : 

Varicocele A cluster of dilated veins occur behind and above the testis. Varicoceles can also cause infertility. Varicocelectomy is performed through an inguinal incision in which the spermatic veins are ligated in the cord.

Cancer of the Penis : 

Cancer of the Penis Epidermoid (squamous) carcinomas developing from squamous cells Circumcision in infancy—almost always eliminates the possibility of penile cancer Painless wartlike growth or ulcer Excisional biopsy Radiation therapy Penectomy

Testicular Cancer : 

Testicular Cancer Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age. With early detection by testicular self-examination and treatment with combination chemotherapy, testicular cancer can be cured. Germ cell tumors arise from sperm-producing cells. Non-germ cell tumors

Testicular Cancer : 

Testicular Cancer

Prostate Cancer : 

Prostate Cancer Most common invasive cancer among men in the U.S. One of the slowest growing malignancies; metastasizes in a predictable pattern First symptoms related to bladder neck obstruction

Prostate Cancer (Continued) : 

Prostate Cancer (Continued) Digital rectal examination Prostate-specific antigen Biopsy necessary to confirm suspected prostatic cancer

Postoperative Care of Radical Prostatectomy : 

Postoperative Care of Radical Prostatectomy Hydration with intravenous therapy Caring for wound drains Preventing emboli Preventing pulmonary complications Antibiotics Analgesics