Assessment & Management of the Male Reproductive System Flashcards
What are we looking for when we examine the penis and scotum?
Look for abnormalities
Palpate for masses
When inspecting we may feel fluid in the scrotal sac. What is this called?
What is a secondary cause
Hydrocele
Secondary cause is trauma like from sports
When inspecting we may feel enlarged veins of the spermatic cord. What is this called?
Varicocele
What else might we find related to STI?
Do we do rectal exams?
Ulcerations Inflammation Discharge So anything that suggests STI And yes, rectal exams are done.
What is gynecomastia?
Why treatment can cause this?
Male enlarged breasts.
Cancer treatment of the prostate
Questions to ask about possible UTI any trouble where is the trouble partners what the urine looks like do they pee a lot
Do you have difficulty urinating? Hard to stop or start the stream? Sexual Hx Urine description How often do they go?
Why might they have nocturia?
Due to prostate
What is double or triple voiding?
Feeling like you’re done urinating but then going again.
What conditions could also affect the sexual dysfunction
3
DM
cardiac
MS
What is the diagnostic test Prostate Specific Antigen or PSA
Why do this?
What if it is high?
Test that measures protein produced by the prostate to look for tumors
It can increase in pathologies
If high, do a Digital rectal exam
What is a Gleason score?
Test done for malignancy investigation. It takes the biopsy of 2 different places and adds them together for a grade.
Low score is better
What is a Transrectal Ultrasonagraphy?
It is an ultrasound of the rectum
It can be done with needle biopsy
What is a penile doppler for?
It just feels for the pulse in the penis.
What should we consider when doing any of these exams?
The patient may be uncomfortable & we need to make it as easy as possible for them.
You know what erectile dysfunction is. What types of causes can be behind it?
Either psychological or organic - from something else that is non-psych.
Psychogenic causes
anxiety
fatigue
depression
very mental
Organic causes
Not mental Diabetes Peripheral Arterial Disease Postsurgery Neuro disorders Trauma alcohol meds drug abuse
Drugs used to manage erectile dysfunction
Sildenafil (Viagra)
Tadafil (Cialis)
Vardenafil (Levitra)
How do you use erectile dysfunction meds?
How do they work?
Why should you be careful if they take Nitro’s?
Just take them right before sex.
They work by enhancing natreous oxide to relax muscles and enhance blood flow.
With Nitro’s, the blood pressure is being dropped. Erectile dysfunction meds will drop the blood pressure also. You can end up with a severely hypotensive patient.
What type of communication should we use when asking questios?
Balance between open ended questions and specific.
Some patients may not fess up to anything unless we bring it up first.
Where is the prostate located?
The anatomy? 2
Located below the bladder, in front of the rectum, and surrounding the urethra
Has alkaline secretion for sperm passage
Has ducts to urethra
Why might it be hard to insert a catheter in males?
Due to an enlarged prostate
What is Prostatitis?
Types?
Inflammation of the prostate Acute bacterial Chronic bacterial Chronic prostatitis/pelvic pain syndrome Asymptomatic Inflammatory prostatitis
And how do we distinguish the two?
90% of cases?
Do a culture, biopsy, and lab
90% of cases are chronic/ pelvic pain syndrome
Causative agents of Prostatitis?
Can these guys travel to other organs and cause inflammation
E. coli
Chlamydia
Klebsiella
Gonorrhea
So more digestive and STI reasons
And yes, they can ascend and travel.
What will urine output look like in Prostatitis?
Dysuria or pain
Frequent and urgent
Cloudy appearance
Where will pain radiate to?
back & in the perineal area
What will a DRE reveal?
A swollen, tender prostate.
What complications of prostatitis could occur in the kidney?
What other complication can arise?
Cystitis
Epididymitis
Pyelonephritis
Sexual dysfunction
What diagnostics might they do for Prostatitis?
UA
CBC
STI
PSA for tumor markers
Antibiotics given for Prostatitis
Ciprofloxacin
Bactrim
Alpha adrenergic blockers given for Prostatitis
Tamsulosin
Due to ability to relax smooth muscle of bladder and neck (for women)
Anticholinergics given for Prostatitis
Tolterodine
decreases frequency
Why give Prostatitis patient a sitz bath?
Should they shower?
Who else can benefit from these?
Warm water over the perineal area helps relax and clean them.
It can help with urination also.
Do not shower.
Post partum mothers.
Should they sit or ride a bike for long period of time?
No. It just adds more pressure.
Is it ok for Prostatitis patient to drink caffeine?
No. Need to avoid stimulants.
Can the Prostatitis take decongestants?
No. Avoid decongestants.
What to address about drinking fluids with Prostatitis?
You will need to encourage pt to drink. They won’t want to but it is needed.
If an STI is present what do you tell them?
Abstinence. and check the partner
What is Benign Prostate Hyperplasia?
What is impaired?
What does this cause?
It is increased cell growth of the prostate that is benign.
It causes an enlarged prostate.
Impairs urine flow
And causes infection and retention
How can Benign Prostate Hyperplasia affect kidneys?
Urine can reflux into the kidneys and cause kidney infection
BPH risk factors?
age - age 40 need to have rectal exam
family hx
diabetes or underlying issues
BPH symptoms relating to urination? benign prostatic hyperplasia
Urinary difficulty Hematuria UTI dribble nocturia
other BPH symptoms?
general pain in pelvic region
Tumor marker test done for BPH too?
Why do we get Creatinine and BUN done?
PSA
Get those done to check up on kidneys
What is a Residual check?
Will they do a TRUS?
Urinate, bladder scan, and straight catheter all to see how much is left or if there’s any residual
yes.
How might they just do active surveillance of the BPH?
through PSA
and DRE
Drug therapy for BPH using 5 alpha reductase inhibitors?
How does it work?
Use 5-alpha reductase inhibitors to decrease size of the prostate
Dutasteride
Finasteride
Alpha blockers for drug therapy of BPH?
alfuzosin
tamsulosin
These relax the bladder neck muscle & muscle fibers of prostate
Laser enucleation for BPH
vaporizes the prostatic tissue
minimally invasive
Microwave thermotherapy for BPH
minimally invasive technique that heats up the tissue
Transurethral needle ablation for BPH
minimally invasive technique also heats tissue
Prostatic urethral lift is also called?
How does it work?
Also called urolift system
Minimally invasive technique that used implants to widen the uretha
What is a Transurethral Incision of the Prostate TUIP
Invasive procedure where an incision into the prostatic tissue to relieve the obstruction
What is a TURP Transurethral Resection of the Prostate?
Invasive procedure that uses excision and cauterization to remove prostatic tissue
What is a simple Prostatectomy?
What are the different methods this is done?
Removing the prostate
Methods are open, laparoscopic, or robot assisted
What age is more at risk of prostate cancer?
What kind of diet is more high risk?
Older than 65
High fat
What urinary symptoms are you looking for with prostate cancer?
Uti’s
Hematuria
Small amounts of urine indicating retention
What diagnostics/lab are going to be used for prostate cancer assessment?
PSA
BUN and Creatinine for kidneys
Gleason score
What are signs of metastization for respiratory?
For musculoskeletal?
cough
bone pain/fractures
What does the Androgen Deprivation drug Therapy do for prostate cancer?
It inhibits testosterone (sort of like how they block estrogen in breast cancer).
The castration part is so they reduce the tumors growth from hormones.
Androgen receptor blockers help with prostate cancer how?
Good example med?
Blocks the action of testosterone this time.
Medication : Bicalutamide
Androgen Synthesis Inhibitors?
Example med?
Stops testosterone creation in the testes, glands, and cancer cells
Medication: Abiraterone
Luteinizing Hormone releasing hormone decreases which hormones? LHRH
Example med?
Decreases LSH and FSH
Decreases testosterone
Medication: Leuprolide
LHRH antagonist does blocks and suppresses what?
Blocks luteinizing receptors
Suppresses testosterone
Gold standard for androgen/testosterone deprivation for prostate cancer?
Prostatectomy?
Relief?
Education?
Bilateral Orchiectomy
It can be done with or without a prostatectomy
Bain pain relief
Educate that it may decrease fertility due to lowered testosterone.
If a patient is doing chemotherapy, what is our main job?
Keep them comfortable. It is mostly palliative. .
T/F Prostate cancer vaccines do not exist
False. They actually do exist. They are just prepared individually for each man. Very expensive.
Stimulates immune system
Sipuleucel-T
Drugs for bone metastasis of prostate cancer?
Boniva & Actonel for osteoporosis
Denosumab
Types of radiation they can do for prostate cancer?
External Beam
Brachytherapy (more internal)
Why use external beam radiation?
How accurate is it?
Benefit?
Con?
Side effects?
Education on clothing?
For cancer that is confined to the prostate.
With cyber knife, it is pinpoint accurate.
Due to accuracy, it wont damage other tissues.
You will have to come in for treatment a lot 5 days a week
Skin burns
Inflammation & bleeding of GI
Diarrhea
Clothing should be loose!
What is Brachytherapy (internal) like?
High dose
Low dose
Teaching with Brachytherapy?
Placing radioactive seeds into the prostate.
High dose is more temporary and lasts a few minutes bc you can do it all at once
Low dose is a more permanent bc the seeds stay in you for several months and slowly release radiation.
Cannot let a grandchild sit on your lap. Or allow pregnant women near you.
Will need to strain urine to see if seeds are lost
Radiation can cause Cystitis. What is it?
Management of the symptom?
It means inflammation of the bladder.
Keep patient hydrated
Avoid bladder irritants
Gi tract issues like diarrhea, cramping, and proctitis ( or rectum inflammation) can happen with radiation.
How do you manage it?
Low residue diet
keep them hydrated
sitz bath
avoiding constipation
Erectile dysfunction occurs with radiation.
How do you manage it?
Therapy
education and make sure the pt knows about this beforehand
Radiation can cause skin irritation, pain, dryness, and redness.
How do you manage it?
Pay attention for infection
Rinse with saline
Use emollients
Fatigue occurs a lot with radiation.
How to manage it?
Manage it by resting and going slow
Which is a common, noninvasive method of surgery for prostate cancer?
Suprapubic open approach?
Perineal open approach?
Retropubic?
TUIP?
Nerves in robotic and da vinci?
TURP
suprapubic bladder is entered
Perineal is where the perineal area
Retropubic is through the bladder
TUIP widens the urethra
nerve sparring
After surgery, pt can become incontinent. What is it permanent?
after 1 year
Other complications from surgery?
infection
sexual dysfunction
spasms
hemorrhage
If a patient is complaining of pain what should you assess first?
If it is from surgery or a bladder spasm
What can you do if the patient is having a bladder spasm?
Belladona bladder spasm
Can you give them anti-spasmodic opioid for pain? why or why not
This is most likely the elderly population. and yes, bc it won’t cause respiratory depression
What to avoid after prostate surgery?
Exercises you can do after ?
Prolonged sitting or travel time.
Ankle pumps
After prostatectomy or prostate surgery, and the patient has a incontinece - what does the nurse need to do?
How can this be done?
Nurse may have to do a catheter with CBI or continuous bladder irrigation
Do use 10mL for the CBI?
What happens if the irrigation is bright red for first 12 hrs?
What direction should you face the catheter?
Where should you check the color of the blood?why?
Why would someone tape the tubing tight to the thigh? why?
No. use 30 mL
Do nothing. Bright red return is normal.
To the door
Check blood in tubing. not the bag. Nurse will have to adjust based off color
Tubing will be taped very tight. The 30mL balloon needs it for pressure
What is a leg bag?
It is an option for post-surgical patients with incontinence issues. It allows them to walk around. And then they just switch to foley at night.
Patient teaching after prosatectomy or surgery?
Avoid straining or heavy lifting
Eat dietary recommendations
What is Epididymitis?
Common cause?
Treatment?
Inflammation of scrotal sac that is unilateral
Common causes:
gonorrhea or chlamydia
e. coli
Treatment is antibiotics and care interventions
Best way to elevate the scrotal sac in epididymitis?
What do to for pain and swelling?
Using rolled up wash cloth
Use ice pack and mild analgesics
What is orchitis?
Main causes?
What contributes to atrophy?
infertility issues?
inflamed testes
main causes:
Follows a bacterial or viral infection
such as mumps
Mumps orchitis contributes to atrophy
Rare issues with infertility bilaterally
Best treatment for orchitis?
Similar to epididymitis.
Antibiotics
Elevate sac
Analgesics
Testicular cancer is the most common in men ages..
Is it curable?
15-40
Yes curable. But it has to be found. Can happen very, very young.
Risk factors of testicular cancer
Will there be fertility issues?
Cryptorchidism or undescended testicles
Family hx of cancer
Hx or Family hx of orchitis
HIV
There will possibly be fertility issues due to low sperm
Symptoms of testicular cancer
What if it is advanced?
mass or lump in scrotum is non-tender and firm
swelling and heaviness of scrotum
dull ache in lower abdomen
lower back or chest pain
cough & dyspnea
How to manage testicular cancer?
Orchiectomy and removal of spermatic cord & lymph nodes
radiation
chemo
surveillance
With testicular cancer, what can you do about infertility problems that may arise due to treatment?
Give sperm to sperm bank. Cryopreservation
What is Testicular Torsion ?
How to treat?
Most prevalent symptom?
Cause?
Testicular Torsion is what Jon had. Twisting of the sperm cords.
Emergency untwist or excision
Sudden pain
Trauma; sports or even cold water
What is a Hydrocele? Hydro= How can you tell? Cause? Magement/treatment?
Hydroceles are Non-tender, fluid filled masses from lymph drainage issues.
Hydro=water
You can tell by transillumination. If it is fluid, you can see through it.
Caused by trauma, radiation, or infections
May have to do aspiration but usually no treatment
What is a Varicocele?
Fertility?
Management?
Varicocele is a cluster of dilated veins that drains the testes
Infertile
Ligate of the vein
Hypospadias?
Assessment?
Hypospadias is when the urethra is on the underside of penis and opens improperly
Check in newborns
Epispadias?
Cause?
Treatment?
Epispadias is when the Urethra is not developed and opens on top or side of penis
Cause is birth defect
Treatment is surgery
Phimosis?
Complications?
Teaching?
Phimosis foreskin not being retracted if uncircumcised
Complications include infection and unhygienic conditions
Need to teach young boys how to do this properly.
Paraphimosis ?
Leads to?
Paraphimosis is when you can’t get the foreskin back to normal.
Need to be able to get it back because if left where it is at, it can cause hypoxia or loss of circulation
Priapism?
Cause?
Prapiasm is a persistent erection
Can be a side effect of ED drugs
Penile cancer
Management?
Vey rare.
Do partial penectomy or amputation
