Male reproductive disorders Flashcards
What is erectile dysfunction
Inability to achieve or maintain an erection sufficient for satisfactory sexual activity
Erectile dysfunction involves what
Sympathetic and parasympathetic components
What are psychogenic causes of ED
anxiety, fatigue, depression, pressure to perform
What are organic causes of ED
occlusive vascular disease, endocrine disease, neurologic disorders, trauma, alcohol and medications
ED - assessment
Thorough - physical, neuro, labs
ED clinical manifestations
decrease frequency of erections
Inability to achieve a firm erection
rapid detumescence (subsidence of erection)
Medical management of ED
Phosphodiesterase-5 inhibitors (viagra)
– complication - priapism
Penile implants
- semigrid rid (constant)
- inflatable (comes and goes)
Viagra - teaching considerations
Take 1 hour prior to sexual sexual activity
Can NOT take with nitrates!!! - will induce hypotension
Describe disorders of ejaculation
The spectrum of disorders of ejaculation responses ranges from occasional ejaculation through intercourse or self-stimulation to complete inability to ejaculate under any circumstances.
Disorders of ejaculation - treatment
depends on severity of the ejaculation problem
Behavioral therapies – include the partner
Pharmacologic and behavioral therapy together may be effective.
Chemical, vibratory, and electrical methods of stimulation have been used with some success.
Disorders of ejaculation - causes
Neurologic disorders (e.g., spinal cord injury, multiple sclerosis, neuropathy secondary to diabetes)
Surgery (prostatectomy)
Medications
What is prostatitis
Inflammation of the prostate gland
What is the most common cause of prostatitis
E. Coli
How do you know if its prostatitis or a UTI?
prostatitis - very tender and swollen prostate
Prostatitis causes what in men?
UTIs
Prostatitis: clinical manifestations
Perineal discomfort Dysuria Urgency/frequency Pain with or after ejaculation Sepsis-like fever, chills, low back pain
Prostatitis: medical management
CBC, urine culture Avoid septicemia PSA (already elevated, not reliable) abx Relief of symptoms
Prostatitis: nursing management
Avoid cycling (repetitive perineal trauma)
Hot sitz baths (10-20 minutes) multiple times a day
Hydration
Avoid sitting for long periods of time
Benign prostatic hyperplasia (BPH)
Prostate gland enlarge and obstructs the outflow of urine
BPH cause
unknown - smoking, alcohol, heart disease, diabetes
BPH - clinical manifestations
Frequency of urination Nocturia Urgency Hesitancy in starting urination Abdominal straining with urination
Decrease in the volume and force of the urinary stream, interruption of the urinary stream, dribbling
Sensation of incomplete emptying, possible acute urinary retention, and recurrent UTIs
DRE may reveal a large, rubbery, and nontender prostate gland, although the size of the prostate correlates poorly with symptom report
BPH medical management
Urinary retention – catheter inserted (Coude)
Alpha-adrenergic blocker – Tamsulosin
Surgical – TURP, balloon dilation
BPH nursing management
intake and output
Risk factors for prostate cancer
Highest in AA men
>65 years
Familial disposition
Diet - excessive red meat or high-fat dairy products
TURP (transurethral resection of the prostate)
pushed back the part of the prostate that was pushing on ureter
TURP - advantages
avoids abdomonal incision safer for patients with surgical risk shorter hospitalization and recovery periods lower morbidity rate causes less pain
TURP disadvantages
Recurrent osbtruction, urethra trauma, stricture may develop
Delayed bleeding may occur
Retrograde ejaculation due to removal of prostatic tissue at the bladder neck, which causes the seminal fluid to flow backward into the bladder
TURP - nursing implications
Monitor for TUR syndrome Monitor for hemorrhage Observe for s/s urethral stricture Monitor urinary output Bladder spasms
What are s/s urethral stricture
dysuria, straining, weak urinary stream
What is TUR syndrome?
Transurethral resection syndrome (TUR) - complication of TURP
What are causes of TUR
Neuro
CV
Electrolyte (hyponatremia, hypo-osmality, hypovolemia)
TUR s/s
Lethargy and confusion Hypertension Tachycardia Nausea and vomiting Visual disturbances Headache Muscle spasms Seizures
TUR interventions
During the operative procedure, normal saline cannot be used at it conducts electricity
– intraoperative irrigating solution of glycine, sarbitol/mannitol, or water is discontinued and replaced with normal saline
- administer diuretics
- monitor i&o
- monitor the patient VS and LOC
- differentiate the lethargy and confusion of TUR syndrome from postoperative disorientation and hyponatremia
- maintain safety during times of confusion
- assess lung and heart sounds for indications of pulmonary edema, heart failure, or both (fluid already presents in profound hyponatremia)
TURP output
When assessing the output, you will follow the tube to the middle point of the tube/line, not just what is in the drainage bag
Prostate cancer
PSA and DRE = most effective
Prostate cancer clinical manifestations - late signs
hematuria, urinary obstruction - signs that it has invaded
Clinical manifestations that prostate cancer has metastasized
hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (less than 400mL/day)
Prostate cancer - prostectomy concerns
prostate is really deep in pelvis and surrounded by a lot of vascular tissue, so the we are concerned about hemorrhage during and after
septicemia, renal issues, respiratory
Radical prostectomy includes removal of what
prostate, lymph nodes, some seminal vesicles
Prostate cancer - radiation
could do brachytherapy
- inflammation or rectum
- ED
Prostate cancer - hormonal therapy
suppressing androgens
– decreasing how much testosterone is circulating in body
Prostate cancer - complications
sexual function – psychological
What are radiation complications for prostate cancer
cystitis, diarrhea, ED, proctitis (inflammation of rectum
Orchitis
inflammation of testes
tx. = rest, ice, elevation (cannot compress), abx, pain meds., antiinflammatories, avoid straining and sexual activity
Epididymitis
swollen and painful duct
most common cause = chlamydia
s/s = soreness, unilateral pain
Testicular cancer most common age
15-40 years old
Testicular cancer - risk factors
Undistended testicles, familial cancer, history of cancer
Testicular cancer s/s
Going to feel a mass or lump on testicle - usually painless
Testicular cancer treatment
removal of teste
chemo
radiation
Hydrocele
Collection of fluid in testes
Hydrocele treatment
If severe - incision to drain fluid
abx
What are we worried about with hydrocele
Hematoma
Varicole
dilation of vein in penis
Varicole treatment
scrotal supporter
Phimosis
Foreskin is constricted cannot be retracted over the glans
Phimosis cause
congenitally or inflammation
Poorly controlled diabetes and obesity are contributing factors
Phimosis treatment
Tx – circumcision or dorsal slit
Paraphimosis
Foreskin is retracted behind the glans that causes narrowness and subsequent edema
- true emergency
Paraphimosis
Uncircumcised male - they pull the skin back but do not return it do respected position
Paraphimosis treatment
firmly compress glans to reduce the size them moving the foreskin forward
Priapism
Erection that is large, hard and painful
Priapism cause
nature or vascular
Why is a priapism an emergency
venous compromise
What patients are prone to priapism
sickle cell disease patients
When is priapism considered a urologic emergency
If it lasts longer than 4 hours
