Male Reproductive System Flashcards
As men age increase __ & __ changes occur.
Physical & hormonal changes
Male Physical Changes include:
- Prostate gland enlarges – can lead to urinary issues (e.g., BPH).
- Prostate secretion decreases – affects semen composition.
- Scrotum hangs lower – due to loss of muscle tone.
- Testes decrease in weight & atrophy – become softer with age.
- Pubic hair becomes sparser & stiffer – due to hormonal shifts.
Male Hormonal changes include:
- Plasma testosterone declines – leads to reduced muscle mass, energy, and libido.
- Reduced progesterone production – affects overall hormone balance.
Impact on SEXUAL function
- Decreased libido & potency – affects up to two-thirds of men over 70.
- Vascular problems (e.g., atherosclerosis) – contribute to 50% of impotence cases in men over 50.
Can men produce sperm their whole life?
Unlike women, men can produce viable sperm throughout life, despite a decline in sperm production.
Spermatogenesis continues (production of sperm)
When does male hypogonadism (decreased function of the testes) typically begin?
A: Around age 50
* leads to a gradual decline in testosterone.
Q: What are 4 impacts of hypogonadism on sexual function?
- Slower sexual response – Longer time to achieve erection.
- Erections may be less firm – Due to decreased testosterone & vascular changes.
- Ejaculation takes longer & may be harder to control – Orgasm may not always occur.
- Resolution without orgasm
Q: What factors can affect sexual function in aging men?
- Psychological problems
- illnesses
- medications
Q: How does sexual activity in later years correlate with the man’s sexual activity in his earlier years?
A: Men who were more sexually active when younger tend to remain more active than average in his later years.
Men >50 years are at increased risk for ___.
genitourinary tract cancers
(kidney, bladder, prostate, and penis)
Q: What screenings help detect early stage Genitourinary malignancies?
- Digital rectal exam (DRE)
- Prostate-specific antigen (PSA) test
- Urinalysis: screens for hematuria.
decreases mortality
What is the prevalence of urinary incontinence in older men?
Urinary incontinence occurs in 20% of community-dwelling older men and rises to nearly 50% in men in long-term care settings.
Older adults admitted to acute care setting should be screened for___.
urinary incontinence
- What are the common causes of urinary incontinence in older men?
- medications
- neurologic diseases
- benign prostatic hyperplasia (BPH)
- Erectile dysfunction: when there is damage to the neural pathways that initiate an erection.
Urinary incontinence:
Diagnostic tests are done to rule out
reversible causes such as:
* medications
* infx
* constipation
* metabolic imbalances
By ruling out these potential causes, they can focus on identifying the true underlying cause of the incontinence
treating these causes can potentially resolve the issue.
Is new-onset urinary incontinence a nursing priority?
YES! requires evaluation.
What does BPH stand for?
Benign Prostatic Hyperplasia
What are the possible causes of benign prostatic hyperplasia (BPH)?
Possible causes include:
* Excess dihydrotestosterone (DHT), which is 5 times stronger than testosterone.
* Reduced serum testosterone levels.
* Increased estrogen levels.
Research is currently inconclusive regarding the exact cause.
Is Benign Prostatic Hyperplasia (BPH) a precursor to prostate cancer?
Research is unclear if BPH is a precursor to prostate cancer.
What diagnostic tests are used to evaluate benign prostatic hyperplasia (BPH)?
- Urinalysis (UA) & Culture and Sensitivity (C&S): Detects infection or hematuria.
- Post-Void Residual (PVR) via bladder scan: Measures urine left in the bladder after voiding.
- Prostate fluid/tissue exam: Evaluates for infection or malignancy.
- Complete Blood Count (CBC): Assesses for infection or anemia.
- Blood Urea Nitrogen (BUN) & Creatinine: Evaluates kidney function.
- Prostate-Specific Antigen (PSA): Screens for prostate cancer.
- Transrectal Ultrasound (TRUS): Provides imaging of the prostate.
- Uroflowmetry: Measures urine flow rate and strength.
- Cystoscopy: Visualizes the bladder and urethra for obstruction.
- Male Sexual Function Tests: Assesses for erectile dysfunction or related issues.
What are the treatment options for Benign Prostatic Hyperplasia (BPH)?
- Watchful Waiting: Preferred for patients with mild symptoms.
- Pharmacology
Pharmacology Therapy for BPH Treatment
- Alpha-1 Blockers (“GOING” Problem): Relax prostate and urinary tract muscles to improve urine flow.
- 5-Alpha-Reductase Inhibitors (5ARIs) (“GROWING” Problem): Reduce prostate size by blocking DHT.
- Combination Therapy: Uses both alpha-1 blockers and 5ARIs for better symptom management.
- Erectogenic Drugs (PDE5 Inhibitors) (“Growing” & “Going” Problem): May help with both urinary symptoms and erectile dysfunction but should be cautiously used, especially in patients with CHF.
BPH Tx:
What are the minimally invasive options for BPH?
List 5
- Transurethral Microwave Thermotherapy (TUMT): Uses microwave energy to shrink prostate tissue.
- Transurethral Needle Ablation (TUNA): Uses radiofrequency waves to destroy excess prostate tissue.
- Laser Prostatectomy: Uses laser energy to remove or shrink prostate tissue.
- Cryosurgery: Freezes and destroys abnormal prostate tissue.
- Urethral Stents: Small tubes inserted into the urethra to keep it open.
What are the surgical treatment options for benign prostatic hyperplasia (BPH)?
- Transurethral Resection of the Prostate (TURP): Removal of prostate tissue using a scope inserted through the urethra.
- Open Prostatectomy: Surgical removal of part or all of the prostate through an abdominal incision (used for very large prostates).
BPH- Watcful Waiting Management:
Recommendations to avoid further complications
- Void when urge felt OR every 2-3 hours: AVOID urinary stasis
- Avoid decongestants & antihistamines: they are alpha adrenergic agonists causing smooth muscle contrations- making BPH WORSE!
- No caffeine or ETOH (diuretic effect)
- Avoid large amt. of fluids in short time; decrease fluid intake at bedtime
- Foley or SUPRAPUBIC catheter for pts who are NOT candidate for surgery – if patient had a previous urethral stent, wait 3 months
BPH Tx:
What are the common side effects of alpha-adrenergic blockers used for BPH?
- Hypotension: Use cautiously with nitrates due to vasodilation effects- especially Orthostatic Hypotension
- Tachycardia: Reflex increase in heart rate due to vasodilation.
- Dizziness / Drowsiness: Can impair balance and alertness.
- Decreased Energy
- Sexual Dysfunction: May cause issues like decreased libido or difficulty with ejaculation.
- First-Dose may cause Syncope: sudden fainting due to a sharp drop in blood pressure.
Changing med type
BPH Tx:
What are the common side effects of 5-alpha reductase inhibitors (5ARIs) used for BPH?
THis is a different Med Type!!
- Decreased Libido: Reduced sexual desire.
-
Ejaculatory Dysfunction: Difficulty or changes in ejaculation.
* Erectile Dysfunction: Trouble achieving or maintaining an erection. -
Teratogenic Risk:
-Pregnant women should AVOID handling tablets or exposure to semen from a patient taking 5ARIs, as it can cause birth defects in a male fetus. - Gynecomastia: Enlargement of male breast tissue due to hormonal changes.
What medications should BPH patients AVOID \ while taking 5-ALPHA Reductase Inhibitors (5ARIs)?
- Anticholinergics: Cant see, cant pee, cant spit, cant shit
- Antihistamines: May cause smooth muscle constriction in the prostate, worsening symptoms.
- Decongestants: Contain alpha-adrenergic agonists, which increase smooth muscle constriction in the prostate and bladder neck, leading to difficulty urinating.
What should patients know about complementary and alternative medicine (CAM) for BPH?
- Herbal supplements like saw palmetto and stinging nettle have NOT been proven to effectively treat BPH.
- Consult with HCP before taking herbal supplements due to potential drug interactions with prescribed BPH medications.
What is TURP?
TURP (Transurethral Resection of the Prostate)
* Surgical procedure commonly used to treat benign prostatic hyperplasia (BPH).
* Scope is inserted through the urethra, and prostate tissue that is blocking the urethra is removed to relieve urinary symptoms.
What is the post-operative care for a patient following TURP?
- Monitor for Complications: Infection, Urinary Incontinence, Hemorrhage, Bladder Spasms
-
Continuous Bladder Irrigation (CBI):
-A 3-way indwelling catheter with a 30-50ml balloon is used.
-Saline gravity drip is used to irrigate the bladder, irrigation stops clot formation.
-Drip is titrated to keep the urine light pink or colorless.
-D/C 24-48 hrs AFTER TURP
-Urine will be pink tinged for 2-3 days POST-op. -
Urine Output:
-Subtract irrigation from the total output when calculating urine volume.
Monitor Continuous Drainage: -
Keep an eye on continuous drainage into the Foley bag.
-Adjust the rate of irrigation if needed to ensure drainage is free of fibrin and clots.
-Goal: is to maintain light pink or clear urine. - Maintain Catheter Patency (open and unobstructed)
-
Manually & Gently Irrigate Catheter (If Necessary):
-Irrigate indwelling catheter with STERILE saline/ water.
-ALWAYS check orders before irrigating.
KNOW:
A client is receiving continuous bladder irrigation (CBI). He suddenly complains of severe retro-pubic pain (10 out of 10). As the nurse, you notice he has had no urinary drainage into his catheterand the bladder feels distended. What will you do (per protocol / orders)?
- Stop CBI - gently irrigate the catheter with 50mL of sterile saline /water.
- Withdraw 50mL of irrigant fluid from the catheterand assess the situation.
- Manage pain with ordered antispasmodics and/or PRN pain medication.
- Document the findings / result of the assessment and any interventions.
MATH PROBLEM:
The patient has had 6000 ml of normal saline irrigation intake via the 3-lumen catheter in the last 8 hours.
His total measured catheter output has been 7250 ml.
What is the total (“true”) urine output for the last 8 hours?
7250 ml – 6000 ml = 1250 ml of urine output
How to control pain due to bladder spasms Post-op TURP
-
Antispasmodics
oxybutynin (Ditropan)
dicyclomine ( Bentyl)
flavoxate (Urispas)
belladonna & opium (B&O) suppositories - Analgesics
- Teach Relaxation & Deep Breathing
What are discharge teaching points for a patient following TURP?
- Catheter and maintenance
- 2 to 3 L fluids per day (unless contraindicated)
- Alcohol, caffeine, spicy foods in moderation
- High fiber diet & stool softener (No straining)
- No strenuous activity; no prolonged sitting
- No driving or sexual activity until cleared by physician
- Teach about urinary dribbling
-
Complications that can occur post-discharge-notify HCP:
-Bleeding
-Urinary incontinence / No urine
-Infection
-Deep vein thrombosis
What is prostate cancer?
- A malignancy of the prostate gland.
- Most common cancer in AMERICAN men.
- slow growing – age > 65
- Increased risk if in family history
- “sporadic” type - ~75%
- “familial” type - ~ 20%
- “inherited” type – 5% - 10%
Growth & Risk factors for Prostate Cancer
- It is Slow-growing
- Risk increases with age (typically over 65 years old).
- Often confined to the prostate capsule, which can lead to a delayed diagnosis.
- Family history increases the risk of prostate cancer.
- Prostate cancer is hormone (androgen) dependent - *stimulates tissue to grow and so cancer cells grow as well. *
Slow growing and confined to capsule leads to DELAYED diagnosis
the prostate capsule is a fibrous layer that surrounds the prostate gland.
Review:
Main risk factors for Prostate cancer are:
- Increasing age
- familial predisposition
- African american (american men)
How do Dx Prostate Cancer
- Digital Rectal Exam (DRE) – start @ age 50; finger used
- Biopsy of prostate gland
- Prostatic Specific Antigen (goal: PSA < 4.0)- blood test measuring PSA levels
- Prostatic Acid Phosphatase (PAP)- blood test to detect elevated enzyme levels
- Gleason Score: score system to grade aggressivness of prostate cancer based on cancer cell patterns.
- Trans-rectal ultrasound
What are the steps for performing a Testicular Self-Exam (TSE)?
- Do exam at SAME time every month
- Visually inspect scrotum in front of a mirror
- Perform exam AFTER a bath or shower when scrotal sac is relaxed.
- Roll each testicle between the thumb and fingers, feeling for a lump, irregularities, or pain. Tissue should be smooth.
- The epididymis (sac behind each testicle) should not be confused with a lump.
- Assess for heaviness, dull ache in groin, or increase or decrease in size of either testicle.
- If a lump or irregularity is found, report to the doctor ASAP
What are the symptoms of TESTICULAR cancer?
-
Gradual Onset of Symptoms:
-A mass or lump on the testicle.
-Painless enlargement of the testis is often the first sign. - Heaviness in the scrotum, inguinal area, or lower abdomen.
- Lower back pain may be an early sign of metastasis, particularly from retroperitoneal node extension.
- Abdominal pain, weight loss, and general weakness can indicate metastasis.
What is the hallmark sign for Testicular cancer?
enlarged testis WITHOUT pain.
Where do testicular tumors commonly metastasize?
Tumors tend to metastasize early, spreading from the testis to:
- Lymph nodes in the retroperitoneum
- Lungs
What are the treatment options for testicular cancer?
- Surgery: Radical orchiectomy (removal of the affected testicle(s))
- Chemotherapy
- Radiation
- “Sperm bank” - cryostorage (freeze)
What is erectile dysfunction (ED)?
the inability to attain or maintain an erection (hard) sufficient for sexual intercourse.
What are common causes of Erectyle Dysfunction (ED)?
- Medications (e.g., anti-hypertensives)
- Substance abuse (recreational drugs or alcohol)
- Thyroid or hormonal dysfunction
- Previous prostatectomy (surgery for prostate cancer)
- Aging
- Vascular disease, such as type 2 diabetes
- Psychological problems (e.g., stress, depression)
ED Rx:
What are phosphodiesterase type 5 inhibitor (PDE5 Inhibitors) medications
- medications used to treat erectile dysfunction (ED
- They relax arterial smooth muscle and increase blood flow to the penis, which helps in attaining and maintaining an erection.
Common medications Phosphodiesterase type 5 Inhibitor (PDE5 Inhibitors) meds used for ED
List 4
- Sildenafil (Viagra)
- Vardenafil (Levitra)
- Tadalafil (Cialis)
- Avanafil (Stendra)
Side Effects of Phosphodiesterase type 5 Inhibitors (PDE5 Inhibitors)
List 6
- Priapism: painful/prolonged erection lasting >4 hrs.
- Headache
- Flushing
- Dizziness / lightheadedness
- Nasal congestion
- Dyspepsia: indigestion/stomach discomfort
ABSOLUTE contraindications with PDE5’s
List the No. 1!
Do NOT take with NITRATES
* causes severe hypotension!!
List 4 RELATIVE contraindications for PDE5 Inhibitors
- Complex antihypertensive or cardiovascular medications.
- Alpha-blockers (risk of low blood pressure).
- Anti-dysrhythmic medications (e.g., amiodarone, sotalol).
-
Cytochrome P450 inhibitors (can increase drug levels):
-Cimetidine
-Erythromycin
-Grapefruit juice
In which medical conditions should PDE5 inhibitors be used with caution?
- Active coronary ischemia (risk of worsening heart conditions).
- Congestive heart failure (CHF).
- Hypotension (can further lower blood pressure).
- Renal disease (drug clearance may be affected).
- Diabetic retinopathy (may worsen vision complications).
What is epididymitis?
Infection/inflammation of the epididymis.
What causes Epididymitis?
- Sexually transmitted infections (STIs)
- Trauma
- Prostatitis
- Urinary tract infections (UTIs)
What are the symptoms of Epididymitis
- Pain along the spermatic cord & inguinal canal (usually unilateral).
- Fever & chills
- UTI symptoms
How is epididymitis treated?
- No lifting, straining, or sexual activity.
- Avoid urethral instrumentation (e.g., catheter insertion).
- Bed rest for 24-48 hours.
- Scrotal elevation to reduce swelling 24-48 hrs.
- Monitor for scrotal abscess formation.
Medication Tx for Epididymitis
- Antibiotics (treat underlying infection).
- Treat STDs if present (partner may need treatment also).
Where does penile (penis) cancer typically originate?
Almost all penile cancers start in the skin cells of the penis.
Why is the cell type in Penile (penis) cancer important?
- The types determine cancer severity and treatment approach.
What is Bowen Disease?
- AKA: Carcinoma in Situ (CIS) -
- Earliest stage of squamous cell carcinoma of the penis.
- Cancer cells are only in the top layers of skin- Has NOT invaded deeper tissues.
- When CIS occurs on the penile shaft, it is called Bowen Disease.
in situ: “in its original place”, “lovalized”
What is priapism?
- A prolonged, unwanted erection, usually NOT related to sexual arousal.
- May occur spontaneously or from certain drugs:
-antidepressants
-erectile dysfunction drugs
What are the symptoms of Priapism?
- Erection lasting > 4 hours or occurring off and on for several hours
- Pain/tenderness due to ischemia (lack of blood flow)
Is ischemic Priapism a Medical Emergency?
YES!!!!
Why is ischemic priapism a medical emergency?
- Permanent vascular and tissue damage will result
- Can lead to scarring & permanent erectile dysfunction (impotence)
Prompt treatment is needed to preserve erectile function
2 Treatment options for Priapism
- Draining blood from the penis (aspiration)
- Medication to restrict blood flow to the penis.
High-Risk Individuals of Priapism:
Sickle cell anemia patients
What is Urethral Stricture?
- Narrowing of the urethra (the tube that carries urine from the bladder out of the body)
- Causes urinary retention.
Is Urinary retention a medical Emergency?
YES!!!!
Urinary retention can lead to hydronephrosis (swelling of the kidneys) and potentially renal failure.
Complications from Urethral Stricture
List 4
- Urinary retention
- hydronephrosis -> kidney failure
- Prostatitis (inflammation of the prostate)
- Urinary tract infections (UTIs)- antibiotics
5 Other Reproductive Disorders
- Testicular Torsion
- Cryptorchidism
- Hydrocele
- Varicocele
- Spermatocele
What is Testicular Torsion?
the twisting of the spermatic cord, cutting off blood flow to the testicle.
When does Testicular Torsion occurs?
- Mostly during puberty
- Sudden onset of acute pain and testicular swelling.
Is testicular torsion an emergency?
It is a SURGICAL EMERGENCY!!!
(requires timely surgery to restore blood flow and prevent damage)
What am I?
Failure of one or both testes to descend into the scrotal sac.
Cryptorchidism
How is Cryptochordism treated?
- Often resolves on its own.
- If not resolved, treatment is an orchiopexy (surgical procedure to move the testes into the scrotum).
-Typically performed by age 2 to avoid infertility risks.
Males with Cryptochidism are at a higher risk for:
testicular cancer in later life.
What am I:
fluid filled mass in the scrotum / “transillumination”
Hydrocele
What am I:
a cluster of dilated veins in the scrotum
Varicocele
What is Spermatocele?
a cyst in the epididymis
What is a vasectomy?
- Its a male sterilization procedure.
- It involves the surgical interruption of both vas deferens (the tubes that carry sperm from the testicles and epididymis to the seminal vesicles)
- Prevents sperm mixing with semen, ensuring fertilization of an egg does NOT occur AFTER ejaculation.
What is VASOvasectomy?
- surgical reversal of a vasectomy.
- reconnect or restore the patency of the vas deferens, allowing sperm to once again mix with the semen and be ejaculated
Outcomes of a VASOVasectomy
- Many men have sperm in their ejaculate after the reversal.
- 50% to 70% of men can impregnate a partner AFTER the procedure.
- Success depends on:
-vasectomy method performed
-the amount of time since the vasectomy
Considerations for VASOVasectomy
- The procedure is costly and not covered by insurance.
- Not permanent—vas deferens may become occluded 2+ years AFTER the reversal (vasovasectomy).
- Results in lower sperm counts than before the vasectomy.
What is Phimosis?
Inability to RETRACT the foreskin due to secondary lesions on the prepuce (foreskin).
What is Paraphimosis?
Ulcer with edema in foreskin remaining contracted over the prepuce (foreskin)
Is Paraphimosis an Emergency?
YES!- It is a urologic emergency!!!
