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8.presentation on male reproductive system [autosaved]

  2. 2. INTRODUCTION Disorders of the male reproductive system include a wide variety of conditions that usually affect both urinary and reproductive systems. These disorder affect sexuality,the patient may experience anxiety and embarrassment
  5. 5. BENIGN PROSTATIC HYPERPLASIA  Non-malignant histologic growth of the glandular elements of the prostate. BPH typically - men older than 40 years  50% of men – By the age of 60  90% of men - By 85 years of age.  BPH - Second most common cause of surgical intervention in men older than 60 years of age.
  6. 6. definition
  7. 7. Obstruction of urethral oulet.  lower urinary tract symptoms (LUTS)  UTI Haematuria compromised upper urinary tract function.
  8. 8. ETIOLOGY AND RISK FACTOR Prostate enlargement is nearly universal but arrested following bilateral orchiectomy.  Imbalance between the 5a-reductase and DHT levels enzyme may be comprom.ised, contributing to prostatic enlargement.  Defect in local substances that regulate the programmed cellular death (apoptosis) common to many tissues within the body.  Imbalances of local growth factors local inflammation genetic factors
  9. 9.  Dietary factor  Smoking  Heavy alcohol consumption  Obesity Frequent use of alpha-adrenergic agonists Reduced activity level  Hypertension  Heart diseases Diabetes
  10. 10. pathophysiology
  11. 11. CLINICAL MANIFESTATION • Frequent or urgent need to urinate • Increased frequency of urination at night (nocturia) • Difficulty starting urination • Weak urine stream or a stream that stops and starts • Dribbling at the end of urination • Inability to completely empty the bladder
  12. 12. ASSESSMENT AND DIAGNOSTIC FINDINGS TEST NAME  Digital rectal examination  Urinalysis  Prostate specific antigen levels FINDINGS • Reveals a large, rubbery, and nontender prostate gland. • To screen for hematuria and UTI • The test measures the amount of prostate-specific antigen (PSA) in blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men
  13. 13. Urinalysis Urine culture Urine cytology  BUN/Cr Uroflowmetry  IVP with post voiding film Cystometrogram  Cystourethroscopy Transrectal prostatic ultrasound
  15. 15. RELAX PROSTATE MUSCLE/SLOW PROSTATE GROWTH 1. ALPHA-ADRENERGIC BLOCKERS a) Relax the smooth muscle b) 5alpha reductase inhibitors 2. ANTIANDROGEN AGENTS a) Decreases the size of the prostate b) Prevents the conversion of testosterone to dihydrotestosterone
  16. 16. RELIVE RETENTION Acute urinary retention is initially managed by an indwelling catheter. It is usually left in place for 2 to 4 weeks to allow the bladder to recover from injury caused by the acute overdistention of the bladder wall associated with acute retention. Alternatively, the client may be taught to perform clean intermittent catheterization, particularly if long-term retention occurs . men a who are not candidates for surgery or intermittent catheterization may require long-term indwelling catheterization.
  17. 17. Minimally invasive surgery
  18. 18. Transurethral Microwave Thermotherapy
  19. 19. Transurethral Needle Ablation
  20. 20. Laser Prostatectomy
  21. 21. Photo vaporization
  22. 22. Interstitial laser coagulation(ILC)
  24. 24. INVASIVE THERAPY Transurethral Resection of the Prostate Transurethral Incision of the Prostate Suprapubic Prostatectomy Retropubic prostatectomy Perineal prostatectomy
  25. 25. Transurethral Resection of the Prostate
  27. 27. Preoperative Management  Information about the procedure and the expected postoperative care Complications of surgery are discussed Bowel preparation Optimal cardiac, respiratory, and circulatory status Prophylactic antibiotics are ordered
  28. 28. Postoperative Management Urinary drainage is maintained and observed for signs of haemorrhage. Wound care.  Pain management Early ambulation  surveillance is maintained for complications.
  29. 29. nursing diagnosis and intervention 1. Impaired Urinary Elimination related to surgical procedure and urinary catheter. 2. Risk for Infection related to surgical incision, immobility, and urinary catheter. 3. Acute Pain related to surgical procedure. 4. Anxiety related to urinary incontinence, difficulty voiding, and erectile dysfunction
  30. 30. Patient Education and Health Maintenance • Reinforce instructions provided on catheter care, maintaining patency, and catheter irrigation. • A cystogram may be performed to confirm healing of anastomosis prior to removing catheter • Advise that stress incontinence may occur after catheter is removed and is more pronounced when abdominal pressure is increased • Teach measures to regain urinary control. • .Reinforce availability of options such as medications for urinary urgency and oral medicine such as sildenafil, vacuum erectile device, penile injections, and penile prosthesis to restore sexual function. • Encourage prostate cancer patients to have a PSA blood test 3 months after surgery and yearly thereafter.
  32. 32. ETIOLOGY AND RISK FACTOR Family history Hereditary association Racial Factors Environmental Factors Diet
  34. 34. Clinical manifestation
  35. 35. DIAGNOSTIC EVALUATION Prostate-specific antigen blood test Digital rectal examination  Biopsy MRI and CT scan Prostascint scan Overexpression of the AMACR gene was found in 90% of prostate cancer patients
  36. 36. MEDICAL MANAGEMENT DECREASE TUMOR GROWTH  Radiation therapy • Teletherapy (external) and brachytherapy (internal) Hormonal deprivation/chemotherapy • Hormonal deprivation therapy is designed to block androgen (testosterone) production
  37. 37. Surgical management Radical prostactomy Laparoscopic radical prostatectomy with robotic assistance Cryosurgical ablation
  38. 38. NURSING MANAGEMENT OF CLIENT WITH PROSTATE CANCER Nursing Assessment • History • palpate lymph nodes • Assess comorbidities, nutritional status, and coping before treatment. Nursing Diagnosis • Anxiety related to fear of disease progression and treatment options. • Sexual Dysfunction related to effects of therapy. • Chronic Pain related to bone metastasis
  39. 39. PROSTATITIS Prostatitis is an inflammation of the prostate gland. It is classified as bacterial prostatitis (acute or chronic) or chronic pelvic pain syndrome (without presence of bacterial invasion).
  40. 40. Pathophysiology and etiology  From reflux of infected urine into ejaculatory and prostatic ducts.  From hematogenous (bloodstream) origin, lymphogenous spread, or direct extension from the rectum.  Secondary to urethritis—from ascent of bacteria from urethra.
  41. 41.  May be stimulated by urethral instrumentation or rectal examination of the prostate when bacteria are present.  May be caused by gram-negative enteric bacteria, such as pseudomonas aeruginosa, e. Coli, and klebsiella pneumonia, and gram-positive cocci, such as streptococcus and staphylococcus; may also be caused by chlamydia trachomatis. Chronic pelvic pain syndrome pain or discomfort without other signs of infection and no known etiologic cause; difficult to diagnose and manage.
  42. 42. Diagnostic Evaluation 1. Urinalysis. 2. Urine culture and sensitivity tests. a. Prostate massage is inadvisable because it can precipitate frank sepsis or bacteraemia. b. In acute bacterial prostatitis, there are numerous WBCs and a positive culture; in chronic bacterial prostatitis, there is a lower bacterial colony count; in chronic pelvic pain syndrome, there may be WBCs but a negative culture. 3. Rectal examination commonly reveals exquisitely tender, painful, swollen (boggy) prostate that is warm to the touch (with acute bacterial prostatitis). 4. Serum WBC count is elevated in acute bacterial prostatitis. 5. Bladder scan for post void residual evaluates bladder emptying. 6. Transrectal ultrasound detects prostate abscess.
  43. 43. MANAGEMENT
  44. 44. Acute Bacterial Prostatitis 1. Antimicrobial therapy generally for 2 to 4 weeks based on drug sensitivity; commonly a fluoroquinolone or sulfatrimethoprim. 2. IV therapy with ampicillin or an aminoglycoside in the hospitalized patient. Patients are hospitalized if there is suspected abscess, urosepsis, or immunocompromise. 3. Urinary retention is managed with suprapubic cystostomy; urethral catheterization usually is avoided. 4. Antipyretics, analgesics, hydration, stool softeners, and sitz baths for symptom relief.
  45. 45. Chronic Bacterial Prostatitis 1. Usually 4 to 6 weeks of oral antibiotic therapy with ability to diffuse into prostate. a. Quinolones such as ciprofloxacin, levofloxacin, ofloxacin, or norfloxacin. b. Sulfonamide such as sulfamethoxazole trimethoprim 2. Oral antispasmodic agents may provide relief from urinary frequency and urgency. 3. Alpha-adrenergic blockers may help with urination.
  46. 46. Chronic Pelvic Pain Syndrome 1. Usually requires multiple modalities. 2. Alpha-adrenergic blockers and skeletal muscle relaxants may provide some relief of symptoms 3. Aggressive diagnostic intervention should take place to rule out other conditions, such as cancer of the prostate or interstitial cystitis. 4. Anti-inflammatory medications such as NSAIDS are helpful. 5. Tricyclic antidepressants may be helpful for pain control. 6. Pentosan may be helpful to relieve discomfort. 7. Quinoline antibiotics may be taken for 4 to 6 weeks. 8. Pelvic floor massage and biofeedback may help relieve perineal muscle spasms.
  48. 48. TESTICULAR CANCER • Testicular cancer is a disease that occurs in younger men between age 15 and 35. It is relatively • uncommon, affecting 9 of 100,000 men annually. It is the most treatable form of urologic cancer.
  51. 51. pathophysiology
  53. 53. Diagnostic evaluation
  54. 54. principles of treatment
  56. 56. spermatic cord twists, cutting off the blood supply suddenly with acute scrotal swelling and severe pain as blood supply to the testicles is interrupted. a testicular scan and Doppler ultrasonography are performed to assess the blood supply Testicular torsion is an emergency requiring immediate surgical intervention
  57. 57. ORCHITIS Acute testicular inflammation Usually caused by a viral infection Mumps orchitis, which occurs in about 30% of men who develop mumps after puberty Assessment reveals edematous and extremely tender testicles, reddened scrotal skin, fever, and prostration Treatment includes bed rest, scrotal support, local heat to the scrotum, and medications for pain reduction, fever, and infection Permanent sterility may occur if both testicles twisted spermatic cord and vessels are affected “whereas decreased fertility may result if only one is affected.
  59. 59. • Infections in the urethra, prostate, or bladder can spread along the vas deferens; infections also spread through the lymphatic and vascular systems. • Epididymitis can occur as a complication related to urethral instrumentation. • Sexually transmitted organisms frequently cause the condition in younger men,urinary pathogens cause epididymitis in older men. • Epididymitis is almost always unilateral.
  60. 60. hydrocele  Hydrocele is a painless collection of clear, yellow fluid in the scrotum caused by an opening between the peritoneum and the tunica vaginalis or by an imbalance in production and reabsorption of fluid within the tunica vaginalis.  If the hydrocele is due to a communication with the peritoneum, it decreases in size when the man lies down. If constant discomfort, embarrassment, or impaired circulation occurs, aspiration or surgical drainage may be performed. Hydroceles can conceal a testicular tumor or inguinal hernia.
  61. 61. HEMATOCELE  A hematocele is a collection of blood in the tunica vaginalis caused by trauma. Hematoceles are less likely than hydroceles to be transilluminated on light examination. They require only drainage.
  62. 62. spermatocele  A spermatocele is a cystic dilation of part of the epididymis that contains a milky fluid and dead spermatozoa. It is typically painless, and surgery is usually not required.
  63. 63. VARICOCELE •Varicocele is a dilation and varicosity of the pampiniform plexus (the network of veins supplying the testicles) within the scrotum. •On palpation, with the man standing, a varicocele feels like a mass of tortuous veins above and posterior to the testicle. When the man lies down, the mass abates. Treatment includes the use of a scrotal support. Surgery is performed if there is severe pain or if the varicocele is thought to contribute to infertility.
  64. 64. VASECTOMY (ELECTIVE STERILIZATION) • The procedure, performed through a small incision in the scrotum, involves cutting out a segment of the vas deferens, ligating the ends, and tucking them into different tissue planes to prevent reanastomosis .
  65. 65. UNDESCENDED OR MALPOSITIONED TESTICLES • When one or both testicles may be arrested in the abdomen, inguinal canal (canalicular), low pelvis, or high scrotum. An ectopic testicle descends to the wrong area outside the normal path of descent. • A retractile testicle descends into the scrotum but pulls back into the inguinal canal because of a hyperactive cremasteric reflex. Complete absence of a testicle may also occur. • Cryptorchidism is associated with infertility. High body temperature, endocrine under stimulation, and an abnormal epididymis that seems to accompany an undescended testicle cause changes that prevent normal fertility in the future.
  66. 66. Male infertility
  67. 67. •Infertility is the inability of a sexually active non- contraceptive couple to achieve pregnancy in one year (WHO).
  68. 68. Etiology and risk factor
  71. 71. Medical management
  72. 72. Pretesticular causes  No treatment is available for primary testicular failure or hypogonadism. Testosterone may be prescribed to correct low testosterone levels. Testosterone is contraindicated for men with prostate cancer or severe bladder outlet obstruction.  Hyperprolactinemia may be treated by surgical removal of a pituitary tumor or by administration of bromocriptine (Parlodel).  If the patient is having Erectile Dysfunction so we can advise him about penile prosthesis.  For oligospermia caused by excessive frequency of ejaculation, recommend that the couple have intercourse only once every 36 hours during the woman's periovulatory period because it takes 24 hours for a normal sperm count to be generated after ejaculation.
  73. 73. TESTICULAR CAUSES  Instruct the client to avoid factors that depress spermatogenesis such as heat, drugs, alcohol, and marijuana.  Keep the testicles cool by avoiding hot baths and tight clothing or by using a commercially prepared, water-dampened scrotal-cooling device; keeping the testes cool appears to improve the sperm count.  Advise the client to maintain good nutrition.  Medications such as hcg or testosterone (depo-testosterone) are sometimes prescribed as hormonal treatments. Nonhormonal therapy may consist of kallikrein, steroids, indomethacin, arginine, zinc, or vitamins.  Varicocele is treated surgically.
  74. 74. POST-TESTICULAR CAUSES •Treatment of male infertility with post-testicular causes involves correcting ejaculatory abnormalities and obstruction. •Obstructive infertility is treated by surgery.
  77. 77. PHIMOSIS •Phimosis occurs when the penile foreskin (prepuce) is constricted at the opening, making retraction difficult or impossible. The condition can be congenital result of inflammation, infection, or local trauma. It is not usually painful, but it can lead to obstructive uropathy if it is severe enough.
  78. 78. • Assessment reveals edema, erythema, tenderness, and purulent discharge. • Intervention includes controlling infection with local treatment and broad-spectrum antimicrobial drugs. •Effective genital hygiene is essential to prevent acquired penile disorders. •Routine circumcision (surgical removal of the foreskin) of male infants has not been considered medically necessary by the american academy of paediatrics •. The rate of penile cancer is almost nil in circumcised men. The procedure should be done with the client under general anaesthesia. Potential risks include excessive bleeding, infection, and penile trauma.
  79. 79. PARAPHIMOSIS • Paraphimosis occurs when a tight foreskin, once retracted, cannot be returned to its normal position. This sometimes happens after rigorous cleaning, masturbation, sexual intercourse, catheter insertion, or cystoscopy if the foreskin is not returned to its normal position. • Surgical incision of the foreskin with local anaesthesia may be necessary if the condition does not resolve.
  80. 80. POSTHITIS AND BALANITIS •Posthitis (foreskin inflammation) and balanitis (inflammation of the glans penis and the mucous membrane beneath it) are caused by irritation and invasion of microorganisms. Good hygiene and thorough drying of the penis are recommended. It is important to assess for diabetes mellitus, which predisposes the client to secondary infection. Antibiotics may help control local infection. Circumcision may be necessary.
  81. 81. PEYRONIE'S DISEASE  Fibrous plaques develop in the connective tissue in Peyronie's disease, usually near the dorsal midline of the penile shaft in middle-age and older men.
  82. 82.  Diagnosis may be made during history-taking, although men usually seek a physician because of concern about penile lumps (fear of cancer), painful erection, or ED. The man may have penile curvature on erection, painful erection, and unsatisfactory vaginalpenetration.  Medical treatment includes vitamin e,para-aminobenzoic acid, tamoxifen, and colchicine.Intralesional injections, local radiation, and ultrasonography have also been used. Surgical correction is necessary when previous treatments have failed and the client is unable to perform sexually.
  83. 83. PRIAPISM  Priapism is a prolonged, persistent penile erection without sexual desire. It can last hours or even days and may be very painful.  CAUSES  The condition is sometimes associated with leukaemia or sickle cell anaemia.  Self-injection of medications (mainly papaverine) to treat impotence is the other common cause. It may also result from some medications, such as anticoagulants, alcohol, phenothiazine, alpha-adrenergic blockers, and marijuana.  TYPES  High-flow arterial priapism  Low-flow veno-occlusive priapism
  84. 84. PENILE CANCER  Penile cancer is rare. In 2019 About 2,200 new cases of penile cancer diagnosed; About 440 deaths from penile cancer. •Human Papillomavirus (HPV) increases the risk of penile cancer. • Associated genital cancer sometimes develops in sexual partners (e.g., cervical cancer in females). •Any dry, wart-like, painless growth on the penis or foreskin that fails to respond to antibiotics should be assessed for cancer.
  85. 85. ERECTILE DYSFUNCTION • ED is defined as an inability to achieve or maintain an erection sufficient for sexual activity.
  86. 86. PATHOPHYSIOLOGY  A normal erection comprises two phases. When the penis is flaccid, local arterioles provide enough blood flow to meet nutritional needs of penile tissues but not enough for rigidity.  A variety of sensory and psychological stimuli may trigger the release of neurotransmitters and paracrines from local nerve receptors and blood vessels, producing an erection.  Following a period of rigidity, the penis returns to a flaccid state.This requires increased tone in the smooth muscle of the arterioles and sinusoids of the cavernous bodies and reversal of venous compression.
  87. 87.  Although the endocrine system influences erectile function via effects on the development of secondary sex characteristics and libido, individual erections are controlled by neurovascular mechanisms. Interruption of any one of these physiologic events as a result of a physiologic disorder or psychological dysfunction leads to erectile failure and may cause ED unless it is corrected.
  89. 89. NURSING MANAGEMENT •Men with illnesses and disabilities may need the assistance of a sex therapist to identify, implement, and integrate their sexual beliefs and behaviours into a healthy and satisfying lifestyle. The nurse can inform patients about support groups for men with erectile dysfunction and their partners.
  90. 90. CONCLUSION • Male genital and reproductive disorders can be complex problems for both the client and the nurse. The client often finds that these disorders threaten sexuality and sexual function or normal urinary elimination. These effects may be physiologic, but complex psychosocial problems also arise. Prostate disorders are among the most common problems experienced by men throughout their lifetime. Cancers of the male reproductive tract can be life-threat-ening, but if they are detected early, they can be cured or at least controlled for long periods. Problems such as ED and infertility directly affect both partners, who experience the diagnostic and treatment phases together. The nurse acts as a caregiver, educator, support and resource person.