1. The document discusses various male reproductive disorders including prostate disorders like benign prostatic hyperplasia and prostate cancer. It describes the anatomy, risk factors, clinical presentation, diagnostic evaluation and treatment options for these disorders. 2. Prostatitis is also covered, including the types, causes, symptoms, tests used for diagnosis and treatment approaches for bacterial versus chronic pelvic pain syndrome. 3. Other topics include testicular disorders like cancer and torsion, as well as scrotal conditions, infertility and disorders affecting the male reproductive system. Surgical and minimally invasive procedures are described for treatment of many of these conditions.

1. MANAGEMENT OF
PATIENT
WITH
MALE REPRODUCTIVE
DISORDER

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

3. ANATOMY AND PHYSIOLOGY
OF MALE REPRODUCTIVE
SYSTEM

6. PROSTATE DISORDER

7. 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.

8. definition

9. Obstruction of
urethral oulet.
 lower urinary
tract symptoms
(LUTS)
 UTI
Haematuria
compromised
upper urinary
tract function.

10. 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

11.  Dietary factor
 Smoking
 Heavy alcohol consumption
 Obesity
Frequent use of alpha-adrenergic agonists
Reduced activity level
 Hypertension
 Heart diseases
Diabetes

12. pathophysiology

14. 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

16. 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

17. Urinalysis
Urine culture
Urine cytology
 BUN/Cr
Uroflowmetry
 IVP with post voiding film
Cystometrogram
 Cystourethroscopy
Transrectal prostatic ultrasound

19. MEDICAL MANAGEMENT

20. 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

21. 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.

23. Minimally invasive surgery

24. Transurethral Microwave Thermotherapy

25. Transurethral Needle Ablation

26. Laser Prostatectomy

27. Photo vaporization

28. Interstitial laser coagulation(ILC)

29. INTRA PROSTATICURETHRAL STENTS

30. INVASIVE THERAPY
Transurethral Resection of the Prostate
Transurethral Incision of the Prostate
Suprapubic Prostatectomy
Retropubic prostatectomy
Perineal prostatectomy

31. Transurethral Resection of the Prostate

32. NURSING
MANAGEMENT

33. 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

34. Postoperative Management
Urinary drainage is maintained and observed for
signs of haemorrhage.
Wound care.
 Pain management
Early ambulation
 surveillance is maintained for complications.

35. 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

36. 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.

37. PROSTATE
CANCER

38. ETIOLOGY AND RISK FACTOR
Family history
Hereditary association
Racial Factors
Environmental Factors
Diet

39. PATHOPHYSIOLOGY

40. Clinical manifestation

41. 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

43. 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

44. Surgical management
Radical prostactomy
Laparoscopic radical
prostatectomy with robotic
assistance
Cryosurgical ablation

45. 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

46. 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).

47. 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.

48.  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.

50. 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.

51. MANAGEMENT

52. 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.

53. 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.

54. 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.

55. TESTICULAR
AND
SCROTAL DISORDERS

56. 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.

57. ETIOLOGY AND RISK FACTOR

58. CLASSIFICATION OF TESTICULAR TUMORS

59. pathophysiology

60. CLINICAL MANIFESTATIONS

62. Diagnostic evaluation

63. principles of treatment

64. TESTICULAR TORSION

65. 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

66. 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.

67. EPIDIDYMITIS

68. • 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.

69. 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.

70. 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.

71. 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.

72. 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.

73. 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 .

74. 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.

75. Male infertility

76. •Infertility is the inability of a sexually active non-
contraceptive couple to achieve pregnancy in one year
(WHO).

77. Etiology and risk factor

78. PATHOPHYSIOLOGY

79. ASSESSMENT ANDDIAGNOSTIC EVALUATION

80. Medical management

81. 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.

82. 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.

83. POST-TESTICULAR CAUSES
•Treatment of male infertility with post-testicular
causes involves correcting ejaculatory abnormalities
and obstruction.
•Obstructive infertility is treated by surgery.

84. NURSING MANAGEMENT
•PROVIDE SUPPORT
•PROVIDE EDUCATION
•PREVENT INFERTILITY

85. PENILE DISORDERS

86. 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.

87. • 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.

88. 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.

89. 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.

90. 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.

91.  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.

92. 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

93. 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.

95. ERECTILE DYSFUNCTION
• ED is defined as an inability to achieve or maintain an erection
sufficient for sexual activity.

96. 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.

97.  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.

99. MEDICAL SURGICAL MANAGEMENT

101. 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.

102. 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.