The Male Reproductive System
• Infections of the male GU tract
• STD’s
• Most common in young, sexually active men
• STD’S include:
– Urethritis – gonococcus & nongonococcal
– Genital ulcers – genital herpes, primary syphilis, chancroid, granulomainguinale
– Genital warts
– Scabies
– Pediculosis pubis
– Hepatitis
– Aids
• Treatment of STD’s must be targeted toward client as well as partner(s) & sometimes
an unborn child
• Must assess sexual history
• Identify partners at risk
• Partners of men with STD’s must be: examined & treated, as well as counseled
to prevent reinfection and complications and spread of STD
The Male Reproductive System
• Sexual abstinence during treatment & recovery is advised.
• Use condoms and spermicides with nonoxynol 9 for at least 6 months after
completion of TX to decrease transmission of human papilloma-virus (HPV) & HIV.
• Patients with 1 STD may have another. Its important to examine for other STD’s.
The Male Reproductive System
• Prostate problems
• Prostatitis – inflammation of the prostate gland caused by infection (bacteria, fungi,
mycoplasa) or other problems (urethral stricture or prostate hyperplasia)
• Symptoms – perineal discomfort, Burning, Urgency, Frequency and Pain with or
after ejaculation
The Male Reproductive System
• Acute bacterial prostatitis may present symptoms of:
• Fever & chills; Perineal, rectal or low back pain; Dysuria; Frequency; Urgency;
Nocturia ; Some patients have no symptoms
• Chronic bacterial prostatitis is a major cause of relapsing urinary tract infection in
men. Symptoms are mild:
– Frequency.
– Dysuria.
– Urethral discharge.
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The Male Reproductive System
Complications of prostatitis
– Swelling of the prostate gland
– Urinary retention
– Epididymitis
– Bacteremia
– Pyelonephritis
Assessment for prostatitis
History
Culture of prostate fluid or tissue
Histological exam
Segmental urine culture – after cleaning, pt voids 10-15 ml into sterile container
(urethral urine) than continues to void 50 – 70ml into 2nd container (bladder urine)
Prostatic massage done to obtain prostatic fluid for 3rd container
The Male Reproductive System
Prostatitis – medical treatment
Avoid abscess formation and septicemia
Broad spectrum antibiotic give for 10 – 14 days
May need IV antibiotics
Bed rest; Sitz baths
Analgesics; Antispasmodics and bladder sedatives
Stool softeners
The Male Reproductive System
Chronic prostatitis.
Difficult to TX as most antibiotics diffuse poorly into the prostatic fluid.
May need continuous low dose antibiotic therapy.
UTI may recur.
Teach patient about s/sx of UTI.
Sitz baths.
Stool softener.
Evaluation of sexual partner to reduce cross-infection.
Fluids are to treat thirst but are not “forced” to maintain effective medication level in
the urine.
Avoid food & fluids that have diuretic effect or increase prostatic secretions such as
alcohol, coffee, chocolate, cola & spices.
Avoid sitting for long periods.
Medical follow-up needed for 6 months to 1 yr because prostatitis can recur.
The Male Reproductive System
• BPH - Benign prostatic Hyperplasia (enlarged prostate).
• Prostate glands can enlarge especially after age 50. It pushes into bladder obstructing
outflow of urine.
• It is the 2nd most common surgical intervention in men older that 60 yrs.
• Assessment for benign prostatic hyperplasia
– Large, rubbery non-tender prostate
– Increased frequency
– Nocturia, Urgency
– Hesitancy in starting urination
– Abdominal straining with urination
– Decrease in volume & force of urinary stream
– Dribbling
– Recurrent UTI’s
• Renal failure can eventually occur with urinary retention from BPH
• Pt may also experience: Fatigue; Anorexia; N/V; Epigastric discomfort
• DRE & other studies are done to assess degree of enlargement
• Urinalysis
• Renal function
The Male Reproductive System
Medical management of BPH:
• TX depends on cause, severity and condition of patient
• May need catheterization with stylet by urologist
• Alpha1-adrenergic receptor blockers – relax smooth muscle of bladder neck &
prostate.
• Antiandrogen agents (Proscar) – prevents the conversion of testosterone to
dihydrotesterone. Glandular activity is suppressed and prostate decreases in size.
– Side effects include gynecomastia, erectile dysfunction & flushing.
• Resection of prostate with lasers.
• Transuretheral needle ablation using low frequency radio waves produces heat which
destroys prostate tissue while sparing urethra, nerves, muscle & membranes.
• Microwave thermo therapy applies heat to prostatic tissue. Water cooling system
helps minimize damage to urethra.
The Male Reproductive System
• Cancer of the prostate.
• Second most common cancer in men.
• Second cause of cancer deaths in American men.
• 1 in 5 men in US will develop cancer of prostate.
Cancer of the Prostate (cont’)
• Manifestations few symptoms in early stages.
• Urinary obstruction in later stage is a common complaint.
– Difficulty and frequency of urination.
– Urinary retention.
– Decreased size and force of urinary stream.
• Metastasizes to bone and lymph nodes with symptoms of
– Backache; Hip pain; Perineal & rectal discomfort
– Anemia; Weight loss; Weakness; N/V; oliguria
Assessment: Cancer of the Prostate
• If detected early cure rate is high.
• Every man over age 40 should have a DRE yearly.
• DX confirmed by histologic exam of prostatic tissue.
• PSA level is proportional to total prostatic mass. Also used to monitor response to
TX.
• Transrectal ultrasound used if elevated PSA and abnormal DRE.
• Bone scans x-rays.
• Sexual complications.
• Commonly experience sexual dysfunction before diagnosis made.
• Treatments also interfere with sexual function.
Medical management.
• Based on stage of disease and pt’s age & symptoms.
• Staging pg 1308 B&S.
Surgical management.
• Radical prostatectomy (removal of prostate & seminal vesicles) is the standard TX for
prostatic cancer thought to be curable.
• This results in sexual impotence & sometimes urinary incontinence.
Radiation therapy.
• May be curative.
– Teletherapy: 5days/wk for 6 – 7 weeks.
– Interstitial seed implantation – 80 – 100 seeds placed with ultrasound.
• Pt goes home.
• Instructed to avoid close contact with pregnant women and infants.
• Use condom for 2 weeks after implantation during intercourse.
• Side effects of radiation therapy include inflammation of rectum, bowel, & bladder.
Cancer of the Prostate
• Hormonal therapy
– Orchiectomy (removal of testes)
– Medications
Cancer of the Prostate
• Orchiectomy – lowers plasma levels of testosterone since 93% originates in testes.
• This results in prostate atrophy.
• Does not have usual side effects of hormone therapy but does have significant
emotional impact.
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Estrogen therapy.
Diethylstilbestrol (DES) inhibits gonadotropins interfering with androgenic activity.
Relieves symptoms of advanced cancer.
Reduces size of tumor.
Many side effects including decreased libido, decreased sperm production &
gynecomastia.
Newer hormonal therapies coming into use.
Cryotherapy used to ablate prostate cancer in patients not able to tolerate surgery or
have recurrence of cancer.
Chemotherapy also used.
Cancer of the Prostate
The Goal is to keep the urethra opening patent by resection or suprapubic catheter.
Should be performed before damage occurs to the urinary tractor cancer progresses.
TURP.
Suprapubic prostatectomy.
Cancer of the Prostate
TURP – most common approach
Uses endoscopy
Overnight hospital stay
Strictures more frequent
Infrequent erectile dysfunction
May cause retrograde ejaculation
The Prostate
Complications of prostatectomy: Hemorrhage; Clot formation
Catheter obstruction and Sexual dysfunction - Sexual activity can be resumed in 6 – 8
weeks.
Prostatectomy
A vasectomy may be done to prevent infection from spreading from prostatic urethra
thru the vas into epididymis.
Nursing care for Prostatectomy
Pain control; Irrigation of bladder with 50 cc NS - Be sure return is what is put into
the catheter.
B & O suppositories.
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• Ambulate; Don’t sit for long periods.