Interventions for Male Clients
with Reproductive Problems
Elsevier items and derived items © 2006 by Elsevier Inc.
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Benign Prostatic Hyperplasia
• Glandular units in the prostate that undergo an
increase in the number of cells resulting in
enlargement of the prostate gland
• Hyperirritable bladder, urgency and frequency,
hypertrophied bladder wall muscles, cellules and
diverticula, hydroureter, hydronephrosis, and
overflow urinary incontinence
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Assessment
• Urinary pattern, frequency, nocturia, and other
symptoms of bladder neck obstruction
• Lower urinary tract symptoms
• Hesitancy, intermittency, reduced force and size
of urinary stream, a sensation of incomplete
bladder emptying, and postvoid dribbling
• Hematuria
• DRE (size, consistency)
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Laboratory Assessment
• Urinalysis
• Complete blood count
• Blood urea nitrogen and creatinine levels
• Prostate-specific antigen
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Drug Therapy
• Finasteride to shrink the prostate gland and
improve urinary flow
• Terazosin hydrochloride
• Doxazosin mesylate
• Tamsulosin hydrochloride
• Estrogens and androgens
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Surgical Procedures
• Transurethral resection of the prostate
• Suprapubic prostatectomy
• Retropubic prostatectomy
• Perineal prostatectomy
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Continuous Bladder Irrigation
• Three-way urinary catheter with a 30- to 45-mL
retention balloon through the urethra into the
bladder
• Traction via taping to client’s abdomen or thigh
• Uncomfortable urge to void continuously
• Antispasmodic medications
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Postcatheterization Care
• Client feels burning on urination as well as some
urinary frequency, dribbling, and leakage.
• Symptoms are normal and will subside.
• Monitor fluid intake.
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Prostate Cancer
• Most common invasive cancer among men in
the U.S.
• One of the slowest growing malignancies;
metastasizes in a predictable pattern
• First symptoms related to bladder neck
obstruction
(Continued)
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Prostate Cancer (Continued)
• Digital rectal examination
• Prostate-specific antigen
• Biopsy necessary to confirm suspected prostatic
cancer
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Postoperative Care of Radical
Prostatectomy
• Hydration with intravenous therapy
• Caring for wound drains
• Preventing emboli
• Preventing pulmonary complications
• Antibiotics
• Analgesics
(Continued)
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Postoperative Care of Radical
Prostatectomy (Continued)
• Laxative and stool softener
• Indwelling urinary catheter
• Antispasmotic
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Complications
• Urinary incontinence
• Erectile dysfunction
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Nonsurgical Management
• Radiation therapy
• Hormonal therapy
• Chemotherapy
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Erectile Dysfunction
• Inability to achieve or maintain an erection for
sexual intercourse
• Organic erectile dysfunction
• Functional erectile dysfunction
• Assessment
– Medical, social, sexual history
– Complete physical examination
– Duplex Doppler ultrasonography test
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Interventions
• Drug therapy includes sildenafil, vardenafil,
tadalafil.
• Avoid alcohol before sexual intercourse.
• Common side effects include headaches, facial
flushing, diarrhea.
• Men who take nitrates should not take these
drugs in addition.
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Vacuum Devices
• Cylinder fits over the penis and sits firmly
against the body.
• Vacuum is created to draw blood into the penis
to maintain an erection.
• Rubber ring (tension band) is placed around the
base of the penis to maintain the erection;
cylinder is removed.
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Intraurethral Applications
• Prostglandin E is a self-administered suppository
that is placed in the urethra with an applicator.
• Erection occurs in about 10 minutes and lasts 30
to 60 minutes.
• Burning of the urethra occurs after application.
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Prosthesis
• Penile implants are used when other modalities
fail.
• Implants are semirigid, malleable, or hydraulic
inflatable and multicomponent or one-piece
instruments.
• Reservoir is placed in the scrotum.
• Major disadvantages are device failure and
infection.
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Testicular Cancer
• Although uncommon, this cancer is the most
common malignancy in men 15 to 35 years of
age.
• With early detection by testicular selfexamination and treatment with combination
chemotherapy, testicular cancer can be cured.
• Germ cell tumors arise from sperm-producing
cells.
• Non-germ cell tumors
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Diagnostics
• Alpha-fetoprotein
• Beta subunit of hCG
• Ultrasound
• Computed tomography
• Magnetic resonance imaging
• Lymphangiograms
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Risk for Sexual Dysfunction
• Interventions include:
– Oligospermia, azoospermia
– Health teaching about reproduction, fertility,
and sexuality
– Sperm storage
– Other reproductive options
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Potential for Metastasis
• Interventions include:
– Surgical management
– Preoperative care
– Operative procedures: radical retroperitoneal
lymph node dissection, orchiectomy
(Continued)
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Potential for Metastasis (Continued)
– Postoperative care; expected problems
include:
• Pain from surgical incisions
• Immobility
• Injuries related to invasive catheters or
tubes
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Nonsurgical Management
• Chemotherapy
• Radiation therapy
• Stem cell transplantation
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Hydrocele
• Cystic mass is usually filled with straw-colored
fluid that forms around the testis resulting from
impaired lymphatic drainage of the scrotum,
causing a swelling of the tissue surrounding the
testes.
• Hydrocele may be drained via needle and
syringe or it may be removed surgically.
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Spermatocele
• A sperm-containing cyst develops on the
epididymis alongside the testicle.
• Normally, spermatoceles are small and
asymptomatic, and require no interventions.
• If they become large enough to cause
discomfort, a spermatocelectomy is performed.
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Intracorporal Injections
• Injecting the penis with vasoconstricting drugs
• Phentolamine and alprostadil
• Adverse effects include:
– Priapism
– Penile scarring
– Fibrosis
– Bleeding
(Continued)
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Intracorporal Injections (Continued)
– Bruising
– Pain
– Infection
– Vasovagal responses
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Varicocele
• A cluster of dilated veins occur behind and
above the testis.
• Varicoceles can also cause infertility.
• Varicocelectomy is performed through an
inguinal incision in which the spermatic veins are
ligated in the cord.
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Scrotal Trauma
• Torsion of the testes involves twisting of the
spermatic cord and occurs most often during
puberty.
• Because the testes are sensitive to any
decrease in blood flow, torsion of the testis is a
surgical emergency.
• Surgical intervention may be required.
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Cryptorchidism
• Results when the testicles fail to descend;
mainly a pediatric problem
• Injections of B-HCG luteinizing hormonereleasing hormone or testosterone optional to
promote descent of the testicles
• Orchidopexy surgical procedure optional
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Cancer of the Penis
• Epidermoid (squamous) carcinomas developing
from squamous cells
• Circumcision in infancy—almost always
eliminates the possibility of penile cancer
• Painless wartlike growth or ulcer
• Excisional biopsy
• Radiation therapy
• Penectomy
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Phimosis and Paraphimosis
• Constricted prepuce that cannot be retracted
over the glans; prepuce remains down around
the tip of the penis
• Prepuce has not been returned to its normal
position after being retracted and forms a
constricting band around the glands →
Constrict lymph drainage → causing the penis
to swell → blood flow become impeded and
tissue death
• Emergency requiring immediate treatment
• Circumcision
• Warm bath to allow dressing to loosen
• Barbiturate sleeping medications
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Priapism
• Uncontrolled and long-maintained erection
without sexual desire; causes the penis to
become large and painful
• Can occur from:
– Thrombosis of veins of corpora cavernosa
– Leukemia
– Sickle cell disease
(Continued)
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Priapism (Continued)
– Diabetes mellitus
– Malignancies
– Abnormal reflex
– Some drug effects
– Recreational drugs
– Prolonged sexual activity
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Collaborative Management
• Urologic emergency
• Goal of intervention: to improve the venous
drainage of the corpora cavernosa
• Meperidine
• Warm enemas
• Urinary or suprapubic catheterization
• Large-bore needle or surgical intervention
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Bacterial Prostatitis
• Often occurs with urethritis or an infection of the
lower urinary tract
• Fever, chills, dysuria, urethral discharge, and
boggy, tender prostate
• Urethral discharge with white blood cells in the
prostatic secretions
• Chronic bacterial prostatitis
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Nonbacterial/Chronic Pelvic Pain Syndrome
• Can occur after viral illness or may be
associated with sexually transmitted diseases
• Other causes: autoimmune, neuromuscular
etiologies, allergy-mediated reactions,
psychosexual problems
• Prostatodynia or pelvic floor pain
• Treatment
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Epididymitis
• Inflammation of the epididymis resulting from an
infection or noninfectious source such as trauma
• Treatment: bedrest with scrotum elevated on a
towel, scrotal support when ambulating
• Comfort measures
• Epididymectomy
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Orchitis (Mumps)
• Acute testicular inflammation resulting from
trauma or infection
• Treatment: bedrest with scrotal elevation,
application of ice, and administration of
analgesics and antibiotics
• Mumps orchitis
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