Lecture Notes on Male Reproductive System System

Prepared By: Mark Fredderick R Abejo R.N, MAN

MEDICAL AND SURGICAL NURSING

Male Reproductive System

Lecturer: Mark Fredderick R. Abejo RN, MAN

Anatomy and Physiology of the Male Reproductive System

Penis

Penis
 Both a sexual organ & an organ for urination Scrotum
 Consists mainly of erectile tissue & urethra through  Sac that lies posterior to the penis
which semen & urine are released via the meatus  Protects the testes, the epididymis and the vas deferens
 The meatus is in the glans penis in a space cooler than the abd cavity
 The glans penis is the cone-shaped end of the penis  Left side normally hangs a bit lower than Right
 The glans penis is enclosed by a fold of skin called the
prepuce or foreskin (may be removed with circumcision) Testes (testicles)
 Composed erectile muscle: 2 corpus cavernosus /  Produce testosterone & sperm
1 corpus spongiosum

Medical and Surgical Nursing 1 Abejo

Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Epididymis
 1st portion of a ductal system that transports sperm from CONGENITAL DISORDERS
the testes to the urethra
 Provides for storage, transport & maturation of sperm
PHIMOSIS
Vas Deferens  A condition in which the penile foreskin (prepuce) is
 Continues from the epididymis constricted at the opening, making retraction difficult or
impossible
 Conveys sperm from the epididymis to the ejaculatory  May be congenital or caused by edema or inflammation
duct  Often associated with poor hygiene beneath the foreskin
 Seminal Vesicles (SMEGMA)
 Provides most of volume of ejaculate
 Each vesicle joins with vas deferens to form the
ejaculatory duct

Ejaculatory Ducts
 Two ducts that descend thru the prostate gland, ending
in the prostatic

Prostate Gland
 Surrounds the urethra at the base of the bladder
Assessment
 Produces an alkaline fld that forms part of the volume of
Edema
the ejaculate
Erythema
 Prostatic fluid aids the passage of sperm & helps keep
Tenderness
them alive it also helps protect the sperm from the Purulent Drainage
acidity of the vagina
Medical Management
Urethra  Antibiotics--systemic, local
 Provides for passage of semen & urine through the  Non Surgical : Application of topical steroid cream, such
meatus as betamethasone, for 4-6 weeks to the narrow part of the
foreskin is relatively simple, less expensive than surgical
treatments and highly effective.
 Surgical : Circumcision

Sperm Cells
 Sperm cells are produced in the seminiferous tubules.
 Sertoli cells nourish the sperm cells and produce small
amounts of hormone
 Fructose is the main source of energy of sperm to move.
 Normal Number : 60 – 120 million / ml
 Normal Amount of Semen : 2 -6 ml
Parts & Functions
1. Head (acrosome, nucleus): contains DNA
Acrosome – a vesicle that contains hyaluronidase and
proteinases, enzymes that aid penetration of the sperm
cell into the secondary oocyte
Nursing Management
 Patient/Parent teaching re: proper cleaning
 Teaching re: pros & cons of circumcision
PARAPHIMOSIS
 Is a medical condition where the foreskin becomes
trapped behind the glans penis, and cannot be pulled back
to its normal flaccid position covering the glans penis.
 If the condition persists for several hours or there is any
sign of a lack of blood flow, paraphimosis should be
treated as a medical emergency, as it can result in
gangrene or other serious complications.

2. Midpiece (mitochondria) – carry on metabolism that

provides ATP for locomotion

3. Tail – a typical flagellum that propels the sperm cell

along its way.

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Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical Management
 This involves compressing the glans and moving the
foreskin back to its normal position, perhaps with the aid
of a lubricant.
 If this fails, the foreskin may need to be cut (dorsal slit
procedure) or removed by circumcision
Nursing Management
 Prevention of recurrence is through education of the
patient and his caregivers on the need to pull back the
foreskin over the glans after it has been retracted (for
example, when cleaning the glans or passing a Foley
catheter)
EPISPADIAS
 Is a rare type of malformation of the penis in which the
urethra ends in an opening on the upper aspect (the
dorsum) of the penis.
 Epispadias occurs in one of three forms.
(1)The urethra may open on top of the head of the penis
(2) The entire urethra may be open the full length of the
penis
(3) The entire urethra may be open with the bladder
opening on the abdominal wall.
Exstrophy is a condition where the bladder may appear to be inside
out and the abdominal wall is partially open leaving the bladder
exposed to the exterior of the body
Treatment
 The main treatment for isolated epispadias is a
comprehensive surgical repair of the genito-urinary area
usually during the first 7 years of life, including
reconstruction of the urethra, closure of the penile shaft
and mobilisation of the corpora.
 The most popular and successful technique is known as
the Modified Cantwell-Ransley Approach
HYPOSPADIAS
 Is a malformation that affects the urethral tube and the
foreskin on a male's penis.
 The urethra is the tube that carries urine from the bladder
to the outside of the body.
 Hypospadias is a disorder in which the male urethral
opening is not located at the tip of the penis.
 The urethral opening can be located anywhere along the
urethra.
 Most commonly with hypospadias, the opening is located
along the underside of the penis, near the tip.
Medical and Surgical Nursing
Risk Factors
Hypospadias is a congenital (present at birth) anomaly
(abnormality), which means that the malformation occurs
during fetal development.
As the fetus develops, the urethra does not grow to its
complete length.
Also during fetal development the foreskin does not
develop completely, which typically leaves extra foreskin
on the topside of the penis and no foreskin on the
underside of the penis.
Signs and Symptoms
Abnormal appearance of foreskin and penis on exam.
Abnormal direction of urine stream.
The end of the penis may be curved downward.
Opening of the penis is NOT at the tip of the penis but is
displaced to the downward side or bottom of the penis
Penis looks hooded due to malformation of the foreskin
Child has to sit down to void
Medical Management
 Usually, the surgical repair is done when the child is
between 6 and 12 months, when penile growth is minimal.
 At birth, your male child will not be able to undergo
circumcision, as the extra foreskin may be needed for the
surgical repair. The surgical repair can usually be done
on an outpatient basis.
CRYPTOCHIDISM (undescended testes)
 Is the absence of one or both testes from the scrotum.
 This usually represents failure of the testis to move, or
"descend," during fetal development from an abdominal
position, through the inguinal canal, into the ipsilateral
scrotum
Causes and Risk Factors
Severely premature infants
Low birthweight due to either prematurity or intrauterine
growth retardation
Environmental chemicals — endocrine disruptors — that
interfere with normal fetal hormone balance has been
proposed and is rarely possible to implicate a specific
chemical exposure for an individual child.
Hernia repair or other surgery in the inguinal area
resulted in trapping of a testis above the scrotum.
Exposure to regular alcohol consumption during
pregnancy (5 or more drinks per week
Exposure to pesticides
Gestational diabetes
Being a twin
Women who drink caffeine (at least 3 drinks per day) [2].
3 Abejo
Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

SCROTAL / TESTICULAR DISODERS

HYDROCELE
 A painless collection of clear yellow to amber fluid
within the scrotum
 Leads to scrotal swelling
 Can be transilluminated, ruling out the presence of a fluid
or mass.
 May be associated with infections, trauma, systemic
infections (e.g., mumps
 Hydroceles are usually not painful
Sign and Symptoms
The testicles are noted to be absent in the scrotum by the
parent or healthcare provider.

Medical Management
 The primary management of cryptorchidism is surgery,
called orchiopexy.
 It is usually performed in infancy, if inguinal testes have
not descended after 4–6 months, often by a pediatric
urologist or pediatric surgeon
 Often, a child is watched until the age of one to see if the
testicle will move into the scrotum by itself. If not,
affected testicles can be brought down into the scrotum
using surgery.
 Surgery improves cosmetic appearance and makes
examination of the testicles to check for cancer easier.
 Surgery may also improve the chance of future fertility in Collaborative Management
some cases.  USUALLY NONE unless there is compromised
testicular circulation
 Surgery is recommended during 12-18 months if
hydrocele still present
 They should be repaired when they cause symptoms or if
they are present during an inguinal hernia repair unless
there is compromised testicular circulation and pain
embarrassment from increased scrotal size

Hydrocele Repair
 Hydrocele repair involves surgical correction of a birth
defect in which there is an open passageway between the
abdomen and scrotum which causes fluid collection
around the testicle (Hydrocele)
An incision is made just above the groin.
The open communication between the abdominal
cavity and scrotum is repaired, the fluid is removed
from the scrotum, and the incision is closed.
In some circumstances, the procedure can be done
laparoscopically

VARICOCELE
 Is an abnormal enlargement of the vein that is in the
scrotum draining the testicles.
 The testicular blood vessels originate in the abdomen and
course down through the inguinal canal as part of the
spermatic cord on their way to the testis

Cause
Thought to be incompetent venous valves or obstruction
of the gonadal vein

Signs and Symptoms

Ragging-like or aching pain within scrotum.

Feeling of heaviness in the testicle(s)
Atrophy (shrinking) of the testicle(s)
Nursing Management Visible or palpable (able to be felt) enlarged vein, likened
 Prevent trauma to the incision site to feeling a bag of worms.
 Watch out for any signs of bleeding Infertility or decrease sperm count and cause atrophy of
 Bed rest and limit movement until wound is heal the testicle, resulting in infertility
 Continue medication Pulling" sensation, dull ache in scrotum
Scrotal swelling

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Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Diagnosis Clinical Manifestations/Assessment

Can be felt upon scrotal palpation (feels like a "bag of Painful scrotal swelling
worms) Pain along the inguinal canal & along the vas deferens
Ultrasound of scrotum Reddened scrotum
Doppler Fever, chills
Pyuria, bacteriuria
Development of an abscess
"Duck waddle" walk

Diagnosis
Increased WBC count
Nuclear med scan with injection of radioactive dye

Collaborative Management
Collaborative Management
 Usually treated in younger pts (to prevent infertility) and
in pts with pain
 Spermatic vein ligation
 Varicocelectomy, the surgical correction of a varicocele,
is performed on an outpatient basis. ORCHITIS or ORCHIDITIS
 The three most common approaches are inguinal (groin),
retroperitoneal (abdominal), and
infrainguinal/subinguinal (below the groin).
 Post Op Nursing Care Causes / Risk Factors
 Ice packs should be kept to the area for the first 24
hours after surgery to reduce swelling.
 The patient may be advised to wear a scrotal support
for some time after surgery.
EPIDIDYMITIS
 Is a medical condition in which there is inflammation of
the epididymis (a curved structure at the back of the
testicle in which sperm matures and is stored).
 This condition may be mildly to very painful, and the
scrotum (sac containing the testicles) may become red,
warm and swollen. It may be acute (of sudden onset) or
rarely chronic. Clinical Manifestation
 Bedrest with scrotum elevated on towel to prevent
traction on the spermatic cord, to facilitate venous
drainage, and to relieve pain (usually about 3-5 days)
 Antibiotics
 Intermittent ice packs/cold compresses may help decrease
swelling & pain
 **Avoid heat
 Avoid lifting, straining, sexual excitement until infection
completely resolved (may take 3 - 4 weeks)
 Epididymectomy for recurrent/chronic epididymitis

Is a condition of the testes involving inflammation.
 It can also involve swelling and frequent infection.
Epididymitis
Infection
Sexually transmitted diseases chlamydia and gonorrhea.
It can also be seen during active mumps
Inadequate immunization against mumps
Being older than age 45
Recurrent urinary tract infections
Congenital problems of the urinary tract
Genito-urinary surgery
Long term use of a Foley catheter (tube inserted into the
bladder to drain urine)
Scrotal swelling
Tender, swollen, heavy feeling in the testicle
Tender, swollen groin area on affected side
Fever
Discharge from penis
Pain with urination (dysuria)
Pain with intercourse or ejaculation
Groin pain
Testicle pain aggravated by bowel movement or straining
Blood in the semen

Diagnostic Procedure
Urinalysis
Urine culture (clean catch) -- may need several samples,
including initial stream, mid-stream, and after prostate
massage
Tests to screen for chlamydia and gonorrhea (urethral
Causes smear)
Infection of the prostate CBC
Long term use of catheter Doppler ultrasound
Prostatic surgery Testicular scan (nuclear medicine scan)
Cystoscopic examination
Trauma Collaborative Management
Urinary tract infection  Antibiotics
Chlamydia (most common cause in men under age 35)  In the case of gonorrhea or chlamydia, sexual partners
**The causative organism passes upward thru the urethra must also be treated.
& the ejaculatory duct, then along the vas deferens to the  Pain medications and anti-inflammatory medications
epididymis  When orchitis is caused by a virus, only analgesics (pain
relievers) are prescribed.
 Bed rest, with elevation of the scrotum and ice packs
applied to the area, is recommended.

Medical and Surgical Nursing 5 Abejo

Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

TESTICULAR CANCER
 Cancer that develops in the testicles, a part of the male
reproductive system.
 It is most common among males aged 15–40 years,
particularly those in their mid-twenties.

Causes / Predisposing Factors

Caucasian men
Men aged 15 – 35
Hereditary
Sedentary lifestyle
Early onset of male secondary characteristics
Conditions such as:
 Cryptorchidism
 Hx of mumps orchitis
 Inguinal hernias
Hx of testicular ca on the other testes

Clinical Manifestation
a lump in one testis or a hardening of one of the testicles
abnormal sensitivity (either numbness or pain)
loss of sexual activity or interest
sexual withdrawal
TESTICULAR TORSION
A burning sensation, especially following physical  The spermatic cord that provides the blood supply to a
activity. testicle is twisted, cutting off the blood supply, often
build-up of fluid in the scrotum or tunica vaginalis, causing orchialgia (pain in the testicle )
known as a hydrocele  Prolonged testicular torsion will result in the death of the
a dull ache in the lower abdomen or groin, sometimes testicle and surrounding tissues.
described as a "heavy" sensation
lumbago - lower back pain
An increase, or significant decrease, or sudden decrease
in the size of one or both testes.
blood in semen
general weak and tired feeling

Staging
 Stage I: the cancer remains localized to the testis.
 Stage II: the cancer involves the testis and metastasis to
retroperitoneal and/or Paraaortic lymph nodes (lymph
nodes below the diaphragm).
 Stage III: the cancer involves the testis and metastasis
beyond the retroperitoneal and Paraaortic lymph nodes.
Stage III is further subdivided into nonbulky stage III and
bulky stage III. [11]
 Stage IV: if there is liver and/or lung secondaries

Collaborative Management
 The three basic types of treatment are surgery, radiation
therapy, and chemotherapy.
 Surgery: Orchiectomy is a relatively minor surgical
procedure to remove a testicle. The procedure is
generally performed by a urologist. Often it is performed
as same-day surgery, with the patient returning home
within hours of the procedure. Some patients elect to
have a prosthetic testicle inserted into their scrotum
 Prevention: Perform a Monthly Testicular Self
Examination
Men from puberty onwards should examine
their testes after a hot shower or bath, when the
scrotum is looser. They should first examine
each testicle separately, feeling for lumps, and
then compare them to see whether one is larger
than the other.
By doing this each month, males will become
familiar with what is normal for them.
Their testicles should be examined by a doctor
if they notice any of the following:
 a lump in one testicle
 pain or tenderness
 blood in semen during ejaculation
 build-up of fluid in the scrotum
 a change in the size of one testicle or the
relative sizes of the two
Causes / Risk Factors
Torsions are sometimes called "winter syndrome".
This is because they often happen in winter, when it is
cold outside. ( The scrotum of a man who has been lying
in a warm bed is relaxed. When he arises, his scrotum is
exposed to the colder room air. If the spermatic cord is
twisted while the scrotum is loose, the sudden contraction
that results from the abrupt temperature change can trap
the testicle in that position. The result is a testicular
torsion.)
Clinical Manifestation
Testicular pain
Tenderness of less than 6 hrs of duration.
Reddened scrotum
Fever, chills
Collaborative Management
 Testicular torsion is a surgical emergency that needs
immediate surgical intervention. If treated within 6 hours,
there is an excellent chance of saving the testicle. Within
12 hours the rate decreases to 70%, within 24 hours is
20%, and after 24 hours the rate approaches 0%
 Once the testicle is dead it must be removed to prevent
gangrenous infection.

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Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

INGUINAL HERNIA Clinical Manifestations

 Is a protrusion of abdominal-cavity contents through the Abacterial Prostatitis
inguinal canal. urgency, frequency
 They are very common (lifetime risk 27% for men, 3% nocturia
for women dysuria
 There are two types of inguinal hernia, direct and indirect: dull pain in perineum/rectal area back pain
Direct inguinal hernias painful ejaculation
- occur medial to the inferior epigastric vessels when Bacterial Prostatitis
abdominal contents herniate through the external same as Abacterial AND
inguinal ring.
fever, chills
Indirect inguinal hernias
urethral discharge upon prostate massage
- occur when abdominal contents protrude through the
boggy, tender prostate
deep inguinal ring, lateral to the inferior epigastric
vessels; this may be caused by failure of embryonic
closure of the processus vaginalis Complications
epididymitis
cystitis
decreased sexual functioning b/o pain

Collaborative Management
 Medications:
Antibiotics---Carbenicillin (Geocillin);
Ciprofloxacin (Cipro)
Analgesic
Stool softeners
 Pt Teaching
Causes / Risk Factors Comfort Measures---sitz baths
Obesity Force Fluid to decrease chance of prostatitis causing
Heavy lifting UTI
Coughing Importance of completing entire ABC (abstinence,
Straining during a bowel movement or be faithful, use condom ) regimen
urination
Chronic lung disease BENIGN PROSTATIC HYPERPLASIA (BPH)
Fluid in the abdominal cavity  An abnormal increase in the number of prostatic cells
A family history of hernias can make you  NOT an increase in cell size
more likely to develop a hernia.  When the prostate enlarges, it extends upward, into the
bladder, and inward
Clinical Manifestation  Approx 80% of men over age 50 have some signs of BPH
Bulge in the groin or scrotum. The bulge may appear  Cause ---unknown, but believed to be hormone related
gradually over a period of several weeks or months, or it
may form suddenly after you have been lifting heavy
weights, coughing, bending, straining, or laughing. Many
hernias flatten when you lie down.
Groin discomfort or pain. The discomfort may be worse
when you bend or lift. Although you may have pain or
discomfort in the scrotum, many hernias do not cause any
pain.
Heaviness, swelling, and a tugging or burning sensation
in the area of the hernia, scrotum, or inner thigh. Males
may have a swollen scrotum, and females may have a
bulge in the large fold of skin (labia) surrounding the
vagina.
Discomfort and aching that are relieved only when you
lie down.

Collaborative Management
 Surgical correction of inguinal hernias, called a
herniorrhaphy or hernioplasty is a surgical procedure Pathophysiology
for correcting hernia. Although androgen levels decrease with aging, the aging
prostate appears to become more sensitive to available
androgen
The expanding tissue compresses surrounding tissue,
narrowing the urethra
PROSTATE GLAND DISODERS
Clinical Manifestation
Urinary frequency
PROSTATITIS Nocturia
 Inflammation of the prostate gland Hesitancy, decreased force of stream
 Two types: Abacterial and bacterial Abd straining upon urination
 Abacterial Prostatitis Post-void dribbling
can occur after a viral illness Sensation of incomplete emptying
can occur after a sudden decrease in sexual activity, Dysuria
especially young males
Urinary retention (can be complete)
many times cause unknown
Bladder distention
 Bacterial Prostatitis
Enlarged prostate (upon rectal exam)
usually associated with a lower UTI
most common organism= E-coli

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Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Complications B. Suprapubic Prostatectomy

UTI (upper & lower)  incision is made into the lower abd & bladder
Hydroureter, Hydronephrosis  prostate removed thru the bladder
Urinary Calculi  with cystostomy tube and 2-way foley catheter postop
Possibly renal failure
Epididymitis C. Retropubic Prostatectomy
Prostatitis  low abd incision made, bladder is retracted, & prostate is
reached directly.
Diagnostic
HX of S/S D. Perineal Prostatectomy
 prostate is removed thru a perineal incision between
UA (bacteria, WBC, protein, blood)
scrotum & rectum
Urine C&S
BUN, Creatinine E. Transurethral Incision of Prostate (TUIP)
Cath for residual  small incisions are made in the prostate to enlarge the
IVP prostatic urethra and relieve obstruction
Cystoscopy
Rectal exam to palpate prostate Nursing Management
Prostate-specific antigen (PSA) to help r/o prostate Postop Care
cancer  Care of the patient with CBI
Serum Acid Phosphatase Maintain patency of the catheter
BX of prostate If drainage is reddish: increase flow rate ( by MD)
If drainage is clear: decrease flow rate (by MD )
Medical Management Practice asepsis
 Pharmacologic Management Use sterile NSS to prevent water intoxication
Alpha blockers used for BPH include doxazosin, Monitor for hemorrhage
terazosin, alfuzosin, tamsulosin, and silodosin. Client Teaching
- Alpha blockers relax smooth muscle in the prostate  Red to light pink urine during the 1st 24 hours
and the bladder neck, thus decreasing the blockage  Amber after 3 days postop
of urine flow.  Advise not to void around the catheter
Finasteride and dutasteride, this medications inhibit  Increase fluid intake
5a-reductase, which in turn inhibits production of  Relieve pain
DHT, a hormone responsible for enlarging the  Avoid the following:
prostate.  Vigorous exercise
Flutamide, Proscar (antiandrogens)  Heavy lifting
Antibiotics to tx UTI, other infections  Sexual intercourse, 3-6 weeks after discharge
 Release of prostatic fluid  Driving, 2 weeks after discharge
prostatic massage  Straining with defecation
frequent intercourse  Prolong sitting / standing
masturbation  Crossing legs
 Prevention of overdistention of bladder  Long trips and travel
Avoid drinking large amount in short time  Observe the following complications:
Avoid diuretics, caffeine  Hemorrhage
Void as soon as urge felt  Shock
Avoid meds that can cause urinary retention :  Obstruction in lower UT with
anticholinergics, antihistamines, decongestants clots/swelling/stricture (with TURP)
 Electrolyte imbalance
Surgical Management  Thrombus/Embolus
Type of Surgical Procedure  Pain, bladder spasms
Depends on  UTI, epididymitis
size of prostate
location of enlargement
PROSTATE CANCER
whether surgery on the bladder is also needed
 Most common male Ca
pt’s age/physical condition  Androgen – dependent adenocarcinomas
A. Transurethral Resection Prostatectomy (TURP)
 very common approach
 no incision
 resectoscope inserted thru urethra & scrapes out the
enlarged portion of the gland
 CBI ( continuous bladder irrigation or cystoclysis is done
postop

Medical and Surgical Nursing 8 Abejo

Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

Causes / Risk Factors PEYRONIE’S DISEASE

50 years of age and above  Is a condition in which a plaque, or hard lump, forms on
Genetic tendency the penis. The plaque may develop on the upper (more
Hormonal factors common) or lower side of the penis, in the layers that
 late puberty contain erectile tissue.
 high frequency of sexual experience  The plaque often begins as a localized area of irritation
 history of multiple sexual partners and swelling (inflammation), and can develop into a
 high fertility hardened scar.
High fat diet  The scarring reduces the elasticity of the penis in the area
Air pollutant affected.
Exposure to fertilizers, rubber, textile, batteries  The hardened plaque reduces flexibility, causing pain and
viruses, STDs forcing the penis to bend or arc during erection.

Clinical Manifestation
urinary hesitancy
hematuria
urinary retention
stool changes
pain radiating down hips and legs
cystitis
dribbling sensation
nocturia
hard, enlarge prostate
pain in defecation
elevated PSA ( prostatic specific antegin )
Causes / Risk Factors
Collaborative Management Unknown cause
 Tx depends on staging of disease Predisposing Factors
 Total prostatectomy - Vasculitis
perineal or retropubic approach usually used - Connective tissue disorder
common complications— impotence, incontinence - Hereditary
 Radiation
 Chemotherapy Collaborative Management
 Hormone Therapy (palliative)  A combination of Vitamin E and colchicine has shown
some promise in delaying progression of the condition.
 Injections to plaques (scar tissue formed by the
inflammation) with Verapamil may be effective in some
patients.
PENILE DISODERS  Surgery, such as the "Nesbit operation",is considered a
last resort and should only be performed by highly skilled
urological surgeons knowledgeable in specialized
corrective surgical techniques
PRIAPISM
 Vacuum therapy devices (or penis pumps), which have
 Is a persistent, often painful erection that can last from
traditionally been used to treat erectile dysfunction, are
several hours to a few days.
currently being prescribed to help correct the curvature of
 The priapism erection is not associated with sexual
the penis
activity and is not relieved by orgasm.
 Injecting medication directly into the plaque in an
 It occurs when blood flows into the penis but is not
attempt to soften the affected tissue, decrease the pain
adequately drained
and correct the curvature of the penis.
 Penile implants can be used in cases where Peyronie’s
Causes / Risk Factors
disease has affected the man’s ability to achieve or
Alcohol or drug abuse (especially cocaine) maintain an erection.
Certain medications, including some antidepressants and
blood pressure medications
Spinal cord problems
Injury to the genitals
Anesthesia
Penile injection therapy (a treatment for erectile
dysfunction)
Blood diseases, including leukemia and sickle cell
anemia

Collaborative Management
 Goal of treatment is to relieve the erection and preserve
penile function. In most cases, treatment involves
draining the blood using a needle placed in the side of the
penis.
 Medications that help shrink blood vessels, which
decreases blood flow to the penis, also may be used
 Surgery may be required to avoid permanent damage to
the penis. If the condition is due to sickle cell disease, a
blood transfusion may be necessary.
 Treating any underlying medical condition or substance
abuse problem is important to preventing priapism.

Medical and Surgical Nursing 9 Abejo

Lecture Notes on Male Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN

BALANITIS  Exercise, particularly aerobic exercise is an effective

 Is an inflammation of the skin covering the head of the cheap treatment for erectile dysfunction
penis.  Counseling
 A similar condition, balanoposthitis, refers to  A purpose-designed external vacuum pump can be used
inflammation of the head and the foreskin to attain erection, with a separate compression ring fitted
to the penis to maintain it
Causes / Risk Factors
uncircumcised
poor hygiene
irritation by a foul-smelling substance (smegma) that can
accumulate under the foreskin.
Other condition such as:
- Dermatitis
- Allergy
- Yeast infection

Clinical Manifestation
First signs – small red erosions on the glans
Redness of the foreskin
Redness of the penis
Other rashes on the head of the penis
Foul smelling discharge
Painful foreskin and penis
Collaborative Management
 If there is an infection, treatment will include an
appropriate antibiotic or antifungal medication.
 In cases of severe or persistent inflammation, a
circumcision may be recommended.
 Taking appropriate hygiene measures can help prevent
future bouts of balanitis.
 Avoid strong soaps or chemicals, especially those known
to cause a skin reaction.
ERECTILE DYSFUNCTION
 Is a sexual dysfunction characterized by the inability to
develop or maintain an erection of the penis sufficient
for satisfactory sexual performance.
Cause / Risk Factors
Drugs (Anti-depressants (SSRIs) and Nicotine are most
common.
Other drugs such as alcohol, cocaine, and heroin
negatively impact male sexual libido.)
Neurogenic Disorders (spinal cord and brain injuries,
nerve disorders such as Parkinson's disease, Alzheimer's
disease, multiple sclerosis, and stroke.[4])
Hormonal Disorders (pituitary gland tumor; low or
abnormally high levels of the hormone testosterone).
Arterial Disorders (peripheral vascular disease,
hypertension; reduced blood flow to the penis).
Venous leak
Cavernosal Disorders (Peyronie's disease.[5])
Psychological causes: performance anxiety, stress, mental
disorders (clinical depression, schizophrenia, substance
abuse, panic disorder, generalized anxiety disorder,
personality disorders or traits.), psychological problems,
negative feelings
Surgery (radiation therapy, surgery of the colon, prostate,
bladder, or rectum may damage the nerves and blood
vessels involved in erection. Prostate and bladder cancer
surgery often require removing tissue and nerves
surrounding a tumor, which increases the risk for
impotence.
Aging.
Lifestyle: alcohol and drugs, obesity, cigarette smoking
(Incidence of impotence is approximately 85 percent
higher in male smokers compared to non-smokers.
Smoking is a key cause of erectile dysfunction. Smoking
causes impotence because it promotes arterial narrowing.
Overtraining
Collaborative Management
 Testosterone supplements may be used for cases due to
hormonal deficiency
EJACULATORY DISODERS
SPERM CELL / SEMEN DISORDER
Aspermia: absence of semen
Azoospermia: absence of sperm
Oligospermia: low semen volume
Oligozoospermia: low sperm count
Asthenozoospermia: poor sperm motility
Teratozoospermia: sperm carry more morphological defects than
usual
RETROGRADE EJACULATION
 Occurs when semen, which would normally be ejaculated
via the urethra, is redirected to the urinary bladder.
 Normally, the sphincter of the bladder contracts before
ejaculation forcing the semen to exit via the urethra, the
path of least pressure. When the bladder sphincter does
not function properly, retrograde ejaculation may occur.
Causes / Risk Factors
Malfunctioning bladder sphincter
Common side effect of medications, such as tamsulosin,
that are used to relax the muscles of the urinary tract
Diabetes due to neuropathy
Treatment
 These medications tighten the bladder neck muscles and
prevent semen from going backwards into the bladder:
Tricyclic antidepressants like Imipramine.
Antihistamines like Chlorphenamine.
Decongestants like Ephedrine and Phenylephrine.
PREMATURE EJACULATION
 is a condition where a man ejaculates earlier than he or
his partner would like him to.
DELAYED EJACULATION
 Is the inability to ejaculate or persistent difficulty in
achieving orgasm despite the presence of normal sexual
desire and sexual stimulation.
 Normally a man can achieve orgasm within 2–4 minutes
of active thrusting during sexual intercourse, whereas a
man with delayed ejaculation either does not have
orgasms at all or can't have an orgasm until after
prolonged intercourse which might last for 30–45
minutes or more.
 n most cases delayed ejaculation presents the condition in
which the man can climax and ejaculate only during
masturbation, but not during sexual intercourse.

Medical and Surgical Nursing 10 Abejo