Problems of the Male Reproductive System

1.Erectile Dysfunction

 The inability to achieve and sustain an erection for intercourse, is a problem

affecting nearly half of the men over 70 years of age.

 Anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, and

tranquilizers are among the medications commonly used among older
adults that can cause erectile dysfunction.

 A variety of treatments can be used to address erectile dysfunction,

including oral erectile agents (e.g., sildenafil citrate [Viagra], vardenafil HCl
[Levitra], and tadalafil [Cialis]), drugs injected into the penis, penile
implants, and vacuum pump devices.

TIP:

 If an older man offers that he has erectile dysfunction, it is important to

assess what he means by that.
 Asking specific questions to clarify symptoms can help the man avoid
seeking erectile dysfunction medications unnecessarily and facilitate
discussions of actions that can be taken to compensate for erectile changes.

2. Benign Prostatic Hyperplasia

 Most older men have some degree of benign prostatic hyperplasia, which
causes approximately one in four of them to have dysuria.

 Dribbling, poor control, overflow incontinence, and bleeding may occur.

  Treatment can include prostatic massage, the use of urinary antiseptics,
and, if possible, the avoidance of diuretics, anticholinergics, and
antiarrhythmic agents.

 The most common prostatectomy approach used for older men with
prostatism is transurethral surgery. The patient should be reassured that
this surgery will not necessarily result in impotence.

3. Cancer of the Prostate

 Prostatic cancer increases in incidence with age. In fact, more than half of
men over 70 years of age have histologic evidence of prostate cancer,
although only a small percentage will die from the disease.

 This disease can be asymptomatic; however, most prostatic cancers can be

detected by digital rectal examination, which emphasizes the importance of
regular physical examinations.

 Symptoms such as back pain, anemia, weakness, and weight loss can
develop as a result of metastasis. A PSA test assists with the diagnosis,
which is confirmed through biopsy.

 Hormones may be used to prevent tumor dissemination. Palliative

treatment, used if the cancer has metastasized, includes irradiation,
transurethral surgery, chemotherapy, orchiectomy, and hormone therapy.

4. Tumors of the Penis, Testes, and Scrotum

 Cancer of the penis is rare and appears as a painless lesion or wartlike

growth on the prepuce or glans.
 A biopsy should be done for any penile lesion. Treatment may consist of
irradiation and local excision for small lesions and partial or total penile
amputation for extensive lesions.
 Testicular tumors are uncommon in older people but are usually malignant
when they do occur; testicular enlargement and pain and enlargement of
the breasts are suspicious symptoms.

 As part of the assessment, nurses should ascertain the patient’s knowledge

of testicular self-examination and provide education on this procedure if
necessary.

 Scrotal masses, usually benign, can result from conditions such as

hydrocele, spermatocele, varicocele, and hernia. Symptoms and treatment
depend on the underlying cause and are the same as for younger men.