Male Reproductive Disorders -Prostate specific antigen (PSA) test – increased PSA = larger prostate

gland.
Benign Prostatic Hypertrophy -Uroflowmetry (insert catheter to check for residual urine)
-Increased cell size of the prostate leading to problems with urination -Normal urine flow is 20-25ml/second
-Male in their 40s to 50s is most common, expected on 50% of these
men will have hypertrophy of the prostate. Medical Management
-Associated with an increase in testosterone -Watchful waiting (initially, if has no or mild symptoms are present then
-Expansion of the prostate presses on the urethra leading to stasis of just observe)
urine which eventually will lead to infection (UTI) -Slow down the growth of the prostate gland with Finasteride (Proscar)
-These patients keep on urinating (frequent scanty urination) which will try to block the conversion of inactive testosterone to active
-If the patient is prone to holding their urine, they are susceptible to UTI form
because if static, urine is an irritant. -Side effect of finasteride: (1) Decreased ejaculatory semen (2)
Decreased Libido (3) Erectile dysfunction (4) Abnormal development of
Etiology & Risk Factors male fetus
-Age (40 – 50) -Anti-androgens / LHRH antagonist
-Family History -lessen testosterone level
-Hormonal alteration (testicular androgen) -given to cancer of prostate gland
-side effects outweigh the benefits (Loss of libido, flushing,
Clinical Manifestations gynecomastia, impotence)
-Prostatism (Urinary frequency, urgency, hesitancy, weak urinary -Medications to relax prostate muscle (Alpha-Adrenergic Blocking
stream, terminal dribbling) Agents) – side effects include: Orthostatic Hypotension, Tachycardia,
-Hematuria Dizziness, Dry mouth, blurring of vision, headache and fatigue.
-No pain -Terazosin (Hytrin)
-if BPH – enlarged firm prostate (hard fixed nodule – cancer already) -Phenoxybenzamine (Dibenzyline)
-in BPH Prostatism occurs in the early stage while in cancer Prostatism -Doxasozin (Cardura)
will occur late and starts at the periphery. -Tamsylosin (Flomax)
-Relieve bladder pressure with FBC
Diagnostic Test Findings -Teach patient to perform straight catheterization (to prevent UTI)
-Digital Rectal Examination (Evaluate size & tissue of prostate gland) -Catheterization is always a last resort (could introduce microorganism)
-Urinalysis (Stagnation = UTI)
-Urine culture
-Blood Test
Nursing Management
-Assessment: presence of hematuria
-Provide teaching of BPH: explain enlargement with pictures
-Encourage fluids (concentrated urine can irritate the bladder)
-Avoid bladder irritants such as Alcohol, Coffee, and Acidic Juices &
Spicy Foods.
-Increase fluid volume (atleast 2000ml per day unless contraindicated)
to prevent UTI
-Explain medications (to relieve anxiety & fear, especially if S/E is
impotence)
-Never force a catheter if there is resistance (refer to physician)
-Monitor urine output hourly
-If present; closely monitor hematuria
-Monitor for shock (post-obstructive diuresis = when catheter is
attached, large amounts of urine will flow out which can cause shock)
-Prevent by clamping the catheter then release every 2 hours.
-Regulate the flow
Surgical Management
-Remove enlarged part of the gland: Prostatectomy (Insert a fibroscope
at urethra and then remove the tissue surrounding the urethra
-Total prostatectomy is indicated for cancer.
-Transurethral resection prostatectomy
-Transurethral electrovaporization of the prostate (Vapor-Trade
procedure)
-Suprapubic Prostatectomy (if prostate gland is bigger – incision enters
into the BLADDER area)
-Retropubic Prostatectomy (Incision enters BELOW THE BLADDER
AREA)
-Perineal Prostatectomy (Entry is in the perineal area; impotence is a
key side effect)
-Transurethral Incision of the prostate
-Transurethral Balloon dilation of the prostate (Balloon is inflated for 15
minutes to dilate the urethra)
-Ultrasound (Laser is guided by the ultrasound)
-Transurethral Needle Ablation System (TUNA)
-Needle goes inside; introduce rapid frequency energy.
-Prostatic Stents
Nursing Management
Pre-op:
-Assess ability to empty bladder; if patient cannot void then insert
catheter.
-If the patient is taking anti-coagulants; stop taking.
-Ascertain presence of consent and patient’s knowledge of supposed
surgery.
Post-op
-Assess for bladder spasms (contraction of the bladder) to relieve the
pressure -> let the pt. sit and dangle at the sides of the bed in the next
morning; promote ambulation
-Discourage patient from straining -> increases intra-abdominal
pressure -> bleeding.
-Control incontinence post op with Kegel’s Exercise
-Treat erectile dysfunction: Sildenafil (Viagra) & Cialis
-Use of triple lumen catheter (Irrigation, Balloon, Output)
-Warm compress & Hot Sitz bath to relieve spasms
-Administer Analgesics
-Monitor Cystoclysis (Use of triple lumen catheter)
-Cranberry / Prune juice to prevent UTI
Self-Care Types Acute Chronic Non- Prostatodynia
-Provide health teachings. Bacterial Bacterial Bacterial
-Resume normal activities after 4 to 6 weeks Prostatitis
-Alternatives to intercourse: cuddling, stroking, manual and oral Causes Gram- Gram-positive Auto- Muscles
stimulation negative (chlamydia immune, spasm,
-Vacuum erection devices: penile implants. bacteria & gonorrhea) trauma, Common in
(E.Coli & excess middle aged
Urethritis Klebsiella) alcohol man.
-Inflammation of the urethra intake,
-commonly associated with STD sexual
-patient will also suffer cystitis (inflammation of the bladder) practices
-Irritated urethra -> swollen, painful, red lining -> Painful urination -> Pus (involving
formation -> Difficulty urinating anal)
Clinical -Urinary Manifestations -Normal -Fever is
Diagnostic Test Findings Manifest frequency may or may DRE present
-Culture & Sensitivity – get sample of the discharge. ations -Urinary not be present -Similar to -Perineal/
urgency -Episodes of chronic Pelvic pain is a
Medical Management -Painful DRE UTI prostatitis major
-Systemic and Topical Antibiotics complaint
-To promote flushing of microorganism: increase fluid intake. Medical -Broad- -Doxycycline - -Alpha-
-Avoid coitus until manifestations subside MGMT Spectrum (2 weeks) Doxycyclin Blockers
-Use lubricants during intercourse Antibiotics -Surgery e (2 (Relax the
-Use condoms to avoid exposure to STDs (10-14 days) weeks) prostate gland)
-Quinolones (Also -NSAIDs
Prostatitis -Bactrim given to -Hot Sitz Bath
-Inflammation of the prostate patients -Encourage
-Four types who want sexual activity
to prevent & masturbation
malaria) to relieve
prostate from
congestion
 Clinical Manifestations
Routes of Infection -Edematous
-From the urethra – ascending infection -Extremely painful
-From the kidneys or bladder – descending infection -Reddened scrotal skin
-Direct extension / lymphatic spread from the rectum -Fever
-Atrophy of the testes (decrease in size of testes)
Prostate Massage – to get sample of secretions -Prostration (weakness & fatigue)
- Wash Glans penis – to get rid of smegma
- Ask patient to urinate 10ml of urine (urethral specimen) and label Acute Phase : seen in 1 week
it VB1 -Most signs and symptoms occur during this time period
- Then 200ml of urine (bladder specimen and label VB2 -You can be sterile if both sides of the testes are affected
- Then massage prostate gland -> sample of secretion Medical management:
-Therapy directed to microorganism
Nursing Management -Rest
-Rest -Elevation of scrotum (scrotal bridge) place folded towel
-Increase fluids & analgesics -Ice packs to reduce edema
-Do away with alcohol & spicy foods -Antibiotic therapy
-Stool softener for constipation -Analgesics
-Complying with antibiotics -Anti-inflammatory meds

Orchitis Nursing Management:

-Acute testicular inflammation -Same as with Epididymitis
-otherwise known as testicular congestion
Epididymitis
Etiology: -comes from an infection coming from the prostate or urinary tract
-Pyogenic (Pus-forming microorganism) -more common than Orchitis
-Viral (Mumps have an affinity to testosterone; sterility is a consequence
when mumps occurs later in life) Etiology
-Spirochetal -complication of gonorrhea
-Parasitic -men younger than 35; caused by chlamydia.
-Traumatic -result from urethral instrumentation (introduces microorganism)
-Chemical
Clinical Manifestations Etiology & Risk Factors
-Unilateral pain -Family history
-Soreness & Pain along inguinal canal -HPCX (Human Prostate cancer of the X chromosome)
-Swelling in the scrotum -Hormonal shifting of testosterone (as men grow older)
-Fever and chills -Alteration in cholesterol and fat metabolism
-Fibrosis or scar formation in the epididymis -> infertility -Vitamin D deficiency (If lower then increased inactive testosterone)
-Occupational and environmental exposure to carcinogens
Medical Management -Sexually transmitted virus-like microorganism
-The physician might inject anesthesia into the spermatic cord to numb -High levels of testosterone
the area. -Increasing age.
-If caused by chlamydia: patient and partner should be treated with
antibiotics. Adenocarcinoma
-If no improvement occurs; the patient could be suffering from testicular -Cancer of the glands
tumor. -Starts in the lateral portion to the periphery of the prostate gland.
-If disease is recurrent; removal of epididymis is indicated -Slow growing
(epididynectomy)
Clinical Manifestations
Nursing Management -Same as BPH but occurs later than in BPH
-Bed Rest -Hematuria (#1 sign for prostate cancer)
-Scrotal Bridge Once there is metastasis
-Anti- microbial agents -Backache
-Intermittent cold compress -Hip pain
-Hot sitz bath -Perineal & Rectal discomfort
-Analgesics -Anemia
-Instruct patient to avoid straining and lifting; return to normal activities -Weight loss
in 4 weeks. -Weakness
-Nausea
Cancer of The Prostate -Oliguria
-common in men 50 years old and above
-If CA occurs in younger men; it is a more aggressive tumor.
-It is a slow growing tumor.
Diagnostic Findings:
-DRE (regular exam for every one over 40 years) – stony, hard fixed
lesion; then the physician will take a sample via fine needle aspiration
biopsy
-PSA – prostate specific antigen
-Presence of HCG in the blood.
-Transurethral ultrasound - (checks for elevated PSA / non-palpable
prostate cancer)
-Bone scans & skeletal x-ray (checks for metastasis)
-Excretory Urography – Urethral Obstruction
-Lymphangiography & Renal Function Test
-Radiolabeled monoclonal antibody ( CAPROMAB PENTIDITIDE
with Indium II) - antibody attracted to cancer cells, will attach to cancer
cells then the patient will undergo scanning.
-Gleason scoring – like staging for prostate cancer but for the
differentiation of cells
(Well-differentiated=Good prognosis, Poor differentiated = Poor
prognosis)
-Remove the testes to remove source of androgen (Orchiectomy)
-Estrogen & GnRH analogs
-Intermittent hormonal therapy
-Chemotherapy (Palliative therapy)
Nursing Management
-Provide education on treatment, side effects and expected outcomes
-Repetitive explanation – to relieve fear and anxiety of the patient.
-Education on external beam radiation side effects such as (1)
Dermatitis (2) Voiding (3) Adhesion (4) Diarrhea
-Provide support by instilling a positive attitude; educate the patient.
-Relieve pain: Narcotics & Opioids
Surgical Management
-Radical Prostatectomy (Entire prostate gland + seminal vesicles, lymph
nodes and portion of the bladder)
-Cryosurgical ablation (Freeze tissue before removing guided by
ultrasound)

Differentiation Scoring & Prognosis Nursing Management

Well differentiated 2-4 Good Prognosis -Prevent injury (secure catheter at abdomen) (removed 2-3 weeks))
Moderately differentiated 5-7 Fair Prognosis -Provide support: reassurance, concerns.
Poorly differentiated 8-10 Poor Prognosis -Monitor complications especially hemorrhage
Drainage should be reddish pink then light pink after 24 hours
Bright red bleeding (Arterial Bleeding) & Dark Red (Venous
Medical Management
bleeding)
-Radiation therapy (could be external or brachytherapy or combination
-If blood loss is extensive, blood transfusion
of both) – alternative choice for cancer.
-Monitor vital signs
-If cancer is at the bone; radiation is indicated.
-Administer meds, IV fluids
-Hormonal therapy : we need to block our androgen by giving anti-
-Accurate intake and output
androgens : Flutamide (Eulexin) & Bicalutamide (Casodex)
--Common side effects of anti-androgens: (1) Gynecomastia,
(2)diarrhea, (3) erectile dysfunction.
-Monitor for infection (Days after surgery) BOWEN’S DISEASE – cancer of the penile shaft (treatable
-1st dressing should be by the physician, succeeding dressings because it is carcinoma in situ)
done by the nurse
-Heat lamp to dry the moisture (wrap the testicle with a towel) Medical Management
-Hot sitz bath -If lesion is small – excision
-Antibiotics -Biopsy
-S/S of infection: Fever, Swelling, Redness & Immobility of the -Topical chemotherapy (S-Fluorouracil cream)
affected part -Radiation therapy – if the cancer is small (squamous cell carcinoma)
-Monitor for Deep Vein Thrombosis -Partial penictomy (removal of the glans penis)
-To prevent: anti-embolic stockings (worm before standing up after -Total penictomy (removal of the entire penis)
waking in the morning so that pooling of blood is not accumulated)
-Health Teachings for compliance Cancer of the Testes
-Low dose heparin -common in younger men (15 to 35 years of age)
-Monitor for an obstructed catheter -curable even in the advanced age
-Promote diuresis by administering Furosemide (Lasix)
-Distended bladder: hard mons pubis during palpation; Classification
restlessness. Germinal – 90% of cancers of testicles.
-Irrigate Cystoclysis Seminomas – sperm producing cells
Monitor for Sexual Dysfunction Non-seminomas – non sperm producing cells, common in 20s.
-Refer the patient to a urologist or genito-urologist. Non-germinal tumors – hormone producing tumors (4% in adults, 20%
-Refer to sex therapists. in children)
Secondary Testicular Tumors – by product of metastasis of penile
Cancer of the Penis cancer or prostate cancer and lymphoma (common cause) and poor
-older than 60 years old prognosis (due to metastasis)
-it is a squamous cell carcinoma

Etiology:
-Uncircumcised men
-Related to hygiene (for uncircumcised)
Etiology & Risk Factors: Surgical Management
-Family history -Radical Orchiectomy
-if exposed to exogenous estrogen: suffer from testicular cancer. -Retroperitoneal lymph node dissection (RPLAND) – prevent
-Undescended testes (Cryptorchidism) – major risk factor spread of cancer
-Fetus is exposed to estrogen (mothers who took estrogen during
pregnancy)
-Radiation therapy (Unilateral, shield other testes with lead
shield)
Clinical Manifestations -Chemotherapy
-Painless enlargement Tumors not responsive to radiation are given Cisplastin with
-Heaviness in the testicle (Dragging sensation) Vinblastin and Bleomycin
-Backache (due to metastasis)
-Abdominal pain Nursing Management
-Weight loss -Maintain a positive attitude
-Enlargement of testes -TSE (once a month)
-Health promotion & health screening activities.
Diagnostic Test Findings
-Thorough description of family & birth history
-Physical exam (if there is a nodule; then do transillumination)
-If it glows = cystic tumor
-If it does not glow = solid tumor / solid tissue.
-Blood studies
-Blood is withdrawn, diagnosis is made and staging with
subsequent surveillance is done with tumor markers.
-Tumor markers include: HCG (+) , Alpha-Fetoprotein, LDH
(Lactic Acid Dehydrogenase) produced by cancer cells itself.
-Ultrasound (determine size and presence of the mass)
-Monthly TSE