Disorders Of The Male

Reproductive System

Lecturer; Warfaa Monday, April 10, 2023

 Introduction
 A variety of conditions are threats to male reproductive
health.
 This chapter provides information about genitourinary
conditions that are specific to male clients such as;
1. Congenital or acquired structural abnormalities,
2. Infectious and inflammatory conditions,
3. Erectile disorders,
4. Benign prostatic enlargement, and cancer
 STRUCTURAL ABNORMALITIES

 Structural abnormalities of the male genitalia may be

congenital or acquired.
 These various abnormalities, including
1. Cryptorchidism,
2. Torsion of the spermatic cord,
3. Disorders of the foreskin, and
4. Benign scrotal swelling, often require surgical repair.
 Nursing management after these surgeries is similar
 CRYPTORCHIDISM
 Cryptorchidism; is a condition in which one or both testes fail
to descend into the scrotum.
 The undescended testis or testes may lie in the inguinal canal,
in the abdominal cavity, or, rarely, in the perineum or femoral
canal.
 The scrotum essentially is empty, but otherwise the client is
asymptomatic.
 During childhood or at puberty, undescended testes
occasionally find their way into the scrotum without treatment.
 At least one testis must be in the scrotum to ensure production
of sperm
 The cause of undescended testes is unknown.
 The longer the testis remains undescended during
childhood, however, the greater is the potential that
fertility will be compromised.
 If the condition is not corrected by 2 years of age,
the seminiferous tubules atrophy and fibrose.
 Some clients are treated with injections of human
chorionic gonadotropin (hCG) twice weekly for 4
weeks after the infant is 6 months of age.
 TORSION OF THE SPERMATIC
CORD
 Torsion means to twist. In this case, it is the
spermatic cord that twists, kinking the artery and
compromising blood flow to the testicle.
 The condition occurs in prepubescent boys and in
men whose spermatic cords are congenitally
unsupported in the tunica vaginalis, the membrane
surrounding the testes.
 Clients report a sudden, sharp testicular pain, with
visible local swelling.
 The pain may be so severe that nausea, vomiting, chills,
and fever occur.
 Torsion may follow severe exercise, but it also may occur
during sleep or after a simple maneuver such as crossing
the legs.
 Physical examination reveals an extremely tender testis.
 Elevation of the scrotum intensifies the pain by
increasing the degree of twist.
 Immediate surgery is necessary to prevent atrophy of the
spermatic cord and preserve fertility.
 INFECTIOUS AND
INFLAMMATORY CONDITIONS

Lecturer; Warfaa Tuesday, April 11, 2023

 PROSTATITIS

 Prostatitis is an inflammation of the prostate gland

and is most often caused by microorganisms that
reach the prostate by way of the urethra.
 E. coli and microbes that cause sexually transmitted
infections often are responsible but in some
instances no evidence of bacterial infection is found
 In any case, inflammation causes glandular swelling and
tenderness.
 Because the prostate surrounds the urethra, a
combination of genitourinary problems develops.
 Clients experience perineal pain or discomfort, an
unusual sensation preceding or fever, chills, dysuria, and
urethral discharge following ejaculation, low back pain,
 Treatment consists of up to 30 days of antibiotic
therapy, mild analgesics, and sitz baths.
 The nurse stresses that sexual partners also need to
be treated.
 He or she tells the client to avoid caffeine, prolonged
sitting, and constipation.
 The nurse instructs the client to comply with
antibiotic therapy and use a mild analgesic for pain.
 HYDROCELE, SPERMATOCELE, AND
VARICOCELE

 The suffix cele means swelling.

 Hydrocele, spermatocele, and varicocele all present
as a swelling of the scrotum but in each case, the
conditions are somewhat different.
 Often, hydrocele and spermatocele are not clinically
significant and do not require treatment; however,
varicoceles are thought to be an underlying cause of
male infertility and may be surgically repaired.
 Hydrocele; Accumulation of as much as 100 mL of
lymphatic fluid between the testis and tunica vaginali
 Spermatocele; Epididymal, sperm containing cyst
 Varicocele; Venous dilation with damage to elastic
fibers and hypertrophy of vein walls
 EPIDIDYMITIS AND ORCHITIS
 An inflammation of the epididymis (epididymitis) and
testis (orchitis) occurs alone or concurrently
(epididymo-orchitis).
 Common causes are an extension of the infectious
agent, leading to prostatitis or an infection elsewhere in
the body.
 Noninfectious epididymitis may result from long-term
indwelling catheter use or genitourinary procedures
such as cystoscopy or prostatectomy (surgical removal
of the prostate).
 Orchitis without epididymal involvement is
associated with a viral mumps infection that
occurs after puberty and may result in testicular
atrophy and sterility.
 Bilateral epididymitis frequently leads to
permanent azoospermia (absence of sperm),
especially when the infection recurs frequently or
becomes chronic.
 The chief complaint; is pain and swelling in the inguinal
area and scrotum.
 Fever and chills occur with bacterial infections, and the
urine contains pus and bacteria.
 Treatment; consists of bed rest, scrotal elevation,
analgesics, anti-inflammatory agents, and comfort
measures such as local cold applications.
 Antibiotic therapy is initiated to eliminate the infectious
agent.
 An epididymectomy (excision of the epididymis).
 ERECTION DISORDERS
Lecturer; Warfaa Tuesday, April 11, 2023
 ERECTILE DYSFUNCTION
 Erectile dysfunction (ED), also known as impotence,
is
(1) the inability to achieve an erection,
(2) the inability to achieve or maintain an erection that is
sufficiently rigid for sexual activity, or
(3) the inability to sustain erection for a satisfactory
period of time.
 There must be multiple or persistent incidences of
failed erection for the disorder to be considered
pathologic
 Pathophysiology and Etiology
 ED may have physical and psychological origins.
Erection depends on three basic processes;
 Appropriate neurologic stimulation;
 Adequate arterial blood flow into blood vessels such as the
cavernous artery, which expands penile tissue;
 Temporary trapping of venous blood so as to sustain an
erection.
 When any one or more of these processes are
ineffective or insufficient, ED occurs
 Common causes
 Common causes of ED include neurologic disorder
such as
 spinal cord injury,
 perineal trauma,
 testosterone insufficiency,
 side effects of drug therapy,
 atherosclerosis, hypertension, and complications of
diabetes mellitus.
 ED also may be related to anxiety or depression.
 Medical and Surgical Management
 Several approaches exist to help restore sexual
function.
 Substituting other drugs for those that cause
impotence or treating the contributing cause may
restore potency (erectile ability).
 It recommends oral phosphodiesterase type 5
(PDE5) inhibitors(Viagra) as first-line therapy.
 Nursing Management
 If the client prefers to self-inject a vasodilator, the
nurse provides instruction on technique, suggested
frequency of injections, and side effects.
 If the client undergoes a penile implant, the nurse
assesses for pain, swelling, bleeding, and surgical
complications such as infection