Chapter 79

Interventions for Male

Clients with Reproductive
Problems
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
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
Laboratory Assessment

 Urinalysis
 Complete blood count
 Blood urea nitrogen and creatinine levels
 Prostate-specific antigen
Drug Therapy

 Finasteride to shrink the prostate gland

and improve urinary flow
 Terazosin hydrochloride
 Doxazosin mesylate
 Tamsulosin hydrochloride
 Estrogens and androgens
Surgical Procedures

 Transurethral resection of the prostate

 Suprapubic prostatectomy
 Retropubic prostatectomy
 Perineal prostatectomy
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
 Traction usually removed first day post-op
 Uncomfortable urge to void continuously
 Antispasmodic medications
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.
 2000 to 2500 mL/day
Complications of TURP
 Bleeding
 Arterial
 Venous
 Bladder Spasms
 B&O Suppositories
 Bentyl
 Antispas
 Ditropan
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)
Prostate Cancer (Continued)

 Digital rectal examination

 Prostate-specific antigen
 Biopsy necessary to confirm suspected
prostatic cancer
Postoperative Care of
Radical Prostatectomy
 Hydration with intravenous therapy
 Caring for wound drains
 Preventing emboli
 Preventing pulmonary complications
 Antibiotics
 Analgesics
(Continued)
Postoperative Care of
Radical Prostatectomy
(Continued)
 Laxative and stool softener
 Indwelling urinary catheter

 Antispasmotic
Complications

 Urinary incontinence
 Sphincture damage
 Erectile dysfunction
 Pudental nerve damage
Cryoablation

 Alternative to radical prostatectomy

 For cancer confined to the prostate
Bilateral Orchiectomy

 Removal of the testes

 Arrests the cancer by removing testosterone
Nonsurgical Management

 Radiation therapy
 Hormonal therapy
 Chemotherapy
 Targeted therapy
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
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.
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.
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.
Intracorporal Injections
 Injecting the penis with vasoconstricting
drugs
 Phentolamine and alprostadil
 Adverse effects include:
 Priapism
 Penile scarring
 Fibrosis
 Bleeding
(Continued)
Intracorporal Injections
(Continued)
 Bruising
 Pain
 Infection
 Vasovagal responses
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.
Testicular Cancer
 Although uncommon, this cancer is the
most common malignancy in men 15 to 35
years of age.
 With early detection by testicular self-
examination and treatment with
combination chemotherapy, testicular
cancer can be cured.
 Germ cell tumors arise from sperm-
producing cells.
 Non-germ cell tumors
Diagnostics
 Alpha-fetoprotein
 Tumor marker
 Beta subunit of hCG
 Tumor marker
 Ultrasound
 Computed tomography
 Magnetic resonance imaging
 Lymphangiograms
Risk for Sexual
Dysfunction
 Interventions include:
 Oligospermia, azoospermia
 Health teaching about reproduction, fertility,
and sexuality
 Sperm storage
 Other reproductive options
Potential for Metastasis
 Interventions include:
 Surgical management
 Preoperative care
 Operative procedures: radical retroperitoneal
lymph node dissection, orchiectomy

(Continued)
Potential for Metastasis
(Continued)
 Postoperative care; expected problems
include:
 Pain from surgical incisions
 Immobility
 Injuries related to invasive catheters or tubes
Nonsurgical Management

 Chemotherapy
 Radiation therapy
 Stem cell transplantation
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.
 Wear scrotal support
 May remain swollen for several weeks
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.
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.
Scrotal Torsion

 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.
Cryptorchidism

 Results when the testicles fail to descend;

mainly a pediatric problem
 Injections of B-HCG luteinizing hormone-
releasing hormone or testosterone
optional to promote descent of the
testicles
 Orchidopexy surgical procedure optional
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
Phimosis and
Paraphimosis
 Constricted prepuce that cannot be
retracted over the glans; prepuce remains
down around the tip of the penis
 Emergency requiring immediate treatment
 Circumcision
 Warm bath to allow dressing to loosen
 Barbiturate sleeping medications
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)
Priapism (Continued)
 Diabetes mellitus
 Malignancies
 Abnormal reflex
 Some drug effects
 Recreational drugs
 Prolonged sexual activity
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
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
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
 Keep the prostate gland drained
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
antibiotics, NSAIDS
 Comfort measures
 Cold compresses
 Sitz Bath
 Epididymectomy
 Avoid straining and sexual activities
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