Male Reproductive Diseases and Disorders 1

Male Reproductive
Diseases and Disorders
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Male Reproductive
Blood Tests
Acid phosphatase – increases in
metastatic prostate CA
Alkaline phosphatase – increases in
bone and liver CA
Tumor Markers
PSA (prostate specific antigen)
screening tool for all men after the
age of 50
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Male Reproductive
Prostatitis – inflammation of the
prostate gland
Can be acute or chronic and is
caused by bacterial infections
S/S – swelling, warmth & tenderness,
dysuria, frequency, hematuria, foulsmelling urine
Tx – antibiotics, analgesics, sitz baths
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Prostatitis
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Male Reproductive
Epididymitis – inflammation of
epididymis caused by infections,
trauma or urinary reflux
S/S – painful scrotal edema, N/V,
chills, and fever
Tx – bed rest, ice packs, sitz baths,
analgesics, antibiotics, anti
inflammatory and scrotal support
Tx sexual partner if caused by STD
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Epididymitis
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Male Reproductive
Orchitis – inflammation of testes, r/t
trauma or infection (mumps)
S/S – fever, tenderness, swelling,
redness
Tx – analgesics, antipyretics, bed
rest, scrotal support, and local heat
packs
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Male Reproductive
BPH – benign prostatic hypertrophy
(hyperplasia) = enlargement of the
prostate gland
S/S
Obstructive – decreased size and force of
urinary stream, urine retention, post-void
dribble
Irritative – urgency, frequency, dysuria,
nocturia, hematuria, urge incontinence
*Alcohol and opiods can trigger retention
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Male Reproductive
Dx – rectal exam, radiographic
studies, ultrasound
Tx-Drugs (Flomax/Hytrin)
Surgical - prostatectomy = surgical
removal
Ablation = destruction of tissue
TURP = transurethral resection of the
prostate
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Male Reproductive
TURP cont.
Obstructed portion of prostate cut away
with a resectoscope through the urethra.
Triple lumen catheter placed for irrigation &
bladder drainage
Irrigation should = urinary output
Suprapubic prostatectomy – through the
bladder through a low abd. Incision. May
cause incontinence and ED
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TURP
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Question
Post-op care of a patient who has a
transurethral resection of the prostate
include:
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Answer
Keep catheter patent and draining
Observe for hemorrhage
Measure I&O
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Male Reproductive
Radical prostatectomy (usually for
prostate CA) – removal of prostate
gland, outer capsule, seminal vesicle,
portion of the vas deferens and
portion of bladder neck.
Usually perineal or retropubic
May cause erectile dysfunction and
urinary incontinence
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Male Reproductive
Erectile dysfunction (ED) = impotence
Caused by vascular, neurologic, endocrine
and psychological factors may contribute.
Also r/t atherosclerosis, high cholesterol,
smoking, excessive alcohol use, illicit
drugs, and injury
DM-neuropathy/atherosclerosis, 50% of
men with DM have ED
Tx-penile implant, drugs (Viagra)
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Male Reproductive
Peyronie’s disease – development of hard,
non-elastic, fibrous plaque under skin of
penis
Caused by injury that causes
inflammation/scarring
Loss of elasticity, decreases filling during
erection
Plaque on dorsal-mid surface causes
upward bending of penis during erection.
May be painful.
Tx- topical/oral meds, surgical correction
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Male Reproductive
Priapism – prolonged penile erection not r/t
sexual desire
Caused by injury, sickle cell crisis,
neoplasms of the brain or spinal cord,
drugs. Can affect blood flow, obstruct urine
flow. May be very painful.
If unresolved in 12 to 24 hrs., may cause
penile ischemia, gangrene, fibrosis and
erectile dysfunction
Tx-removal of blood, injecting smooth
muscle contracting meds, emergency
surgery may be needed.
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Male Reproductive
Phimosis – inflammation under
foreskin causes edema preventing
retraction of foreskin.
Tx – antibiotics and proper cleaning.
Circumcision is sometimes
recommended. Need to retract
foreskin daily and clean (then make
sure to put foreskin back)
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Male Reproductive
Male Infertility can be caused by
endocrine disorders, testicular
problems or ejaculatory
abnormalities.
Infection can cause testicular and
ejaculatory dysfunction
Structural – cryptorchidism, testicular
torsion, varicocele (dilation of vein
from testes)
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Male Reproductive
Male infertility cont.
Chlamydia STD may cause infertility
Neisseria gonorrhea STD causes urethral
infection
Cryptorchidism-testes located outside of scrotum
Congenital = 30% in premies, 1 to 3.4% in full
term males
Corrected within 1st 18 mos. Of life increase
chances of fertility
Undescended testes increase testicular cancer
chances 10 to 30%
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Male Reproductive
Testicular Torsion – spermatic cord twists
and cuts off blood supply to testicle. Needs
immediate surgical removal of testicle
Occurs mostly in adolescents
S/S-intense pain, N/V
Varicocele-lengthening and enlargement of
scrotal portion of venous system that
drains testicle, decreases
spermatogenesis
Tx-scrotal support, surgical ligation, may
reoccur after surgery
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Male Reproductive
Vasectomy-surgical removal of portion of
vas deferens. No sperm produces, but
erection and ejaculation unaffected
Use ice, mild analgesics, scrotal support.
Analysis of semen after 15 ejaculations.
Use alternative birth control until final
confirmation from MD.
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Question
What would you include in patient
teaching for a man undergoing a
vasectomy?
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Answer
Ice post procedure
Analgesics
Need a semen analysis before having
unprotected sex.
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Question
What for of birth control has a high
failure rate when used in a typical
manner?
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Answer
Male condoms
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Male Reproductive
Penile CA-relatively rare, in mostly
uncircumcised men, hx of multiple
sex partners, STD’s.
Removal and extensive resection or
amputation may be necessary.
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Male Reproductive
Testicular CA – germ cell carcinoma,
mostly in young men 18 to 34 yrs.
3 risk factors: cryptorchidism, white race,
previous testicular CA
S/S – hard, painless tumors
Early detection with self exam is best
chance of finding early-stage disease.
Best done in the shower
Tx-orchiectomy, radiation, chemo, monitor
tumor markers
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Male Reproductive
Prostate CA
30% of men 50 yrs or older
Risk factors- age over 50, AfricanAmerican, overweight, high fat diet, family
hx
Slow growing, confined to prostatic
capsule
Recommended men over 50 get a digital
rectal exam and PSA every year. Men at
high risk may start this at 40 yrs.
Tx-”watchful waiting”, radiotherapy,
surgery, cryoablation, hormone therapy
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