Assessment and Management of Problems

Related to Male Reproductive Processes

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02/22/2025 1
 Objectives
• At the end of this chapter students are
expected to:
– Assess male patients with reproductive system
disorder
– Diagnose male patients with reproductive system
disorder
– Treat male patients with reproductive system
disorder

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 Introduction

• Disorders of the male reproductive system include a

wide variety of conditions that usually affect both
urinary and reproductive systems

• Because these disorders involve the genitalia and often

affect sexuality, the patient may experience anxiety
and embarrassment

• The nurse must be aware of the patient’s need for

privacy as well as his need for education and support
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Anatomic and Physiologic Overview

• In the male, several organs serve as parts of both

the urinary tract and the reproductive system

• Disorders in the male reproductive organs may

interfere with the functions of one or both of
these systems

• As a result, diseases of the male reproductive

system are usually treated by a urologist
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Anatomic and Physiologic ….
• The structures in the male reproductive system include:
1. External male genitalia, consisting of the testes,
epididymides, scrotum, and penis
2. Internal male genitalia, consisting of:
 the vas deferens (ductus deferens), ejaculatory duct, and
prostatic
 membranous sections of the urethra, seminal vesicles,
and
 certain accessory glands, such as the prostate gland and
Cowper glands (bulbourethral glands)

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Anatomic and Physiologic …..

• The testes have a dual function:

 Spermatogenesis (production of sperm) and
 Secretion of the male sex hormone testosterone,
which induces and preserves the male sex
characteristics.

• The testes, or ovoid sex glands, are encased in the

scrotum, which keeps them at a slightly lower
temperature than the rest of the body to facilitate
spermatogenesis
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 Anatomic and Physiologic …..
• The testes consist of numerous seminiferous tubules in which the
spermatozoa form.

• Collecting tubules transmit the spermatozoa into the epididymis,

a structure lying on the testes and containing winding ducts that
lead into the vas deferens

• The tract is continued as the ejaculatory duct, which passes

through the prostate gland to enter the urethra

• Testicular secretions take this pathway when they exit the penis
during ejaculation.
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 Anatomic and Physiologic …..

• The penis is the organ for both copulation and urination.

• It consists of the glans penis, the body, and the root
• The glans penis is the soft, rounded portion at the distal
end of the penis.
• The urethra, the tube that carries urine, opens at the tip
of the glans

• The glans is naturally covered by elongated penile skin

(foreskin) which may be retracted to expose the glans.
• However, many men as newborns have had the foreskin
removed (circumcision).
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 Anatomic and Physiologic …..

• The body of the penis is composed of erectile tissues

containing numerous blood vessels that become dilated,
leading to an erection during sexual excitement.

• The urethra, which passes through the penis, extends from

the bladder through the prostate to the distal end of the
penis

• The prostate gland, lying just below the neck of the bladder
• It surrounds the urethra and is traversed by the ejaculatory
duct, a continuation of the vas deferens.
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 Figure Structures of the male reproductive system
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 Assessment
Health History
 Male sexuality is a complex phenomenon that is
strongly influenced by personal, cultural, religious, and
social factors.
 Sexuality and male reproductive function become
concerns in the presence of illness and disability
 Throughout the assessment process, the nurse must
recognize the importance of sexuality to the patient
 The patient is asked about his usual state of health and
any recent change in general physical and sexual
activity
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 Assessment ….
• Assessment should address the following problems:
 increased urinary frequency
 dysuria (painful urination)
 hematuria (blood in the urine)
 nocturia (urination during the night)
 hematospermia (blood in the ejaculate)
 manifestations of sexual dysfunction
 The presence of factors that may affect sexual function
such as diabetes, multiple sclerosis, stroke
 Use of antihypertensive and anticholesterolemic medications,
psychotropic agents), stress
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 Assessment ….
Physical Assessment
 Digital Rectal Examination
 It is used to screen for prostate cancer and recommended
annually for every man older than 50 years of age
 The clinician assesses for tenderness of the prostate gland
on palpation and for the presence and consistency of any
nodules
 may be performed with the patient leaning over an
examination table or positioning the man in a side-lying
position with legs flexed toward the abdomen

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 Assessment ….
 Testicular Examination
 The male genitalia are inspected for abnormalities and palpated
for masses.
 The scrotum is palpated carefully for nodules, masses, or
inflammation.

 Examination of the scrotum can reveal such disorders as

hydrocele, inguinal hernia, testicular torsion, orchitis,
epididymitis, or tumor of the testis

 The penis is inspected and palpated for ulcerations, nodules,

inflammation, discharge, and curvature.
 If the patient is uncircumcised, the foreskin should be retracted
for visualization of the glans penis.
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 Assessment ….
Diagnostic Evaluation
• Prostate-Specific Antigen Test
– The cells within the prostate gland produce a protein
that can be measured in the blood
• Ultrasonography
– may be performed in patients with abnormalities
detected by DRE and in those with elevated PSA levels.
• Prostate Fluid or Tissue Analysis
– if disease or inflammation of the prostate gland is
suspected.
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Disorders of Male Sexual Function

Erectile Dysfunction
• It is also called impotence, is the inability to achieve
or maintain an erect penis
• The physiology of erection and ejaculation is complex
and involves parasympathetic and sympathetic
components.
• Erection involves the release of nitric oxide into the
corpus cavernosum during sexual stimulation.
• This allows flow of blood into the corpus
cavernosum, resulting in erection
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Disorders of Male Sexual…..
• The man may report decreased frequency of
erections, inability to achieve a firm erection
• Erectile dysfunction has both psychogenic and
organic causes.
• Psychogenic causes include:
anxiety, fatigue, depression, pressure to perform
sexually, negative body image
absence of desire, privacy, and trust and
relationship issues.
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 Disorders of Male Sexual…..

• Organic causes include

cardiovascular disease, endocrine disease
(diabetes, pituitary tumors, testosterone
deficiency, hyperthyroidism, and hypothyroidism),
cirrhosis, chronic renal failure, genitourinary
conditions, neurologic disorders (neuropathies,
parkinsonism, spinal cord injury),
trauma to the pelvic or genital area, alcohol,
smoking, medications, and drug abuse

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 Disorders of Male Sexual…..
Assessment and Diagnostic Findings
• The diagnosis of erectile dysfunction requires:
A sexual and medical history
An analysis of presenting symptoms
A physical examination, including a neurologic
examination
A detailed assessment of all medications, alcohol,
and drugs used

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 Disorders of Male Sexual…..
 Medical Management
• Treatment can be medical, surgical, or both, depending on
the cause
• Pharmacologic therapy
– Oral medication (sildenafil)
– Injection (alprostadil, papaverine, phentolamine)
– Urethral suppository (alprostadil)
• Penile implants Surgically implanted into corpus
 Semi-rigid rod
 Inflatable
 Soft silicone
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 Disorders of Male Sexual…..
Disorders of Ejaculation
• It is the occurrence of ejaculation sooner than desired,
either before or shortly after penetration, causing
distress to either one or both partners

• Evaluation of pre-ejaculation involves a thorough sexual

history focusing on:
 the duration of symptoms
 time to ejaculation
 degree of voluntary control over ejaculation
 frequency of occurrence
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 Disorders of Male Sexual…..
• Treatment depends on the nature and severity of PE
and perceived distress it causes
 Behavioral therapy:
 counseling, sex therapy, psycho-education, and couples
therapy
 often involves both the man and his sexual partner
 Pharmacologic management involves:
 selective serotonin reuptake inhibitors, alpha1
adrenoceptor antagonists
 the tricyclic antidepressant clomipramine (Anafranil), and
topical anesthetics.
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 Conditions of the Prostate

1. Prostatitis
• Prostatitis is an inflammation of the prostate gland that
is often associated with lower urinary tract symptoms
and symptoms of sexual discomfort and dysfunction.

• Prostatitis may be caused by:

 infectious agents (bacteria, fungi, mycoplasma)
 other conditions (eg, urethral stricture, benign prostatic
hyperplasia)
E. coli is the most commonly isolated organism,
although Klebsiella and Proteus species are also found
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 Conditions of the Prostate ….

• There are four types of prostatitis:

1. Acute bacterial prostatitis (type I)
2. Chronic bacterial prostatitis (type II)
3. Chronic prostatitis/chronic pelvic pain syndrome
(CP/CPPS) (type III), which occurs in more than
90% of cases
4. Asymptomatic inflammatory prostatitis (type IV)

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 Conditions of the Prostate ….
• Acute prostatitis is characterized by:
 the sudden onset of fever, dysuria, perineal prostatic pain
 severe lower urinary tract symptoms: dysuria, frequency,
urgency, hesitancy, and nocturia.
• Patients with type II disease are typically asymptomatic
between episodes.
• Patients with type III prostatitis often have no bacteria in
the urine in the presence of genitourinary pain
• Patients with type IV prostatitis are usually diagnosed
incidentally during a workup for other disorders.

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 Conditions of the Prostate ….

Medical Management
• The goal of treatment is to eradicate the causal
organisms.
• Hospital admission may be necessary for patients with:
 unstable vital signs, sepsis, or intractable pelvic pain
 those who are frail or immunosuppressed
 those who have diabetes or renal insufficiency.
• Specific treatment is based on the results of culture
 If bacteria are cultured from the urine, antibiotics,
including trimethoprim-sulfamethoxazole or a
fluoroquinolone (eg, ciprofloxacin
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 Conditions of the Prostate ….

2. Benign Prostatic Hyperplasia (BPH)

• Benign prostatic hyperplasia (Enlarged Prostate) is one of
the most common diseases in aging men
• BPH typically occurs in men older than 40 years of age
• By the time they reach 60 years of age, 50% of men have
BPH
• It affects as many as 90% of men by 85 years of age
• BPH is the second most common cause of surgical
intervention in men older than 60 years of age
• The cause of BPH is not well understood, but testicular
androgens have been implicated
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 Conditions of the Prostate ….
• Dihydrotestosterone (DHT), a metabolite of
testosterone, is a critical mediator of prostatic growth
• Estrogens may also play a role in the cause of BPH
• BPH generally occurs when men have elevated
estrogen levels and when prostate tissue becomes
more sensitive to estrogens and less responsive to
DHT
• Smoking, heavy alcohol consumption, obesity,
reduced activity level, hypertension, heart disease and
diabetes, are risk factors for BPH
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 Conditions of the Prostate ….

Clinical Manifestations
• Urinary frequency, urgency, nocturia, hesitancy in starting
urination, decreased and intermittent force of stream
• The sensation of incomplete bladder emptying,
abdominal straining with urination, a decrease in the
volume and force of the urinary stream, dribbling
• Complications of acute urinary retention and recurrent
UTIs.
• Generalized symptoms may also be noted, including
fatigue, anorexia, nausea, vomiting, and pelvic
discomfort.
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 Conditions of the Prostate ….
 Assessment and Diagnostic Findings
• Health history
• A urinalysis to screen for hematuria and UTI
• If invasive therapy is considered, urodynamic studies,
urethrocystoscopy, and ultrasound may be performed
• Complete blood studies are performed
• Cardiac status and respiratory function are assessed
 because a high percentage of patients with BPH have
cardiac or respiratory disorders because of their age

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 Conditions of the Prostate ….

Medical Management
• The goals of medical management of BPH are to:
improve quality of life
improve urine flow
relieve obstruction
prevent disease progression
minimize complications
• Treatment depends on the severity of symptoms,
the cause of disease, the severity of the
obstruction, and the patient’s condition.
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 Conditions of the Prostate ….

• If a patient is admitted on an emergency basis because he is

unable to void, he is immediately catheterized

• Pharmacologic treatment for BPH includes:

Alpha-adrenergic blockers, which include alfuzosin,
terazosin, doxazosin and tamsulosin
They relax the smooth muscle of the bladder neck and
prostate

• Surgical resection of the prostate gland is another

option for patients with moderate to severe lower
urinary tract symptoms of BPH
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 Conditions of the Prostate ….

3. Cancer of the Prostate

• Prostate cancer is the most common cancer in
men other than non-melanoma skin cancer
• Risk factors for prostate cancer include:
Increasing age
Racial or ethnic group
Genetic link increases the risk of early-onset disease
Lower level of engagement in the health care
system
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 Conditions of the Prostate ….

Clinical Manifestations
• Cancer of the prostate in its early stages rarely
produces symptoms
• Usually symptoms that develop from urinary
obstruction occur in advanced disease
Difficulty and frequency of urination, urinary
retention, and decreased size and force of the urinary
stream)
Blood in the urine or semen and painful ejaculation
Sexual dysfunction is common before the diagnosis is
made.
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 Conditions of the Prostate ….
Assessment and Diagnostic Findings
If prostate cancer is detected early, the likelihood of
cure is high
It can be diagnosed through an abnormal finding
with the DRE and serum PSA
Detection is more likely with use of combined
diagnostic procedures
The diagnosis of prostate cancer is confirmed by a
histologic examination
 Most prostate cancers are detected when a man seeks
medical attention for symptoms of urinary obstruction
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 Conditions of the Prostate ….

Management
Treatment is based on the patient’s life expectancy,
symptoms, risk of recurrence after definitive
treatment, size of the tumor
Management may be nonsurgical and involve watchful
waiting or be surgical and entail prostatectomy
Radiation therapy also used to treat cancer of the
prostate
Prostate surgery may be indicated for the patient with
BPH or prostate cancer

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 Conditions Affecting the Testes and
Adjacent Structures

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 Testes and Adjacent Structures ….

1. Orchitis
• Orchitis is acute inflammatory response of one or both testes
as a complication of systemic infection

• Micro-organisms may reach the testes through the blood,

lymphatic system, or, more commonly, by traveling through the
urethra, vas deferens

• Causative organisms include Neisseria gonorrhoeae, Chlamydia

trachomatis, E. coli, Klebsiella, Pseudomonas aeruginosa,
Staphylococcus species, and Streptococcus species
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Testes and Adjacent Structures ….

• Signs and symptoms of orchitis include:

Fever
Pain which may range from mild to severe
tenderness in one or both testicles
bilateral or unilateral testicular swelling
penile discharge
blood in the semen
Leukocytosis
• Treatment of orchitis is based on whether the
causative organism is bacterial or viral
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Testes and Adjacent Structures ….

2. Epididymitis
• Epididymitis is an infection of the epididymis,
which usually spreads from an infected urethra,
bladder, or prostate.
• Risk factors for epididymitis include:
recent surgery or a procedure involving the urinary
tract
Participation in high-risk sexual practices
History of STD, past prostate infections or UTIs,
lack of circumcision and the presence of a chronic
indwelling urinary catheter
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Testes and Adjacent Structures ….
Clinical Manifestations
– low-grade fever, chills, and heaviness in the affected
testicle
– The testicle becomes increasingly tender to pressure
and traction
– The patient may report unilateral pain, soreness in
the inguinal
– pain and swelling in the scrotum and the groin.
– The epididymis becomes increasingly swollen, with
extreme pain in the lower abdomen and pelvis.
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Testes and Adjacent Structures ….

Medical Management
 The selection of an antibiotic depends on the
causative organism
 Supportive interventions include reduction in physical
activity, ice packs, anti-inflammatory agents, analgesics
 In chronic epididymitis, a 4- to 6-week course of
antibiotics for bacterial pathogens is prescribed
 An epididymectomy may be performed for patients
who have recurrent, refractory, incapacitating
episodes of this infection
 With long-term epididymitis, the passage of sperm
may be obstructed which may result infertility
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Testes and Adjacent Structures ….

3. Hydrocele
 A hydrocele is a collection of fluid most commonly
located between the visceral and parietal layers of the
tunica vaginalis of the testis, although it may also
collect within the spermatic cord
 This condition is the most common cause of scrotal
swelling
 Acute hydroceles primarily develop in adults older than
40 years of age; they may occur in association with
inflammation
 Chronic hydroceles may occur related to the imbalance
between fluid secretion and reabsorption in the tunica
02/22/2025vaginals. 43
Testes and Adjacent Structures ….

• On physical examination, an easily

transilluminated, painless, extratesticular mass is
found.
• Ultrasonography is recommended for large
hydroceles to differentiate them from testicular
tumors
• Treatment may involve surgical excision or needle
aspiration
• Treatment is usually not required unless the
hydrocele is compromises testicular circulation
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 Conditions Affecting the Penis

1. Phimosis
 Phimosis is a condition in which the foreskin (prepuce)
cannot be retracted over the glans in uncircumcised
males
 Paraphimosis is a condition in which the foreskin, once
retracted over the glans, cannot be returned to its usual
position
 Treatment for phimosis secondary to inflammation is the
application of steroidal cream to the foreskin to soften
and correct the narrowness
 Phimosis is the most common indication for adult
circumcision
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Conditions Affecting the Penis ….
2. Urethral Stricture
 Urethral stricture is a condition in which a section of
the urethra is narrowed
 It can occur congenitally or from a scar along the
urethra
 Prostatitis is a common complication
 Treatment involves dilation of the urethra or, in severe
cases, urethrotomy (surgical removal of the stricture)
 Antimicrobial agents are necessary for resolution of
UTIs, followed by long-term prophylactic therapy until
the stricture is corrected
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Conditions Affecting the Penis ….

3. Circumcision
 Circumcision is the surgical excision of the foreskin
(prepuce) of the glans penis
 In adults, circumcision may be indicated as part of
treatment for phimosis, paraphimosis
 Postoperatively, a petrolatum (Vaseline) gauze
dressing is applied and changed as indicated
 The patient is observed for bleeding
 Because considerable pain may occur after
circumcision, analgesic agents are administered as
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needed. 47
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