Male Reproductive Diseases and Disorders 1
Male Reproductive Diseases and Disorders 1 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 2 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 3 Prostatitis 4 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 5 Epididymitis 6 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 7 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 8 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 9 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 10 TURP 11 Question Post-op care of a patient who has a transurethral resection of the prostate include: 12 Answer Keep catheter patent and draining Observe for hemorrhage Measure I&O 13 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 14 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) 15 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 16 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. 17 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) 18 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) 19 20 21 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% 22 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 23 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. 24 Question What would you include in patient teaching for a man undergoing a vasectomy? 25 Answer Ice post procedure Analgesics Need a semen analysis before having unprotected sex. 26 Question What for of birth control has a high failure rate when used in a typical manner? 27 Answer Male condoms 28 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. 29 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 30 31 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 32
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