Problems of The Male Reproductive System

Evaluation & Assessment of ED and it's causes

The health care provider will attempt to determine the cause of the ED through a variety of diagnostic tests. These may include: -glycated hemoglobin -lipid panel for cardiac risk factors -thyroid-stimulating hormone (TSH) to rule out thyroid disease -serum total testosterone Doppler ultrasonography can be used to determine blood flow to the penis.

Active survelliance

This form of treatment involves initial surveillance with active treatment only if the symptoms become bothersome. The average time from diagnosis to start of treatment is up to 10 years. During the AS period, men are monitored at regular intervals through DRE and PSA testing.

Screening for prostate cancer

>40 for men with multiple first-gen relatives >45 for men that are black or have first-gen relative >70 stop screening

Causes & risk factors of BPH

*Cause not entirely known -aging -increased dihydrotestosterone (DHT) levels -black men <65 -genetics -family history -obesity -metabolic syndrome -coffee & caffeine

BPH postop care

-Urinary catheter placed into bladder. -Traction via taping to patient's abdomen or thigh. -Uncomfortable urge to void continuously. -Analgesics for pain. -Intake fluids, 2000 to 2500 daily. -Urine will be blood-tinged after surgery. Small clots and tissue debris may pass. -Some patients will have continuous bladder irrigation (CBI), a 3-way urinary catheter. -When the catheter is discontinued, the patient may experience burning on urination and urinary frequency. -Kegel exercises. -Some cases the patient may be discharge with the catheter in place. -The most common post op complication is hemorrhage; therefore, it is imperative that urine output is assessed for amount and color. ❖The presence of bright red urine with increased viscosity and clots following a TURP indicates arterial bleeding and should be reported to physician immediately. ❖The presence of dark urine with less viscosity and few clots after a TURP indicates venous bleeding, which can be managed by applying traction to the urethral catheter. -Other complications, uncommon, are infection and incontinence.

Interventions for prostate cancer

-active surveillance -radiation therapy -hormone therapy -chemotherapy *Surgery is the most common intervention for a cure -bilateral orchiectomy (removal of both testicles) -laparoscopic radical prostatectomy (LRP) -transrectal high-intensity focused ultrasound (HIFU) -cryotherapy

Causes & risks of prostate cancer

-aging (leading factor, 65> greatest risk) -black men -first-generation relative

Interventions for BPH

-avoid drinking large amounts of fluid at a time -caffeine and alcohol consumption should be limited -avoid drugs that can cause urinary retention -drug therapy -frequent sexual intercourse -void as soon as you feel the urge -Serenoa repens (saw palmetto) - has been used to treat mild to moderate BPH -prostate artery embolization (threads a small vascular catheter into an artery in the wrist or groin. An arteriogram (dye injected in the blood vessels) allows the IR to see the vessels that feed the prostate, into which particles are injected to reduce some of the blood flow. In turn, this shrinks the prostate gland.) -transurethral resection of the prostate (TURP) (enlarged part of the prostate is removed through an endoscopic instrument) -transurethral incision of the prostate (TUIP)

Benign Prostatic Hyperplasia

-benign growth of cells within the prostate gland -prostate gland enlarges, it extends upward into the bladder and inward, causing bladder outlet obstruction (BOO)

Diagnostics for prostate cancer

-digital rectal exam -transrectal ultrasound (TRUS) -biopsy -prostate-specific antigen (PSA) test for screening purposes (the most commonly used and valuable test for early detection of prostate cancer) -serum acid phosphatase level if metastatic prostate cancer is suspected (this is typically elevated in patients who have prostate cancer that has metastasized) -cancer marker test: early prostate cancer antigen (EPCA-2)

Diagnostics for BPH

-digital rectal examination (DRE) -transrectal ultrasound (TRUS) -MRI -Urodynamic pressure-flow studies (determining if there is urine blockage or weakness of the detrusor muscle) -labs to rule out other causes

Erectile dysfunction

-impotence, is the inability to achieve or maintain an erection for sexual intercourse -two types: organic & psychogenic

S/S of prostate cancer

-in early prostate cancer, there are often no signs or symptoms experienced by the patient -first symptoms that the man may notice and report are related to bladder outlet obstruction (BOO), such as difficulty in starting urination, frequent bladder infections, and urinary retention -Gross blood in the urine (hematuria) is a common sign of late prostate cancer. -Pain in the pelvis, hips, spine, or ribs, and swollen nodes indicate advanced disease that has spread. -nocturia -pain with sexual intercourse -unexpected weight loss -advanced prostate cancer=elevated levels of serum acid phosphatase -bone metastasis=elevated serum alkaline phosphatase levels

Effects BPH

-lower urinary tract symptoms (LUTS)—an umbrella term that includes problems such as urinary retention, urinary leaking, or incontinence -overflow urinary incontinence, in which the urine "leaks" around the enlarged prostate, causing dribbling -urinary stasis can also result in urinary tract infections and bladder calculi (stones) -chronic urinary retention may result in a backup of urine and cause a gradual, abnormal distention of the ureters (hydroureter) and enlargement of the kidneys (hydronephrosis) if benign prostatic hyperplasia (BPH) is not treated -hematuria in older men due to infection These effects can lead to kidney disease if not treated.

S/S of testicular cancer

-most common report is a painless, hard swelling or enlargement of the testicle -testicular pain -lymph node swelling -bone pain -abdominal masses or aching -sudden hydrocele (fluid in the scrotum) -gynecomastia (man boobs)

Vasectomy

-most effective mode of male contraception -interruption or occlusion of each vas deferens -vasectomy can be reversed microsurgically in approximately 50% to 70% of cases -The patient is usually instructed by the health care provider to rest for 1 to 2 days, and then he can return to light work. -Heavy lifting, sports, and sexual intercourse should be avoided for at least 1 week. -Teach the patient and partner to use an alternate form of contraception until a 3-month follow-up. At that time, a semen analysis will be performed to determine if the procedure was effective. -Remind the patient that mild pain, swelling, and bruising are normal, however, for the first few days.

Testicular cancer

-occur in one or both testicles, is a rare cancer that most often affects men between 20 and 35 years of age, strikes men at a productive time of life. Two types: • Germ cell tumors (GCTs) arising from the sperm-producing cells (account for most testicular cancers) • Non-germ cell tumors arising from the stromal, interstitial, or Leydig cells that produce testosterone (account for a very small percentage of testicular cancers) -most common type of testicular tumor is seminoma. Patients with seminomas have the most favorable prognoses because the tumors are usually localized, metastasize late, and respond to treatment. They often are diagnosed when they are still confined to the testicles and retroperitoneal lymph nodes.

Prostate Cancer

-prostate cancer is one of the slowest growing, and it metastasizes in a predictable pattern -common sites of metastasis are the nearby lymph nodes, and bones. Some can go to the lungs or liver as well -nearly 100% survival rate

Causes & risks for testicular cancer

-undescended testis (cryptorchidism) -human immune deficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS [HIV-III]) -frequent use of marijuana -history of testicular cancer

Psychogenic ED

If the patient has episodes of ED, it usually has a psychogenic cause. Men with this type of ED usually still have normal nocturnal (nighttime) and morning erections. Onset is usually sudden and follows a period of high stress.

Organic ED

Organic ED is a gradual deterioration of function. The man may first notice diminishing firmness and a decrease in frequency of erections. Causes include: • Vascular, endocrine, or neurologic disease • Chronic disease (e.g., diabetes mellitus, renal failure) • Penile disease or trauma • Surgery or pharmaceutical therapies • Obesity • Psychological conditions

T or F A dry climax may occur if the prostate is removed because it produces most of the fluid in the ejaculate.

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T or F After TURP, teach the patient that sexual function should not be affected after surgery but that retrograde ejaculation is possible, wherein semen flows backward into the bladder so only a small amount will be ejaculated from the penis.

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T or F After prostate cancer is diagnosed, the patient has additional imaging and blood studies to determine the extent of the disease. Common tests include lymph node biopsy, CT of the pelvis and abdomen, and MRI to assess the status of the pelvic and para-aortic lymph nodes. A radionuclide bone scan may be performed to detect metastatic bone disease. An enlarged liver or abnormal liver function study results indicate possible liver metastasis.

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T or F BPH presents as a uniform, elastic, nontender enlargement; whereas cancer of the prostate gland feels like a stony-hard nodule.

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T or F External beam radiation causes ED. & Common potential long-term complications of open radical prostatectomy are erectile dysfunction (ED) and urinary incontinence.

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T or F If he has a retroperitoneal lymph node dissection (RPLND) or chemotherapy, he may become sterile because of treatment effects on the sperm-producing cells or surgical trauma to the sympathetic nervous system resulting in retrograde ejaculation.

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T or F In BPH, detrusor (bladder) muscle thickens to help urine push past the enlarged prostate gland.

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T or F PSA should be drawn before the DRE because the examination can cause an increase in PSA as a result of prostate irritation.

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T or F Some patients may be discharged with a urinary catheter in place for a short period of time. Teach patients not to take a bath or swim, to prevent a urinary tract infection while the catheter is in place. When the urinary catheter is removed, the patient may experience burning on urination and some urinary frequency, dribbling, and leakage. Reassure him that these symptoms are normal and will decrease.

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T or F Synchronous bilateral testicular cancer is extremely rare; many men have metastatic disease versus those who experience primary testicular cancer (in one testicle).

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T or F The patient who had a TURP may have a catheter and continuous bladder irrigation (CBI) in place for several days. For the CBI, a three-way urinary catheter is used to allow drainage of urine and inflow of a bladder irrigating solution (Fig. 67.3). Be sure to maintain the flow of the irrigant to keep the urine clear. When measuring the fluid in the urinary drainage bag, subtract the amount of irrigating solution that was used, to determine actual urinary output. Remind the patient that because of the urinary catheter's large diameter and the pressure of the retention balloon on the internal sphincter of the bladder, he will feel the urge to void continuously. This is a normal sensation, not a surgical complication. Advise him not to try to void around the catheter, which causes the bladder muscles to contract and may result in painful spasms.

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T or F Women who are pregnant or might become pregnant should avoid handling crushed or broken anti-androgen medication because of the risk to birth defect in the male fetus.

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Interventions for ED

Treatment depends on the underlying cause, and may include: • Lifestyle modifications (e.g., smoking cessation, weight loss, management of hypertension) • Management of medications that may cause ED (e.g., antidepressants) • Penile self-injection with prostaglandin E1 • Phosphodiesterase-5 (PDE5) drug therapy • Psychotherapy • Testosterone and PDE5 drug therapy (for men with hypogonadism) • Surgery (prosthesis) • Vacuum-assisted erection devices

Prevention of prostate cancer

eat a healthy, balanced diet, including decreasing animal fat (e.g., red meat) and the intake of dairy product. Also reinforce the need to increase fruits and vegetables. Drink/eat soy too.

S/S of BPH

• Difficulty in starting (hesitancy) and continuing urination • Reduced force and size of the urinary stream ("weak" stream) • Sensation of incomplete bladder emptying • Straining to begin urination • Postvoid (after voiding) dribbling or leaking

Testicular self exam

• Examine your testicles monthly immediately after a bath or a shower, when your scrotal skin is relaxed. • Examine each testicle by gently rolling it between your thumbs and fingers. Testicular tumors tend to appear deep in the center of the testicle. • Look and feel for any lumps; smooth rounded masses; or any change in the size, shape, or consistency of the testes. • Report any lump or swelling to your primary health care provider as soon as possible.