Chapter 39: Disorders of the Male Genitourinary System

The parents of a baby born with hypospadias ask the nurse if the baby can be circumcised. The best response would be: a. "The circumcision will not be done now; the foreskin is needed for surgical repair." b. "The condition can be treated with topical medication; circumcision is not needed." c. "The circumcision can be performed now." d. "The circumcision will be done when the child reaches puberty."

a. "The circumcision will not be done now; the foreskin is needed for surgical repair." (Explanation: Surgery is the treatment of choice for hypospadias. Circumcision is avoided because the foreskin is used for surgical repair. Factors that influence the timing of surgical repair include anesthetic risk, penile size, and the psychological effects of the surgery on the child.)

An adolescent male comes to the urgent care clinic. Upon assessment, the following is noted: history of circumcision, erythema of the glans, and prepuce with a malodorous discharge. Based on symptoms, the probable diagnosis would be: a. Acute superficial balanoposthitis b. Acute phimosis c. Balanitis xerotica obliterans d. Penal carcinoma

a. Acute superficial balanoposthitis (Explanation: The symptoms for this client are suggestive of acute superficial balanoposthitis. It occurs in males who have phimosis or a large redundant prepuce. Balanitis xerotica occurs in uncircumcised males.)

An adolescent male asks the health care provider what function the testes play in the male body. The best response would be: a. Production of androgens and spermatozoa b. Functions in both urine elimination and sexual function c. Produces the fluid constituents of semen d. Aids in the storage and transport of spermatozoa

a. Production of androgens and spermatozoa (Explanation: The testes function in the synthesis of androgens [male sex hormones] and the production of spermatozoa. The ductile system aids in the storage and transport of spermatozoa, and the accessory genital organs produce the fluid constituents of semen. The penis functions in both urine elimination and sexual function.)

A 52-year-old male diagnosed with erectile dysfunction (ED) asks the nurse what will be implemented as a first option for treatment. The best response would be: a. Psychosexual counseling and PDE-5 inhibitor medications b. Catheterization and increased fluids to increase vascular flow c. Intravenous administration of a PDE-5 inhibitor d. Surgical placement of a penile prosthesis

a. Psychosexual counseling and PDE-5 inhibitor medications (Explanation: Treatment methods include psychosexual counseling, androgen replacement therapy, oral and intravenous drug therapy, vacuum restriction devices, and surgery. Commonly prescribed drugs for ED are the selective inhibitors of phosphodiesterase type 5 [PDE-5]. The PDE-5 inhibitors are taken orally. Surgery would not be the initial therapy, and increasing fluids does not increase blood flow to the penis.)

The nurse is reviewing the laboratory results of a client who has noninflammatory prostatitis. The nurse would expect the results to include: a. Increased PSA level b. Normal leukocyte count c. Positive urine culture for bacteria d. Pain radiating down the inner thighs

b. Normal leukocyte count (Explanation: Men with noninflammatory prostatitis have symptoms resembling those of nonbacterial prostatitis but have negative urine culture results and no evidence of prostatic inflammation [i.e., normal leukocyte count]. A normal leukocyte count indicates no evidence of prostatic inflammation and is a key factor to consider when making a noninflammatory prostatitis diagnosis. PSA and bacterial culture are not used in considering either of these diagnoses.)

A nurse is providing teaching to the parents of a child who has undergone corrective surgery for cryptorchidism. The most important information for the nurse to provide is: a. Explanations that medication therapy needs to be administered until puberty. b. Parents should be taught that their child needs frequent follow-up visits. c. Parents must understand that their child is at increased risk for sterility. d. Teaching should include methods to prevent recurrence of this problem.

b. Parents should be taught that their child needs frequent follow-up visits. (Explanation: Treatment of men with undescended testis should include lifelong follow-up, considering the sequelae of testicular cancer and infertility. Parents need to be aware of the potential issues of infertility and increased risk of testicular cancer. On reaching puberty, boys should be instructed in the necessity of testicular self-examination.)

A client comes to the urgent care center because he thinks he may have a urinary tract infection. He is diagnosed with epididymitis. Select the risk factors that may have contributed to the diagnosis. Select all that apply. a. Recent weight loss b. Recent urinary surgery c. Limited physical activity d. Bike riding e. Sexual activity f. Prostate obstruction

b. Recent urinary surgery d. Bike riding e. Sexual activity f. Prostate obstruction (Explanation: Risk factors for epididymitis in all men include sexual activity, heavy physical exertion, and bicycle or motorcycle riding. Recent urinary tract surgery or instrumentation and anatomic abnormalities such as prostatic obstruction are risk factors in older men. Weight loss is not a cause.)

The health care provider has just completed an assessment of a client who is experiencing erectile dysfunction. Select the psychogenic factors that may be contributing to the dysfunction. Select all that apply. a. Stroke b. Schizophrenia c. Depression d. Parkinson disease e. Anxiety f. Hormonal imbalance

b. Schizophrenia c. Depression e. Anxiety (Explanation: Psychogenic causes of ED include performance anxiety, a strained relationship with a sexual partner, depression, and overt psychotic disorders such as schizophrenia. Depression is a common cause of ED. Organic causes include neurogenic, hormonal, vascular, drug-induced, and penile-related etiologies, Parkinson disease, stroke, and cerebral trauma.)

A 70-year-old male tells the health care provider he is now in a relationship with a younger woman who is capable of reproduction. The client asks if he may still be fertile. The best response would be: a. "Why do you want children at your age?" b. "No, fertility ends at 50 years of age." c. "Yes; some 80- and 90-year-old men have been known to father children." d. "Have you ever fathered a child before?"

c. "Yes; some 80- and 90-year-old men have been known to father children." (Explanation: Gonadal and reproductive failures usually are not related directly to age because a man remains fertile into advanced age; 80- and 90-year-old men have been known to father children. Past history may not identify fertility. Asking "why" is considered a confrontational response.)

A client asks the nurse what can cause or contributes to the development of benign prostatic hypertrophy (BPH). The best response would be: a. Decreased amounts of estrogen lead to the enlargement of the cells within the walls of the prostate gland. b. The repeated actions of bladder retractions place increased pressure on the prostate gland causing hypertrophy of the gland. c. Dihydrotestosterone (DHT) proliferates the growth of prostatic stromal cells, leading to a reduction in the death of the epithelial cells. d. Decreased amounts of intraprostate levels of insulin-like growth factor that results in the overgrowth of the prostate gland.

c. Dihydrotestosterone (DHT) proliferates the growth of prostatic stromal cells, leading to a reduction in the death of the epithelial cells. (Explanation: It is thought that dihydrotestosterone [DHT]-induced growth factors contribute to the development of BPH by increasing the proliferation of prostatic stromal cells and decreasing the death of epithelial cells.)

Select the factor that would increase a male's risk for the development of testicular cancer. a. Occupational exposure to soot b. Improper hygiene practices c. History of cryptorchidism d. Exposure to ultraviolet A radiation

c. History of cryptorchidism (Explanation: History of cryptorchidism is the greatest risk for developing testicular cancer. Additional predisposing factors include genetic factors and disorders of testicular development. The remaining options are risk for scrotum cancer.)

A client who has a strong family history of prostate cancer asks the nurse if there are any dietary modifications to decrease his risk factors. The best response would be: (Select all that apply.) a. Increasing dietary fats b. Decreasing intake of soy c. Increasing tomato-rich products d. Avoiding selenium e. Vitamin D and E supplementation f. Consumption of green tea

c. Increasing tomato-rich products e. Vitamin D and E supplementation f. Consumption of green tea (Explanation: Several factors appear to be protective against the development of prostate cancer: dietary fat reduction, supplementation with vitamins D and E and selenium, and intake of soy, green tea, and tomato-rich products [lycopene] may also be important. Vitamin D is not technically a vitamin, but a steroid hormone that has a variety of antiproliferative and proapoptotic effects.)

The nurse has just completed the admission assessment of a client diagnosed with invasive penile cancer. The most likely plan of treatment will be: a. Application of fluorouracil cream b. Laser treatment to the affected area c. Surgical removal of the affected area d. Radiation treatment to the affected area

c. Surgical removal of the affected area (Explanation: The mainstay of treatment for invasive cancer is surgery. Fluorouracil cream or laser treatments are both conservative treatments. Radiation may be considered a palliative treatment.)

A male client has developed priapism. The nurse is aware that the client is at risk for: a. Cancer of the penis b. Swelling of the testicles c. Premature ejaculation d. Impotence

d. Impotence (Explanation: Priapism is an involuntary, prolonged [>4 hours], abnormal, and painful erection that continues beyond, or is unrelated to, sexual stimulation. The prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. The other results will not occur.)

A parent brings her 8-year-old boy to the emergency department. The child has been complaining of radiating pain in the inguinal area and is experiencing nausea. Upon visual inspection, the left testicle is high in the scrotum and enlarged. Select the most appropriate treatment for the child to receive. a. Administration of pain medications along with ice application. b. An orchiectomy must be performed as soon as possible. c. Manual manipulation of the testicle to encourage descent. d. A surgical detorsion procedure to be performed immediately.

d. A surgical detorsion procedure to be performed immediately. (Explanation: The boy is experiencing testicular torsion. The usual presentation is severe distress within hours of onset, nausea, vomiting, and tachycardia, and the affected testis is large and tender, with pain radiating to the inguinal area. A surgical detorsion is required for this emergent condition. An orchiectomy may be needed at a later time if the testicle is deemed nonviable. The other options are not treatment for this condition.)

A client asks the gynecologist what gland is responsible for urethral lubrication during male sexual stimulation. The best response would be: a. Adrenal glands b. Pituitary gland c. Thyroid gland d. Bulbourethral glands

d. Bulbourethral glands (Explanation: The bulbourethral glands are peanut-sized glands located next to the membranous urethra. Sexual stimulation causes a release of a clear mucous-like secretion that constitutes the major portion of the preseminal fluid and serves to lubricate the penile urethra. The other glands are not involved in the function.)

A client is concerned that he may have mumps orchitis and asks the nurse practitioner what the symptoms would be. The best response would be: a. Abnormal increase in sexual drive b. Purplish or red-colored scrotum after an abdominal procedure c. Painful urination with the presence of urethral discharge d. Painful enlargement of the testes with fever 3 days after parotitis

d. Painful enlargement of the testes with fever 3 days after parotitis (Explanation: Onset of mumps orchitis is sudden - approximately 3 to 4 days after the onset of the parotitis: fever, painful enlargement of the testes, and small hemorrhages into the tunica albuginea. Urinary symptoms are absent. Sexual drive is not increased. Androgenic hormone function is usually maintained in these cases.)

The assessment data of a client include verbalization of painful erections and bent erections, in addition to the presence of a hard mass at the site of fibrosis. The health care provider would interpret this as: a. Priapism b. Prostate disease c. Paraphimosis d. Peyronie disease

d. Peyronie disease (Explanation: The manifestations of Peyronie disease include painful erection, bent erection, and the presence of a hard mass at the site of fibrosis. Approximately two thirds of men report pain as a symptom.)

Select the structure responsible for secreting fructose that will provide energy for spermatic motility. a. Prostate gland b. Bulbourethral gland c. Hypothalamus d. Seminal vesicles

d. Seminal vesicles (Explanation: The seminal vesicles are the only structure that secretes fructose to provide energy for sperm motility.)

A client who had been utilizing pharmacologic management for BPH is now experiencing severe signs of obstruction. The client would most likely require: a. Radiation treatment of the prostate b. Insertion of a urinary catheter c. Injecting the prostate with a chemotherapy drug d. Transurethral prostatectomy

d. Transurethral prostatectomy (Explanation: TURP is the most commonly used treatment for BPH. Late complications of a TURP include erectile dysfunction, incontinence, and bladder neck contractures. Immediate complications of TURP include the inability to urinate, postoperative hemorrhage or clot retention, and urinary tract infection. A catheter would provide only short-term relief and predispose the client to infection. Radiation would be a palliative measure. The condition is not malignant and does not require chemotherapy.)