Male Reproductive Disorder- Med surg p.1012-1016.

negative-pressure (vacuum) device to maintain and sustain an erection. What should the nurse caution the patient about with the use of this device?

Do not leave the constricting band in place for longer than 1 hour to avoid penile injury.

Which should be included as part of the home care instructions for a client with epididymitis and orchitis?

Take prescribed antibiotics

Amorphine

dopamine agonist, an older drug used in tx of Parkinson's disease- possible alternative for ED. safer for those with CAD.

ED Nursing Management

if implant- assess for pain, swelling, bleeding and surgical complication like infection.

Tx of torsion of spermatic cord?

immediate surgery to prevent atrophy. apply jockstrap especially when out of bed.

penile prosthesis

implantation of a device designed to provide an erection of the penis; used to treat physical impotence

erectile dysfunction (ED)

impotence; the inability of the male to achieve or maintain a penile erection. Multiple failed erection before dx.

prostatitis

inflammation of the prostate gland by organisms that reach prostate by urethra. E. coli responsible. swelling. Urinary problems. pain. back fever. chills, dysuria. 30 days of antibiotics, sitz bath. pain meds.

Medical management of ED

restore sexual function. PDE5 inhibitors first line.

Concern if cryptorchidism is not corrected by 2 years old:

seminiferous tubules atrophy and fibrous.

Which statement is accurate regarding sildenafil?

side effects include headache, flushing, and dizziness.

PDE5 inhibitors ex

sildenafil (viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn) or avanafil (stendra). Facilitate inflow of blood. no effect w/o sexual stimulation. taken on demand 15 min, 1/2 hr, to 1 hr before sexual activity or daily.

Sildenafil Action

smooth muscle relaxation, vasodilation, and erection (FILs the Penis)

continuous bladder irrigation. Which nursing intervention is appropriate?

sterile when irrigating.

azoospermia

absence of sperm in the semen

Epididymititis & Orchitis causes

assoc, with lower UTI (Cath) & prostatitis, Orchitis w/o epididymal is associated w/ viral mumps after puberty- leads to testicular atrophy and sterility.

ED s/s

can't achieve erection.

Hydrocele, spermatocele, varicocele

cele=swelling. Swelling of scrotum. Varicocele- cause of male infertility and should be surgically repaired.

Testicular cancer has been linked to:

cryptorchidism

structural abnormalities

cryptorchidism, Torsion of spermatic cord, foreskin disorder, benign scrotal swelling.

Torsion of spermatic cord

testicle rotation that twists spermatic cord around testicular artery- reduced blood flow. Occur in prepubescent boys and men. s/s: sharp sudden testicular pain. swelling. n/v, chills and fever from pain. can occur during exercise or even during sleep. Elevation of scrotum intensifies pain.

How is fertility affected by cryptorchidism

the longer the testis remain undescended during childhood, greater risk for compromised fertility.

Phimosis and Paraphimosis

uncircumcised males. Foreskin constricted.

cryptorchidism

undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence. Scrotum empty. At least 1 taste has to be in scrotum to produce sperm.

Etiology for ED:

*Psychogenic* *Neurogenic/neurologic* *Venous & Arterial insufficiency* Hormonal imbalance *Cavernosal VENOUS leak* Impaired venous occlusion

ED Possible complications:

- Erosion of penile or urethral tissue from implant. -Erosion of scrotal, bowel, or bladder tissue if an implant w/ a fluid reservoir is used. - Migration of cylinder, pump, or reservoir from intended location. -Malfunction of device by under inflation, bulging, trauma, or improper use.

TX of cryptorchidism

-injection of hCG after infant is 6 mo of age. this stimulate testes to release testosterone causing descent into scrotum. If not descended THEN: - Orchiopexy performed between 1-2 years of age.

ED can be caused by # of meds

Antidepressants/ anti anxiety agent, antihistamines, antihypertensives, diuretic, cancer agent, anti cholesterol, antiretroviral, opioids, NSAIDS, Proton pump inhibitors.

A young client who awoke with sudden, severe testicular pain with edema arrives at the ED unable to walk and nauseated. After examination, what treatment would the physician likely order?

In spermatic cord torsion, immediate surgery is necessary to prevent atrophy of the spermatic cord and preserve fertility.

Which term refers to the surgical removal of one or both testes?

Orchiectomy

TSE Instruction

1. both hands palpate testis. normal is smooth and uniform. 2. index and middle finger under testis and thumb on top roll gently. Feel for lumps. 3. find and palpate epididymis-cordlike structure that transports sperm. normal to find one testis is larger than other.

Gerontologic consideration:

ED increase as men age.

Epididymititis & Orchitis

Epididymis inflammation and testis(orchitis). pain and swelling in inguinal area and scrotum.Fever & Chill w/ bacterial infection. swollen testes. scrotal skin red and tense. TX: bed rest, scrotal elevation, analgesics, anti-inflammatory agents. Use ice bags

perineal discomfort, burning, urgency, and frequency with urination.pain with ejaculation.

Prostatitis

Which is the most common type of prostate surgery?

TURP

testicular self-examination (TSE)

examination of the testicles by the patient

orchiopexy

fixation of an undescended testis in the scrotum.

A nurse is teaching a male client to perform monthly testicular self-examinations. Which point is appropriate to make?

highly curable.

phimosis

narrowing of the opening of the prepuce over the glans penis

Causes of ED

neurologic- spinal cord injury, trauma, testosterone insufficiency, atherosclerosis, hypertension, complication of ED, anxiety or depression.

Dx Findings ED

nocturnal penile tumescence and rigidity test- check for spontaneous erection during sleep. - those who do not achieve erection via phosphodiesterase type 5 inhibitors like sildenafil (Viagra) or tadalafil (ciaslis) ultrasound may be performed.

Paraphimosis

painful constriction of glans by retracted foreskin cause- small foreskin, inflammation, poor hygiene or infection. pain w/ erection. can lead to edema and urinary retention. * Circumcision- surgical removal of foreskin or wash under foreskin daily.