Patho Ch 39 Disorders of Male GU

Which of the following diagnoses is most likely to require surgical correction? A. Hypospadias B. Orchitis C. Erectile dysfunction D. Spermatocele

A Hypospadias is a congenital disorder of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra; surgery is the treatment of choice for hypospadias. Orchitis, erectile dysfunction (ED), and spermatocele rarely require surgical intervention.

After seeking care due to recent history of testicular enlargement and scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which of the client's following statements indicates the need for further teaching? A. "I can't shake this feeling like I've received a death sentence." B. "I have to admit that the prospect of losing a testicle is a bit overwhelming." C. "I really hope the cancer hasn't spread anywhere, because I've read that it's a possibility." D. "I guess there's some solace in the fact that this cancer wasn't a result of an unhealthy lifestyle."

A Testicular cancer has the potential for metastasis, but outcomes are positive for most clients and survival rates are high. With appropriate treatment, the prognosis for men with testicular cancer is excellent. Orchiectomy remains the standard treatment, and the pathogenesis of testicular cancer is not thought to be related to lifestyle factors.

During physical exam of a newborn, the nurse palpates the scrotal sac and only locates one testicle. Which statement about undescended testicles is most accurate? A. "The child can become infertile later in life as a result of decreased sperm count." B. "This is more common in full-term infants when compared to premature births." C. "This may be a precursor to the development of prostate cancer later in life." D. "The child will need surgery to move the testes back into the scrotal sac since they rarely descend spontaneously."

A The consequences of cryptorchidism include infertility, testicular torsion, testicular (rather than prostate) malignancy, and the possible psychological effects of an empty scrotum. Males with cryptorchidism usually have decreased sperm counts, poorer-quality sperm, and lower fertility rates than do men whose testicles descend normally. Spontaneous descent often occurs during the first 3 months of life, and by 6 months of age, the incidence decreases to 0.8%. Spontaneous descent rarely occurs after 4 months of age.

Which of the following disorders of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment? A. Spermatocele B. Benign prostatic hyperplasia (BPH) C. Intravaginal testicular torsion D. Erectile dysfunction

C Although all of the noted health problems warrant monitoring and possible treatment, intravaginal testicular torsion is an emergency that requires prompt surgery to save the torsed testicle.

Which of the following clients is at greatest risk for developing balanitis xerotica obliterans? A. A homosexual male with a monogamous partner B. A client who has had their pituitary gland removed due to cancer C. A male who has an uncircumcised penis D. A middle-aged male with history of chronic prostatitis

C Balanitis xerotica obliterans is a chronic, sclerosing, atrophic process of the glans penis that occurs solely in uncircumcised men. As such, the uncircumcised state supersedes the influence of sexual behavior, prostatitis, or hormonal effects of not having a pituitary gland.

Men older than age 50 are at high risk for prostatic hypertrophy with complications that include: A. Hypospadias B. Scrotal edema C. Urine retention D. Testicular cancer

C Benign prostatic hypertrophy (BPH) is a common disorder in men over 50; because the prostate encircles the urethra, BPH exerts its effect through obstruction of urinary outflow from the bladder. Hypospadias is a congenital condition in which the termination of the urethra is on the ventral surface of the penis. Scrotal edema is often the result of testicular disease or inflammation rather than prostate enlargement. Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort.

A client comes to the college campus nurse complaining of unilateral pain, swelling, and redness on his scrotal area. The nurse knows these clinical manifestations are likely caused by: A. Syphilis B. Testicular torsion C. Epididymitis D. Ticks bites

C Epididymitis is characterized by unilateral pain and swelling, accompanied by erythema and edema of the overlying scrotal skin that develops over a period of 24 to 48 hours. Initially, the swelling and induration are limited to the epididymis. Syphilis is a sexually transmitted disease that is contagious and caused by a spirochete (Treponema pallidum). If left untreated it can produce chancres, rashes, and systemic lesions in a clinical course with three stages continued over many years. Twisting of the spermatic cord (which is very painful) with a resulting compromise of the blood supply to the testis is known as testicular torsion. There is no indication that the client has experienced a tick bite.

A 41-year-old male client is planning on having a vasectomy. While explaining this surgery to the client, the health care worker will include which physiologic principle as the basis for this contraception technique? A."Spermatogenesis is inhibited because sex hormones no longer stimulate the Sertoli cells." B. "Spermatozoa can no longer reach the epididymis and do not survive." C. "The rete testis becomes inhospitable to sperm." D. "Sperm can no longer pass through the ductus deferens."

D When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis is altered.

A client arrives in the emergency department complaining of severe testicular pain associated with nausea and vomiting. Their pulse rate is 120 beats/minute. Physical exam reveals an enlarged testis that is painful to palpation. The nurse suspects: A. Inguinal hernia B. Cancer of the scrotum C. Testicular aneurysm D. Testicular torsion

D With testicular torsion, the testis rotates about the distal spermatic cord, obstructs perfusion through the testicular arteries and spermatic veins, and obstructs nerve conduction. The torsion obstructs venous drainage, with resultant edema and hemorrhage, and subsequent arterial obstruction. The dartos muscle separates the two testes and responds to changes in temperature by contracting when cold and relaxing when warm. Most squamous cell cancers of the scrotum occur after 60 years of age and are linked to poor hygiene, chronic inflammation, exposure to ultraviolet A radiation, or human papilloma virus (HPV). After descent of the testes, the inguinal canal normally closes almost completely; failure of this canal to close predisposes to the development of an inguinal hernia later in life.

A client has been diagnosed with an anterior pituitary tumor, and synthesis and release of follicle-stimulating hormone has become deranged. What are the potential consequences of this alteration in endocrine function? A. Dysfunction of spermatogenesis B. Overproduction of luteinizing hormone C. Inhibition of testosterone synthesis D. Impaired detumescence

A Two gonadotropic hormones are secreted by the pituitary gland: FSH and luteinizing hormone (LH). In the male, LH also is called interstitial cell-stimulating hormone. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. FSH does not directly affect the production of LH, since both are produced by the anterior pituitary. FSH does not stimulate testosterone synthesis, and impaired detumescence is unlikely to be a direct consequence of changes in FSH synthesis and release.

Which of the following clinical manifestations are characteristic for clients with Peyronie disease? Select all that apply. A. Painful erection B. Thick, yellow discharge from the penis C. Presence of a hard mass on the tunica albuginea of the penis D. Papillary lesions on penis filled with serous-colored fluid E. Thick, nonretractable foreskin of uncircumcised male

A, C Peyronie disease involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. 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 complain of pain as a symptom. Discharge and lesions from the penis is usually caused from infections or STDs. Thick, nonretractable foreskin of uncircumcised male is associated with balanitis xerotica obliterans.

Which of the following physiologic processes results from the synthesis and release of testosterone? A. Protein catabolism B. Musculoskeletal growth C. Release of luteinizing hormone (LH) D. Prostatic hyperplasia

B Among the numerous effects of testosterone are the promotion of musculoskeletal growth in particular and protein anabolism in general. LH and FSH precede the synthesis and release of testosterone, whereas prostatic hyperplasia is not a normal effect of testosterone.

Common risk factors associated with erectile dysfunction due to generalized penile arterial insufficiency include: A. Cryptorchidism B. Cigarette smoking C. Testicular torsion D. Benign prostate hypertrophy

B Common risk factors for generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation. Cigarette smoking induces vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Cryptorchidism is a major risk factor for testicular cancer. Benign prostate hypertrophy (BPH) is a risk factor for ejaculatory pathway obstruction rather than erectile difficulties. With testicular torsion, testicular arterial perfusion is impaired.

A 17-year-old male has developed phimosis to the point that he is having difficulty voiding. The nurse should prepare this teenager for: A. Radiation therapy to loosen the foreskin B. Circumcision C. Injection of lidocaine into the head of the penis D. Traumatic retraction of the foreskin

B Phimosis refers to a tightening of the prepuce or penile foreskin that prevents its retraction over the glans. If symptomatic phimosis occurs after childhood, it can cause difficulty with voiding or sexual activity. Circumcision is then the treatment of choice. Radiation therapy is utilized for cancer treatment. Lidocaine and forceful retraction of the foreskin is not a standard treatment for phimosis.

An elderly male client has been diagnosed with prostate cancer. However, because he has a history of heart failure with an ejection fraction of 20% and chronic obstructive pulmonary disease due to many years of smoking, the client is not a candidate for major surgery. Which of the following treatments should the nurse anticipate being utilized for this client? A. Transurethral prostatectomy (TURP) that only utilizes epidural blocks and small amounts of Versed and Fentanyl B. Stent placed to widen and maintain the patency of the urethra C. Teaching the client how to perform a straight catheterization every time they feel the need to empty their bladder D. Brachytherapy inserted into the penis and instilled into the prostate tissue

B The surgical removal of an enlarged prostate can be accomplished by the transurethral, suprapubic, or perineal approach. Currently, transurethral prostatectomy (TURP) is the most commonly used technique. For men who have heart or lung disease or a condition that precludes major surgery, a stent may be used to widen and maintain the patency of the urethra. A stent is a device made of tubular mesh that is inserted under local or regional anesthesia. Within several months, the lining of the urethra grows to cover the inside of the stent. It would be highly unlikely for the client to be asked to straight cath for urination. Brachytherapy would not be a treatment of choice since it would block the passage of urine from the bladder.

Which of the following statements are accurate when it comes to changes in the male reproductive system as one ages? Select all that apply. A. Androgen hormone levels increase with age. B. Sexual energy levels decrease as one ages with decreasing testosterone levels. C. The testes become smaller and lose their firmness. D. The prostate gland enlarges with age. E. The force of ejaculation increases with age.

B, C, D Male sex hormone levels, particularly testosterone, decrease with age. The sex hormones play a part in the structure and function of the reproductive system and other body systems from conception to old age; they affect protein synthesis, salt and water balance, bone growth, and cardiovascular function. Decreasing levels of testosterone affect sexual energy, muscle strength, and the genital tissues. The testes become smaller and lose their firmness. The prostate gland enlarges, and its contractions become weaker. The force of ejaculation also decreases because of a reduction in the volume and viscosity of the seminal fluid.

During a visit to the health care provider, a client complains of swelling in the scrotum. The health care worker suspects a hydrocele and performs an exam by shining a light through the scrotum. If the hydrocele is dense, the health care worker should: A. Continue to monitor the client every 6 months to see if there is a change in size. B. Prescribe diuretics like Lasix to help remove excess fluid. C. Order an ultrasound or biopsy to rule out testicular cancer. D. Gently try to express the fluid out of the scrotal sac.

C Hydroceles are palpated as cystic masses that may attain massive proportions. If there is enough fluid, the mass may be mistaken for a solid tumor. Transillumination of the scrotum (i.e., shining a light through the scrotum to visualize its internal structures) or ultrasonography can help to determine whether the mass is solid or cystic and whether the testicle is normal. A dense hydrocele that does not illuminate should be differentiated from a testicular tumor. The fluid cannot be removed by diuretics or by trying to express the fluid out of the scrotum.

Which of the following statements about screening for prostate cancer is most accurate? A. Digital rectal examination detects the majority of new cases of prostate cancer. B. A positive prostate-specific antigen (PSA) test is definitive for prostate cancer. C. BPH and prostatitis can confound prostate screening results. D. Digital rectal examination and PSA testing have been proven ineffective.

C PSA is a glycoprotein secreted into the cytoplasm of benign and malignant prostatic cells that is not found in other normal tissues or tumors. However, a positive PSA test indicates only the possible presence of prostate cancer. It also can be positive in cases of BPH and prostatitis. Detection using digital rectal examination varies from 1.5% to 7%. Screening remains somewhat controversial, but it has not been proven wholly ineffective.

While discussing the physiological process behind penile erection, the anatomy and physiology instructor mentions that what substance is released to facilitate smooth muscle relaxation and shunting of blood into the sinusoids? A. Norepinephrine B. Nitroglycerine C. Nitric oxide D. Nicotinic acid

C Parasympathetic innervation must be intact and nitric oxide synthesis must be active for erection to occur. Parasympathetic stimulation results in release of nitric oxide, a nonadrenergic-noncholinergic neurotransmitter, which causes relaxation of the trabecular smooth muscle of the corpora cavernosa. This relaxation permits inflow of blood into the sinuses of the cavernosa at pressures approaching those of the arterial system. The nicotinic acid in cigarette smoke can induce vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Nitroglycerine is a vasodilator that has no effect on trabecular smooth muscle. A norepinephrine action is vasoconstriction, rather than relaxation, as part of sympathetic nervous system response.

Squamous cell cancer of the penis is characterized by which of the following clinical manifestations? A. Erectile dysfunction with prolonged erection B. Herpes ulcerations on the penile shaft C. Painless lump on the inner surface of the prepuce D. Smegma accumulation in uncircumcised male requiring regular reminders about hygiene

C The cause of penile cancer is unknown. Invasive squamous cell carcinoma of the penis usually begins as a small lump or ulcer on the glans or inner surface of the prepuce. Several risk factors have been suggested, including poor hygiene, human papillomavirus infections (rather than herpes simplex virus infections), ultraviolet radiation exposure, and immunodeficiency states. There is an association between penile cancer and poor genital hygiene and phimosis. Circumcision confers protection, and hence cancer of the penis is extremely rare in men circumcised at birth. It is thought that circumcision is associated with better genital hygiene, which, in turn, reduces exposure to carcinogens that may accumulate in smegma and decreases the likelihood of potentially oncogenic strains of HPV. Erectile dysfunction can be the result of depression, androgen level imbalance, systemic medications, or arterial insufficiency that are unrelated to squamous cell tissue changes.

Which of the following assessments is most likely to reveal a potential exacerbation in a 70-year-old client's diagnosis of benign prostatic hyperplasia (BPH)? A. Urine testing for microalbuminuria B. Blood test for white blood cells and differential C. Digital rectal examination D. Sperm morphology testing

C The diagnosis of BPH is based on history, physical examination, digital rectal examination, urinalysis, blood tests for serum creatinine and prostate-specific antigen (PSA), and urine flow rate. The digital rectal examination is used to examine the external surface and size of the prostate. An enlarged prostate found during a digital rectal examination does not always correlate with the degree of urinary obstruction. Some men can have greatly enlarged prostate glands with no urinary obstruction, but others may have severe symptoms without a palpable enlargement of the prostate. Proteinuria, increased WBCs, and changes in sperm morphology are not associated with BPH.

Which of the following clients is at high risk for developing acute bacterial prostatitis? A. A middle-aged male with prostate hyperplasia B. A fifth grade male diagnosed with acute pyelonephritis C. An elderly male diagnosed with frequent UTIs testing positive for gram-negative rods D. A sickle cell anemia client complaining of prolonged erection lasting less than 4 hours

C The most likely etiology of acute bacterial prostatitis is an ascending urethral infection or reflux of infected urine into the prostatic ducts. E. coli, other gram-negative rods, and enterococci, organisms known to cause urethritis are the most common infectious agents, rather than a descending bacterial infection from the kidneys (as in pyelonephritis). Benign prostatic hyperplasia (BPH) is an age-related, nonmalignant enlargement of the prostate gland caused by overgrowth of the prostate mucosal glands. Prolonged erection does not increase the probability of developing acute bacteria prostatitis.

A 30-year-old man has been diagnosed with mumps orchitis. The nurse should educate the client that which of the following complications may occur? A. Erectile dysfunction B. Hematocele formation C. Sterility D. Penile atrophy

C The residual effects seen after the acute phase of mumps orchitis include hyalinization of the seminiferous tubules and atrophy of the testes, along with impaired spermatogenesis that has the potential to result in sterility. Spermatogenesis is irreversibly impaired in approximately 30% of testes damaged by mumps orchitis. Penile atrophy, hematuria, and hematocele are not among the signs, symptoms, and sequelae of mumps orchitis.

From the following list of clients, which ones are at high risk for developing priapism? Select all that apply. A. A teenage cocaine abuser who has been "high" for the past 72 hours B. An uncircumcised male with poor hygiene habits C. A sixth grade male returning to school following sickle cell crisis D. A college student with complete spinal cord injury at T12 level following auto accident E. A middle-aged adult male with recent history of myocardial infarction

C, D Priapism is due to impaired blood flow in the corpora cavernosa of the penis. Priapism is classified as primary (idiopathic) or secondary to a disease or drug effect. Secondary causes include hematologic conditions (e.g., leukemia, sickle cell disease, polycythemia), neurologic conditions (e.g., stroke, spinal cord injury), and renal failure. Two mechanisms for priapism have been proposed: low-flow (ischemic) priapism, in which there is stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence (diminution of swelling or erection), and Peyronie disease, which involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. Circumcision trauma to the penis and abnormal tightening of foreskin are external penile problems associated with phimosis rather than the internal vascular problem of priapism.

When evaluating a client with suspected benign prostatic hypertrophy (BPH), the health care worker should collect data related to which of the following signs/symptoms? Select all that apply. A. Frequency of erectile dysfunction B. Enlarged inguinal lymph nodes C. Urinary frequency issues D. Weak urine stream E. Straining to empty the bladder

C, D, E It is now thought that the single most important factor in the evaluation and treatment of BPH is the man's own personal experiences related to the disorder. The American Urological Association Symptom Index consists of seven questions about symptoms regarding incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Erectile dysfunction may develop secondary to the androgen hormone imbalances associated with BPH. Enlarged lymph nodes usually relates to a regional infection.