Chapter 55: Caring for Clients with Disorders of the Male Reproductive System

A client who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this client's concern?

Inform the client that urinary control is likely to return gradually. It is important that the client know that regaining urinary control is a gradual process; he may continue to "dribble" after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A client has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action?

Inform the urologist of this finding. The physician should be informed if there is significant leakage around a suprapubic catheter. Some leakage is expected, but larger amounts should be communicated to the care team. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer?

It is highly responsive to treatment. Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following?

Light yellow and clear Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery. Dark amber urine suggests concentrated urine commonly associated with dehydration.

An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem?

Phimosis Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

A patient is having a DRE in the physician's office and the nurse is to assist in the examination. What can the nurse instruct the client to do to decrease the discomfort from the exam?

Take a deep breath and exhale when the physician inserts a gloved finger into the rectum. To minimize discomfort and relax the anal sphincter during the digital rectal examination, the patient is instructed to take a deep breath and exhale slowly as the practitioner inserts a finger. If possible, he should turn his feet inward so his toes are touching.

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

Take prescribed antibiotics. Home care for a client with epididymitis and orchitis includes instructions to continue administering prescribed antibiotics, take Sitz baths, apply local heat after scrotal swelling subsides, avoid lifting, and refrain from sexual intercourse until symptoms are relieved.

When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI?

The number of sexual partners The single greatest risk factor for contracting an STI is the number of sexual partners. As the number of partners increases, so does the risk of exposure to a person infected with an STI.

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply.

Wearing a scrotal support garment Using sitz baths Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the client to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to:

cryptorchidism. Cryptorchidism (failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.

Which cancer ranks second as the cause of death in American men?

prostate Prostatic cancer is second to skin cancer in frequency among American men. It ranks second as the cause of deaths from cancer. Cancer of the testes is a malignancy seen in men between 18 and 40 years of age. Although this cancer is relatively rare, accounting for approximately 1% of cancers in men, it is the most common type in men between 15 and 34 years of age and is the leading cause of cancer deaths in men between 25 and 34 years of age. Skin cancer ranks first in frequency among American men. Penile cancer is rare and occurs more often in men who are uncircumcised.

Which client is most likely to develop prostate cancer according to a nurse working at a health screening at the local mall?

A 56-year-old African American man Age over 40 and African American race are both risk factors for prostate cancer. Age younger than 40 and Asian heritage reduce the risk of prostate cancer.

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what group?

African Americans African American men have a higher risk of prostate cancer.

A client with a history of hypertension and heart disease is being seen by the urologist because of erectile dysfunction. What would be the most likely cause of the client's erectile dysfunction?

All options are correct. Common causes of ED include neurologic disorder such as spinal cord injury, perineal trauma, testosterone insufficiency, side effects of drug therapy, atherosclerosis, hypertension, and complications of diabetes mellitus. Certain medications such as antihypertensive drugs (e.g., methyldopa, spironolactone), antidepressants, narcotics, and cimetidine can cause sexual dysfunction in men. Atherosclerosis is a common cause of ED. ED may be related to anxiety or depression.

A client is being seen by an urologist for perineal pain, low back pain, fever lasting 5 days, and painful urination. The physician confirms a diagnosis of prostatitis and orders treatment. During client education, which recommendation does the nurse make?

All options are correct. The nurse instructs the client to avoid caffeine, prolonged sitting, and constipation and regularly to drain the prostate gland through masturbation or intercourse. The nurse instructs the client to comply with antibiotic therapy and use a mild analgesic for pain.

A client presents to the emergency department with paraphimosis. The health care provider is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, the nurse should prepare the client for what intervention?

Circumcision Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is used for erectile dysfunction and would not be used for paraphimosis.

A patient is planning to use a 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. Negative-pressure (vacuum) devices may also be used to induce an erection. A plastic cylinder is placed over the flaccid penis, and negative pressure is applied. When an erection is attained, a constriction band is placed around the base of the penis to maintain the erection. To avoid penile injury, the patient is instructed not to leave the constricting band in place for longer than 1 hour.

A client has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following?

Pelvic floor exercises Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include?

Performing perineal exercises frequently throughout the day After a prostatectomy, the client should be instructed in how to perform perineal exercises and to perform them hourly throughout the day, each day. In addition, the client should avoid bearing down (straining) to urinate because of the increased risk for hematuria. He should also avoid strenuous exercise, which increases the tendency to rebleed. The client should be instructed to urinate as soon as he feels the first urge to do so.

A nurse is assessing a client who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what?

Permanent vascular damage The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been implicated in the development of UTIs, chronic pain, or erectile dysfunction.

The student nurse studying the male reproductive tract demonstrates understanding movement of testicular secretions when they exit the penis by selecting which pathway?

Seminiferous tubules, epididymis, vas deferens, ejaculatory duct The correct pathway of testicular secretions is seminiferous tubules, epididymis, vas deferens, ejaculatory duct, urethra, and penis.

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Which nursing intervention is appropriate?

Use sterile technique when irrigating the catheter. If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection. Urinating around the catheter can cause painful bladder spasms. The nurse should encourage the client to drink fluids to dilute the urine and maintain urine output. The catheter remains in place for 2 to 4 days after surgery and is removed only with a physician's order.

A client asks the nurse what PSA is. The nurse should reply that it stands for:

prostate-specific antigen, which is used to screen for prostate cancer. PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.

A client has a suprapubic catheter following surgery to remove the prostate gland. Which interventions will be included in the client's care plan? Select all that apply.

Avoid straining to have a bowel movement. Drink about one glass of water every hour while awake. Bearing down increases blood pressure, which can trigger fresh bleeding. A generous fluid intake keeps the urine dilute and the catheter patent. Traction is maintained for at least 6 hours after surgery. Traction provides pressure on blood vessels, which facilitates hemostasis. Slow or interrupt the bladder irrigation if hyponatremia or fluid excess is suspected; report assessment data to the physician.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize?

Testicular cancer is a highly curable type of cancer. Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

Which client would the nurse identify as having the greatest risk for testicular cancer?

A 36-year-old European American who is HIV positive The client who is 36 years old, European American, and HIV-positive would have the greatest risk. Testicular cancer is the most common cancer diagnosed in men 15 to 35 years old and the second most common malignancy in those 35 to 39 years old. European Americans have a five times greater risk than African Americans and more than two to three times greater risk than Asian, Native American, and Hispanic men. The risk of developing testicular cancer is higher in HIV-positive men. Occupational hazards such as exposure to chemicals in mining, oil, and gas production, and leather processing have been suggested as possible risk factors. No evidence has linked testicular cancer to prenatal exposure to diethylstilbestrol. The client who is 20 years old is in the appropriate age group, but his ethnicity poses a lower risk than that of the 36-year-old European American. Both the 50-year-old Hispanic American and 45-year-old Asian American are at lower risk based on their ethnic group. Additionally, both these clients are not in the typical age group affected. Working in a textile factory and having an enlarged prostate are not risk factors associated with testicular cancer.

A patient experiences hypotension, lethargy, and muscle spasms while receiving bladder irrigations after a transurethral resection of the prostate (TURP). What is the first action the nurse should take?

Discontinue the irrigations. Transurethral resection syndrome is a rare but potentially serious complication of TURP. Symptoms include lethargy, hypotension, and muscle spasms. The first action the nurse should take is to discontinue irrigation. The other interventions listed are not appropriate.

A 29-year-old client has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the client admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the client's subsequent care?

Disturbed Body Image Related to Effects of Surgery The client's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This client is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the client's concerns.

A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?

Prostate biopsy If prostate cancer is detected early, the likelihood of cure is high (Eggert, 2010). It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.

A nurse is teaching a 53-year-old man about prostate cancer, given the fact that he has a family history of the disease. What information should the nurse provide to best facilitate the early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done as recommended. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that are especially relevant when a client has a family history. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A nurse is reviewing a journal article about benign prostatic hyperplasia and possible risk factors associated with this condition. Which factor would the nurse most likely find as playing a role in increasing a man's risk for this condition? Select all that apply.

Smoking Diabetes Hypertension Recent studies have identified smoking (both current and former smoking), heavy alcohol consumption, hypertension, heart disease, and diabetes as risk factors associated with BPH. Atrial fibrillation has not been associated with BPH.

A client is scheduled for a transurethral resection of the prostate (TURP). Which statement demonstrates that the expected outcome of "client demonstrates understanding of the surgical procedure and aftercare" has been met?"

"The surgeon is going to insert a scope through my urethra to remove a portion of the gland." TURP involves the surgical removal of the inner portion of the gland through an endoscope inserted through the urethra. There is no external skin incision. Typically, the procedure is performed in an outpatient setting but may require an overnight hospital stay.

A client with erectile dysfunction is prescribed sildenafil (Viagra). Which of the following would the nurse include in the teaching plan for this client?

"You may experience headache and some flushing with this drug." Sildenafil (Viagra) may cause headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness. It is taken 30 minutes to 4 hours before sexual activity. It can be taken more than once a day, but doing so will not increase its effect. It should be taken only when the client wants to have intercourse, to a maximal dose of 100 mg/24 hours. The drug may cause low blood glucose levels and abnormal liver function tests.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?

Brachytherapy Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. Teletherapy involves 6 to 7 weeks of daily radiation treatments. High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.

A nurse is providing care for a client who has recently been admitted to the postsurgical unit from PACU following a transurethral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action?

Closely monitoring the input and output of the bladder irrigation system Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

Which term refers to a failure of one or both or both of the testes to descend into the scrotum?

Cryptorchidism Cryptorchidism is the failure of one or both of the testes to descend into the scrotum. Hydrocele is a collection of fluid, generally in the tunica vaginalis of the testes. Varicocele is an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum. Phimosis is a condition in which the foreskin is constricted so that is cannot be retracted over the glans.

A nurse is teaching a male client who is older than 50 years about prostate cancer. What teaching should be included by the nurse?

Have a digital rectal examination. A serum prostate-specific antigen level test and a digital rectal exam, which are recommended by the American Cancer Society, are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and those of African American ethnicity. Testicular self-examinations won't identify changes in the prostate gland because of its location in the body. A transrectal ultrasound, complete blood count, blood urea nitrogen, and creatinine level test are usually done after diagnosis to identify the extent of the disease and potential metastasis.

Which of the following may result if prostate cancer invades the urethra or bladder?

Hematuria Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.