Chapter 39: Disorders of the Male Genitourinary System-Patho Level 3

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

"The circumcision will not be done now; the foreskin is needed for surgical repair." 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.

A male client is diagnosed with an inguinal hernia. Which statement by the client indicates that the nurse's teaching about the hernia has been effective?

"The hernia is a loop of bowel protruding through a weak spot in my abdominal muscles." An inguinal hernia or "rupture" is a protrusion of the parietal peritoneum and part of the intestine through an abnormal opening from the abdominal cavity. A loop of small bowel may become incarcerated in an inguinal hernia (strangulated hernia), in which case its lumen may become obstructed and its vascular supply compromised.

An 18-month-old boy is diagnosed with cryptorchidism. Based on this diagnosis, which of the following does the nurse expect to observe during the physical assessment? a) Testes that are hard and difficult to palpate b) Enlargement of the scrotum c) Absence of the testis in the scrotum bilaterally d) Testes that migrate into the abdomen when the child squats

Absence of the testis in the scrotum bilaterally Cryptorchidism is the failure of the testes to descend into the scrotum.

A nurse practitioner has a 30-year-old male patient presenting with fever/chills, urinary frequency/urgency and pain with urination. A urine sample displays cloudy and foul-smelling urine. During digital rectal exam of the prostate, the nurse notes a thick white discharge. A likely diagnosis would be which of the following? a) Acute bacterial prostatitis requiring antimicrobial therapy b) Testicular cancer requiring appointment with an urologist c) Inflammation of the epididymis requiring scrotal elevation d) Urinary tract infection requiring a prescription of sulfur drugs

Acute bacterial prostatitis requiring antimicrobial therapy Manifestations of acute bacterial prostatitis include fever and chills, malaise, frequent and urgent urination, and dysuria. The urine may be cloudy and malodorous because of urinary tract infection. Rectal examination reveals a swollen, tender prostate. During exam, prostatic massage produces a thick discharge with WBCs that grows a large numbers of pathogens on culture.

The pediatric nurse is caring for a newborn with hypospadias. The mother requests that a circumcision be performed prior to discharge. Which information related to treatment of hypospadias should the nurse convey?

Circumcision is avoided as the foreskin will be used to repair the urinary opening. Surgery is the treatment of choice for hypospadias (termination of the urethra is on the ventral surface of the penis). Circumcision is avoided because the foreskin is used for surgical repair, usually performed between the ages of 6 and 12 months.

The stages of the sexual act that constitute the culmination of the male sexual act include which of the following? You selected:

Emission Emission and ejaculation, which constitute the culmination of the male sexual act, are a function of the sympathetic nervous system.

A male athlete admitted to the emergency room is suspected of abusing androgens. Which physical characteristic would the nurse expect to see if the testosterone has been aromatized to estradial?

Enlarged breast Androgens have been abused to enhance athletic performance. By testosterone being aromatized to estradiol in the peripheral tissues, gynecomastia (breast enlargement) can occur.

While teaching a health class to junior and senior male high school students, the school nurse educates them that which of the following is the first sign of testicular cancer? a) Back pain b) Coughing bloody sputum c) Enlargement of the testicle d) One testicle lower than the other in the scrotal sac

Enlargement of the testicle Often the first sign of testicular cancer is a slight enlargement of the testicle that may be accompanied by some degree of discomfort. - Back pain and hemoptysis are last signs leading to a metastatic lesion. -It is normal for one testicle to hang lower than the other.

The nurse is assessing a client with a collection of blood in the tunica vaginalis of the scrotum. How does the nurse correctly document this in the medical record?

Hematocele Disorders of the scrotum and testes include collection of fluid (hydrocele), blood (hematocele), or sperm (spermatocele) in the tunica vaginalis or varicosities of the veins in the pampiniform venous plexus (varicocele.

A patient is admitted with a prolonged and painful erection that has lasted longer than four hours. The nurse knows that this is a true urologic emergency, and that the cause is which of the following? a) Chronic inflammation of the glans penis b) Poor hygiene c) Cardiovascular disease d) Impaired blood flow in the corpora cavernosa of the penis

Impaired blood flow in the corpora cavernosa of the penis Priapism is an involuntary, prolonged (>4 hours), abnormal, and painful erection that continues beyond, or is unrelated to, sexual stimulation. Priapism is a true urologic emergency because the prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of subsequent impotence. Priapism is caused by impaired blood flow in the corpora cavernosa of the penis

A male client has developed priapism. The nurse is aware that the client is at risk for:

Impotence 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 male client reports sudden pain and a bulging in the scrotal sac after lifting a heavy object. The swelling does not reduce when the client is supine and he begins to sweat profusely. What condition is the likely cause of these manifestations? a) Inguinal hernia b) Benign prostatic hypertrophy c) Phimosis d) HPV infection

Inguinal hernia An inguinal hernia is when a loop of small bowel slips into the inguinal canal. -A strangulated hernia occurs when the bowel becomes trapped and blood supply to the bowel is compromised. -Phimosis is when the foreskin is constricted and cannot be easily retracted. -Human papillomavirus (HPV) is a sexually transmitted infection which can cause genital warts, and cervical and penile cancers.

A nurse is evaluating diagnostic tests for a client suspected of having prostate cancer. Which of the following results requires further evaluation? a) Uroflow examination 12 mL/second b) BUN 20 ng/mL c) Creatinine 1.0 ng/mL d) Prostate-specific antigen (PSA) of 12 ng/mL

Prostate-specific antigen (PSA) of 12 ng/mL A prostate-specific antigen (PSA) level of 12 ng/mL is high (<4.0 ng/mL is considered normal); all other tests are within normal limits. Uroflow examination shows obstruction with a flow of less than 7 mL/second (average normal flow is 12 mL/second). The findings are positive for prostate cancer. PSA testing may be recommended annually for men, starting at age 50.

Spermatogenesis, or generation of spermatozoa or sperm, begins at approximately 13 years of age and continues as long as a man remains fertile. It is in the seminiferous tubules that spermatogenesis takes place. Of what is the inner lining of the seminiferous tubules composed? a) Cowper cells b) Leydig cells c) Sertoli cells d) Epididymal cells

Sertoli cells The outer layer of the seminiferous tubules is made up of connective tissue and smooth muscle; the inner lining is composed of Sertoli cells, which are embedded with sperm in various stages of development. The other answers are incorrect.

Priapism (a prolonged painful erection not associated with sexual excitement) can occur at any age. In boys, ages 5 to 10, what are the most common causes of priapism?

Sickle cell disease or neoplasms Priapism can occur at any age, in the newborn as well as other age groups. Sickle cell disease or neoplasms are the most common cause in boys between 5 and 10 years of age. Hemophilia and hypospadias are not linked to priapism in any age group.

The nurse conducting a health promotion class for teenage boys on human reproduction determines that the participants are understanding the information when they state:

Spermatogenesis continues throughout a man's reproductive years. Spermatogenesis typically begins around 13 years of age and continues throughout the reproductive years of a man's life. Spermatogenesis occurs in the seminiferous tubules of the testes. Sperm in various stages of development are embedded in the sertoli cells.

The pediactric nurse is teaching the mother of a newborn with hypospadias about this disorder. Which of these does the nurse convey? a) The opening of the urethra is found on the underside of the penis. b) The foreskin of the penis is unable to be fully retracted. c) Medication will be given to correct this problem. d) Undescended testes are frequently associated with hypospadias.

The opening of the urethra is found on the underside of the penis. In hypospadias, which affects approximately 1 in 350 male infants, the termination of the urethra is on the ventral or underside surface of the penis.

A male patient is being prepared for a physical examination of his prostate gland. How will the nurse explain the location of the prostate gland?

The prostate gland is located in the pelvis, inferior to the bladder. The prostate is a fibromuscular and glandular organ lying just inferior to the bladder.

A client who had been utilizing pharmacologic management for BPH is now experiencing severe signs of obstruction. The client would most likely require:

Transurethral prostatectomy 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

A nurse is performing a genital examination on a male client who develops an erection. Which of the following is the nurse's most appropriate intervention?

reassure the client that this is a normal response and continue with the examination Emission and ejaculation, which constitute the culmination of the male sexual act, are a function of the sympathetic nervous system. Genital stimulation can produce erection. In the flaccid or detumescent state, sympathetic discharge through ?-adrenergic receptors maintains contraction of the arteries that supply the penis and vascular sinuses of the corpora cavernosa and corpus spongiosum. Parasympathetic stimulation produces erection by inhibiting sympathetic neurons that cause detumescence and by stimulating the release of nitric oxide to effect a rapid relaxation of the smooth muscle in the sinusoidal spaces of the corpus cavernosum.

A 40 year-old male client with multiple health problems has been diagnosed with a testosterone deficiency. The nurse knows that which of the following assessment findings would correlate with a testosterone deficiency? Select all that apply.

• A high-pitched voice. • A low muscle mass in proportion to his total body weight. Vulnerability to infection and hip dysplasia would likely not be a manifestation of low testosterone. Low muscle mass, hot flashes and diaphoresis, and a lack of male voice characteristics could develop secondary to testosterone deficiency.

If a male has a history of impaired blood flow in his vascular system, he may be prone to developing: a) Premature ejaculation. b) Penile engorgement. c) Vascular clots in pudendal arteries. d) Erectile dysfunction.

Erectile dysfunction. Vascular disease affects male potency because it may impair blood flow to the pudendal arteries or their tributaries, resulting in loss of blood volume with subsequent poor distention of the vascular spaces of erectile tissue. -Premature ejaculation is not caused by a vascular problem. - Penile engorgement is expected as part of an erection. -Vascular clots may relate to a trauma or surgery to the penis.

Of the following list of medications, which would likely be prescribed to a patient with benign prostatic hyperplasia (BPH) as a way to decrease the prostate size by blocking the effects of androgens on the prostate? a) Imdur (isosorbide mononitrate), a vasodilator b) Leuprolide (Lupron), a gonadotropin-releasing hormone analog c) Finasteride (Proscar), a 5a-reductase inhibitor d) Birth control pills containing both estrogen and progestin

Finasteride (Proscar), a 5a-reductase inhibitor Finasteride (Proscar), a 5a-reductase inhibitor reduces prostate size by blocking the effect of androgens on the prostate. Vasodilators, BCPs, and GnRH analogs do not decrease prostate size.

A male patient is admitted with a spinal injury that has damaged his sacral plexus. The nurse understands that this type of injury could affect the impulse stimulation for initiating the sexual act through which of the following? a) Glans penis b) Scrotum c) Prostate d) Testes

Glans penis The most important source of impulse stimulation for initiating the male sexual act is the glans penis, which contains a highly organized sensory system. Afferent impulses from sensory receptors in the glans penis pass through the pudendal nerve to ascending fibers in the spinal cord by way of the sacral plexus.

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) Transurethral prostatectomy c) Insertion of a urinary catheter d) Injecting the prostate with a chemotherapy drug

Transurethral prostatectomy 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.

While the cause of BPH is unknown, we do know that the incidence of BPH increases with age. What ethnic group is BPH highest in?

African American The incidence of BPH increases with advanced age and is highest in African Americans and lowest in native Japanese. The other answers are incorrect.

The nurse is re-enforcing information given to the client who is asking about screening for prostrate cancer. Which of these will be nurse teach the client about the PSA test?

An elevated score on a PSA test does not necessarily indicate the presence of cancer. A positive PSA test indicates only the possible presence of prostate cancer. It can also be positive in cases of BPH and prostatitis. In fact, every man who has an elevated PSA will not necessarily have prostate cancer. PSA levels normally increase with age.

An elderly male patient is complaining of dribbling after he urinates and feeling like he never empties his bladder. The nurse suspects the patient may have a problem with: a) An enlarged prostate gland. b) Blood clots clogging the urethra. c) Calcium sediment in the bladder. d) Kidney stones.

An enlarged prostate gland. Symptoms of obstruction, including dribbling after urinating and the continuous sensation of having to urinate are most likely due to enlargement of a prostate gland. Kidney stones cause intense flank pain; blood clots are usually associated with trauma or surgery; calcium sediment could imply a kidney stone or be a result of a procedure to break up kidney stones into smaller segments.

The anatomy of the prostate gland is made up of three concentric areas surrounding the prostatic uretha, into which they open. The nurse understands that an overgrowth of the mucosal glands can cause which disorder in older men? a) Benign prostatic hypertrophy b) Testicular cancer c) Prostate cancer d) Neoplasm cells of the prostate

Benign prostatic hypertrophy The prostate gland is made up of many secretory glands arranged in three concentric areas surrounding the prostatic urethra, into which they open. The component glands of the prostate include the small mucosal glands associated with the urethral mucosa, the intermediate submucosal glands that lie peripheral to the mucosal glands, and the large main prostatic glands that are situated toward the outside of the gland. It is the overgrowth of the mucosal glands that causes benign prostatic hypertrophy (BPH) in older men.

The gerontology nurse recognizes that aging male clients may enter a stage referred to as andropause. Which of these does the nurse recognize as characteristic of this stage? a) Decrease in urinary output b) Decline in sexual function c) Prostate cancer d) Weight gain

Decline in sexual function Male sex hormone levels, particularly testosterone, decrease with age. The term andropause has been used to describe an ill-defined collection of symptoms in aging men, typically causing decreased muscle strength, smaller testes, erectile dysfunction, and inhibited sperm production. those older than 50 years, who may have a low androgen levels.

A patient arrives in the emergency department complaining of severe pain in the left testicular area with nausea and vomiting for 2 hours. The left testicle is large and tender to palpation and radiating to the inguinal area. Which of the following reflexes can the nurse assess the absence of to indicate testicular torsion?

Cremasteric reflex When assessing the patient for testicular torsion, the cremasteric reflex is frequently absent. To elicit the cremasteric reflex, the medial aspect of the thigh is stroked and testicular retraction is observed. The other reflexes do not indicate testicular torsion.

A patient arrives in the emergency department complaining of severe pain in the left testicular area with nausea and vomiting for 2 hours. The left testicle is large and tender to palpation and radiating to the inguinal area. Which of the following reflexes can the nurse assess the absence of to indicate testicular torsion? a) Fluid wave b) Superficial neurologic reflex c) Abdominal reflex d) Cremasteric reflex

Cremasteric reflex When assessing the patient for testicular torsion, the cremasteric reflex is frequently absent. To elicit the cremasteric reflex, the medial aspect of the thigh is stroked and testicular retraction is observed. The other reflexes do not indicate testicular torsion.

The male reproductive system is comprised of two systems. The nurse knows that which system is responsible for the transportation and storage of sperm?

Ductile system The ductile system (epididymides, vas deferens, and ejaculatory ducts) transports and stores sperm, and assists in their maturation; and the accessory glands (seminal vesicles, prostate gland, and bulbourethral glands) prepare the sperm for ejaculation.

Which of the following is the final site for sperm maturation?

Epididymis The final site of sperm maturation is in the epididymis. The bladder, urethra, and bulbourethral gland do not store sperm.

In the complex interaction of the sexual act in males, the nurse is aware that there are four stages involved. Which of the following stages involves shunting of blood into the corpus cavernosum?

Erection In the male, the stages of the sexual act involve erection, emission, ejaculation, and detumescence. Erection involves the shunting of blood into the corpus cavernosum.

A patient comes to the clinic and informs the nurse that he was playing soccer and was kicked in the scrotal area on the right side. The nurse observes that the scrotal skin on the right side is dark red. Which of the following should the nurse suspect this patient may have?

Hematocele A hematocele is an accumulation of blood in the tunica vaginalis, which causes the scrotal skin to become dark red or purple. It may develop as a result of an abdominal surgical procedure, scrotal trauma, a bleeding disorder, or a testicular tumor. This client sustained an injury to the scrotal area that created the hematocele. A spermatocele is a painless, sperm-containing cyst that forms at the end of the epidydmis. Spermatoceles are freely movable and transilluminate. A varicocele is characterized by varicosities of the pampiniform plexus, a network of veins supplying the testes. The left side of the scrotum is more commonly affected. A hydrocele forms when excess fluid collecting between the layers of the tunica vaginalis.

The nurse on the urology unit teaches the nursing student that which of these tests assists in detecting a recurrence of prostate cancer after prostatectomy?

PSA level A rising PSA (prostate-specific antigen) after treatment is consistent with progressive disease and is used to detect recurrence after total prostatectomy. Because the prostate is the source of PSA, levels should drop to zero after surgery.

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) "Have you ever fathered a child before?" c) "Yes; some 80- and 90-year-old men have been known to father children." d) "No, fertility ends at 50 years of age."

Yes; some 80- and 90-year-old men have been known to father children." 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.

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

• A sixth grade male returning to school following sickle cell crisis • A college student with complete spinal cord injury at T12 level following auto accident 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.