Group 5 Reproductive Disorder2Presentation Transcript
REPRODUCTIVE SYSTEM DISORDER WELCOME
it is the tightness of the prepuce (foreskin) of the penis that prevents the retraction of the foreskin over the glans. What is PHIMOSIS ?
CAUSES Congenital phimosis Acquired phimosis RISK FACTORS Sex-Male only Age-occur at any age; a higher incidence is seen in infancy and adolescence Repeated catheterization CLINICAL MANIFESTATIONS Pain Penile swelling Penile inflammation Penile discharge/ Purulent discharge Urination difficulties Pain on urination Erythema Tenderness
Gangrene of the glans
Posthitis (inflammation of the prepuce)
Back pressure due to obstruction of flow of urine
Meatal Stenosis - narrowing of penile opening
Sometimes a cancerous ulcer on glans can cause the adhesion to take place.
Infection of the Foreskin
Fibrosis/ Scar Formation
Antibiotics-may control the infection
Application of topical steroid cream for 4-6 weeks to the narrow part of the foreskin
Hot soaks-may help separate the foreskin from the glans
Removal of Tissue
Patient and Parental Education
What is HYPOSPADIA ? is a congenital malformation of the male sex organs: The urethra does not open through the glans of the penis, but somewhere through the underside of the penis shaft or even at the base of the penis.
TYPES ANTERIOR HYPOSPADIA (70% of the cases) MEDIUM HYPOSPADIA (10% of the cases) POSTERIOR HYPOSPADIA (20% of the cases) CAUSES CONGENITAL >Hormonal imbalance >Deficiency during a certain critical period before the baby is born >Genetic factors >Environmental factors CLINICAL MANIFESTATIONS Urethral opening in the shaft of the penis Urinary obstruction Absence of prepuce DIAGNOSIS Physical examination X-rays to provide pictures of the urinary tract
REASONS to have surgery:
first 18 months of life
5-6 years old,before he starts attending school
Types of SURGERY:
Duckett'stechnique: A rectangle of skin is cut from the dorsal prepuce. This rectangle is then transferred to the ventral side of the penis and is involved in the reconstruction of the new urethra.
Mathieu's technique: A strip of skin on the ventral side of the penis is cut an overturned forward in order to cover the meatus until the apex of the glans
Snodgrass's technique: The new urethra is created after the tissue of the ventral surface of the penis has been incised and tubularized
narrowing of the urethra (stricture)
curvature of the penis
Most-operative assistance for hypospadia
The child is discharged on the day following the operation, so as to limit the stay in hospital and the psychological trauma.
In order to help the parents with the post-operative assistance information on the following matters is very useful.
What is EPISPADIA ? It is a congenital anomaly characterized by a variable defect in the dorsal urethra. * It is often part of the condition termed epispadias-exstrophy of the bladder.
more common in whites than in other races.
For classic bladder exstrophy, common in male than in female
As this is a congenital abnormality, newborns are affected.
Abnormal opening from the joint between the pubic bones to the area above the tip of the penis
Backward flow of urine into the kidney (reflux nephropathy)
Short, widened penis with an abnormal curvature
Urinary tract infection
Widened pubic bone
Abnormal clitoris and labia
Abnormal opening where the from the bladder neck to the area above the normal urethral opening
Backward flow of urine into the kidney (reflux nephropathy)
Widened pubic bone
Urinary tract infections
Obtain a CBC
~intravenous pyelogram (IVP)
Obtain an ECG for operating room guidelines.
No medical treatment corrects epispadias.
Surgical repair of epispadias is recommended in patients with more than a mild case. Leakage of urine (incontinence) is not uncommon and may require a second operation.
Urethroplasty and restoring the normal appearance of the genitalia are contraindicated in infancy because of the small size of the structures.
Distal epispadias. Outlining of local flaps from the glans to reconstruct the distal urethra. Reconstruction of distal penile urethra using local flaps (arrows). Vertical island flap drawn on the ventral aspect of the penis. Island flap transferred dorsally and anastomosed to the urethra. Island flap sutured into a tube to reconstruct the missing portion of the urethra. Urethral reconstruction is completed.
Urethrocutaneous fistula with urinary leakage from the new urethra and urethral stricture occur in approximately 10-19% of all epispadias repairs.
Drawing of the final appearance at the end of the operation.
Arm and leg restraints may be necessary
Monitor patients with a flow rate study at 3 weeks and at 3 and 12 months postoperatively.
Hyperthermia related to inflammatory process
Pain related to disease process
Urinary incontinence related to disease process
Body image disturbance
Cryptorchidism, is a congenital condition of infant
Literally means hidden or obscure testis and
generally refers to an undescended or maldescended
testis, is the most common genital problem
encountered in pediatrics.
The testes start to develop 40 days after conception.
Male external genitalia during the 3rd and 4th months
of gestation and the fetus continues to grow,
develop, and differentiate.
The testes remain high in the abdomen until the 7th
month of gestation, when they move from the
abdomen through the inguinal canals into the two
sides of the scrotum.
They grow inside the fetal abdomen. Near the end of
the eighth month, they travel down the inguinal canal
and through the abdomen wall.
They reach their low-hanging position in the scrotum
a few days before birth.
Occasionally, one or both testes do not descend into
the scrotum by birth but may come down later.
Support the scrotum in the palm of your hand and become familiar with the size and weight of each testicle.
Examine each testicle by rolling it between your fingers and thumb. Gently feel for lumps, swellings, or changes in firmness.
Each testicle has an epididymis at the top which carries sperm to the penis. Don’t panic if you feel this - it’s normal.
Regular self examination will help you become more aware of the normal feel and size of your testicles so that any abnormalities can be spotted early on.
If you notice anything unusual, go and see your physician as soon as you can.
Early diagnosis and management of cryptorchism is needed to preserve fertility and improve early detection of testicular cancer.
Urologist, may palpate the scrotum and abdomen to locate the testicles while the patient is in the squatting position or in a warm bath.
plasma testosterone concentrations
m easuring the amount of gonadotropin hormone in the blood.
Pelvic ultrasound or magnetic resonance imaging can often, but not invariably, locate the testes while confirming absence of a uterus.
The true undescended testicle may be intra-abdominal, inguinal or suprascrotal.
Ectopic testicles migrate outside the external inguinal ring to an abnormal position, such as the superficial ring pouch (most commonly), perineum, prepenile region, etc.
An absent testicle occurs only in 20 to 40% and can be present as a unilateral or bilateral anomaly.
If hormone therapy is not successful, the doctor may perform a surgery called orchiopexy through a small cut in the groin.
An orchiopexy is used to repair an undescended testicle in childhood. An incision is made into the abdomen, the site of the undescended testicle, and another is made in the scrotum (A). The testis is detached from surrounding tissues (B) and pulled out of the abdominal incision attached to the spermatic cord (C). The testis is then pulled down into the scrotum (D) and stitched into place (E).
Collection of amber fluid within the testes, tunica vaginalis, and spermatic cord.
Hydroceles may be a sign of a more serious condition
Hydrocele can be present at birth (congenital)
Hydroceles occur in males only. The testes, or testicles, are the two male reproductive glands that produce sperm and the male hormone testosterone.
Men who have a hydrocele experience swelling of the testicles
Unknown in newborns
Hydroceles that appear later in life may be caused by
an injury or surgery to the scrotum or groin area, by
inflammation or infection of the epididymis or
Hydroceles may occur with cancer of the testicle or
the left kidney.
Often a hydrocele does not cause symptoms.
enlargement of your scrotum
redness of the scrotum
a feeling of pressure at the base of the penis.
Discomfort in sitting and walking
Diagnosis will begin with taking a careful
history, including sexual history, recent
injury, or illnesses, and observing signs
Hydroceles can sometimes be diagnosed
in the doctor's office by visual examination
and palpation (touch).
Hydroceles are distinguished from other
testicular problems by transillumination
(shining a light source through the
hydrocele so that the tissue lights up) and
ultrasound examinations of the area
around the groin and scrotum.
Abdominal X-ray. A basic X-ray uses
electromagnetic radiation to make images
of your bones, teeth and internal organs.
Infection or tumor. Either may impair sperm
production or function.
Inguinal hernia. A loop of intestine could become
trapped in the weak point in the abdominal wall
(strangulated), a life-threatening condition.
Surgical excision (Hydrocelectomy).
Hydrocelectomy may require you to have a drainage tube and wear a bulky dressing over the site of the incision for a few days after surgery. Also, you may be advised to wear a scrotal support for a time after surgery. Ice packs applied to the scrotal area during the first 24 hours after surgery may help reduce swelling. Surgical risks include blood clots, infection or injury to the scrotum.
Post operative care
Instruct the client that if an incision drain may present,
some serous-sanguineous may be present in the first
2 – 48 hours after surgery.
Explain the importance of wearing scrotal support.
Assess and observe the client for pain every 2-3 hours
immediately after surgery.
If the client pain does not resolve this time, be alert to
the possible development of wound complication
such as infection or bleeding.
Instruct the client to schedule a follow-up visit with the
surgeon to have the wound evaluated for healing.
Stress the importance of continuing to wear a scrotal
support to promote drainage and comfort
Instruct the client to stay off his feet for 3-5 days and
to limit physical activity for a week.
Here is a large hydrocele of the testis
Enlarged left hemiscrotum Puncture: serohemorrhagic liquid exposure of the vaginal cavity. Skin suture and declivis drainage of hemiscrotum.
Varicocele is an enlarged mass of veins in the spermatic
cord in the scrotum
Varicoceles reduce blood flow in the testicles (testes)
Impaired blood flow in the testicles can affect sperm
Varicocele is a common cause for male infertility
A varicocele develops when the valve that regulates blood flow from the vein into the main circulatory system becomes damaged or defective. Reduced blood flow in the spermatic cord can cause enlarged veins. Enlarged veins in the testicles can lead to infertility. Causes
Signs and Symptoms
Most men who have a varicocele have no symptoms.
Asymptomatic (i.e., symptom-free) cases are often
diagnosed during a routine physical examination.
Signs and symptoms include the following:
Ache in the testicle
Feeling of heaviness in the testicle(s)
Shrinkage (atrophy) of the testicle(s)
Visible or palpable (able to be felt) enlarged vein
Recurrent or constant discomfort or pain in the genital region should be reported to a urologist or primary care physician to determine the cause.
Varicocele Ligation Varicocele Embolization
Large varicoceles may be seen with
the naked eye.
Medium-sized varicoceles may be detected
during physical examination by feeling
(palpating) the area. A patient suspected of
having a varicocele should be examined
while standing up, as a varicocele is more
prominent in this position than while lying
down, face up (supine).
Small varicoceles may be discovered by
physician using one of the following
varicocelectomy (i.e., surgically "tying off" the affected spermatic veins). The following methods are used.
Shrinkage of the affected testicle (atrophy).
What is the prostate gland?
The prostate gland is an organ that is located at the base or outlet (neck) of the urinary bladder.
One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds.
Another function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar.
What is prostate cancer?
Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland.
Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer.
Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.
What causes prostate cancer?
The cause of prostate cancer is unknown.
The risk (predisposing) factors for prostate cancer
Age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products.
Environmental factors, such as cigarette smoking and diets.
What are the symptoms of prostate cancer? In the early stages
Prostate cancer often causes no symptoms for many years.
Experience burning with urination or blood in the urine.
Painfully obstructed and enlarged urinary bladder.
Needing to urinate often, especially at night
Weak flow of urine
In the later stages
Pain in the abdomen and jaundice (yellow color of the skin)
Chest pain and coughing.
What are the screening tests for prostate cancer?
Digital rectal examination
Prostate specific antigen (PSA)
Biopsy of the prostate
What are the treatment options for prostate cancer?
Through the abdomen
Between the scrotum and anus
TURP ( transurethral resection of the prostate )
Early diagnoses can be made by screening men for prostate cancer.
Early treatment of these malignancies (cancers) can stop the growth
Avoid having multiple partner
The ovaries are part of a woman's reproductive system
The ovaries make the female hormones -- estrogen and progesterone.
They also release eggs
Ovarian cancer can:
Family history of cancer
Personal history of cancer
Age over 55
Signs and Symptoms
Pressure or pain in the abdomen, pelvis, back, or legs
A swollen or bloated abdomen
Nausea, indigestion, gas, constipation, or diarrhea
Feeling very tired all the time
Less common symptoms include:
Shortness of breath
Feeling the need to urinate often
Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Spread of the cancer to other organs
Progressive function loss of various organs
Ascites (fluid in the abdomen)
Rarely, radiation therapy
Same as with the prostate cancer
Predisposing Factor Precipitating Factor Age ( 30 y. o. and above) Genetics Race (black American) Sex (female) Anatomy hormonal therapy stress in uterine (multiple contraction) nullipara Transformation or abnormal growth of myocytes Growth of Formation of fibroids (asymptomatic) Enlarged fibroids/myomas in the uterus Acute pain pelvic pressure constipation urinary retention infertility/abortion abnormal bleeding fibroid presses other organs erosion of weak fibroids obstruction hysterectomy Fibroids shrink during Menopausal stage myomectomy Able to conceive Unable to conceive Twisting of fibroid stalk
Observation and examination in 4 to 6 months.(for few symptoms or desires child bearing)
If menopausal, fibroids will shrinks and surgery is not necessary
Uterine artery embolism
Avoid jogging, aerobic exercise, participating in sports, or any strenuous activity for 6 weeks
Explain changes in the body after surgery
Take showers rather than tub baths
Avoid the sitting position for any extend period.
Eat a well – balanced diet with extra protein and vitamin c to help heal your tissue
do not engage sex at least 4 to 6 weeks , as prescribed by your surgeon
REFERENCE: INTERNET http://www.healthscout.com/ency/68/360/main.html http://emedicine.medscape.com/article/777539-overview http://www2.hu-berlin.de/sexology/ECE3/html http://www.wrongdiagnosis.com http://www.steadyhealth.com/ http://www.medindia.net/ http://www.urethralsurgery.com http://www.medcyclopaedia.com/ http://www.healthline.com BOOK Medical-Surgical Nursing by Black et.al. 6th edition.