Male Reproductive System


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Male Reproductive System

  1. 1. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MAN MEDICAL AND SURGICAL NURSING Male Reproductive System Lecturer: Mark Fredderick R. Abejo RN, MAN Anatomy and Physiology of the Male Reproductive System PenisPenis Both a sexual organ & an organ for urination Scrotum Consists mainly of erectile tissue & urethra through  Sac that lies posterior to the penis which semen & urine are released via the meatus  Protects the testes, the epididymis and the vas deferens The meatus is in the glans penis in a space cooler than the abd cavity The glans penis is the cone-shaped end of the penis  Left side normally hangs a bit lower than Right The glans penis is enclosed by a fold of skin called the prepuce or foreskin (may be removed with circumcision) Testes (testicles) Composed erectile muscle: 2 corpus cavernosus /  Produce testosterone & sperm 1 corpus spongiosumMedical and Surgical Nursing 1 Abejo
  2. 2. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANEpididymis 1st portion of a ductal system that transports sperm from CONGENITAL DISORDERS the testes to the urethra Provides for storage, transport & maturation of sperm PHIMOSISVas Deferens  A condition in which the penile foreskin (prepuce) is Continues from the epididymis constricted at the opening, making retraction difficult or impossible Conveys sperm from the epididymis to the ejaculatory  May be congenital or caused by edema or inflammation duct  Often associated with poor hygiene beneath the foreskin Seminal Vesicles (SMEGMA) Provides most of volume of ejaculate Each vesicle joins with vas deferens to form the ejaculatory ductEjaculatory Ducts Two ducts that descend thru the prostate gland, ending in the prostaticProstate Gland Surrounds the urethra at the base of the bladder Assessment Produces an alkaline fld that forms part of the volume of Edema the ejaculate Erythema Prostatic fluid aids the passage of sperm & helps keep Tenderness them alive it also helps protect the sperm from the Purulent Drainage acidity of the vagina Medical ManagementUrethra  Antibiotics--systemic, local Provides for passage of semen & urine through the  Non Surgical : Application of topical steroid cream, such meatus as betamethasone, for 4-6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective.  Surgical : Circumcision Nursing Management  Patient/Parent teaching re: proper cleaning  Teaching re: pros & cons of circumcisionSperm Cells Sperm cells are produced in the seminiferous tubules. PARAPHIMOSIS Sertoli cells nourish the sperm cells and produce small  Is a medical condition where the foreskin becomes amounts of hormone trapped behind the glans penis, and cannot be pulled back Fructose is the main source of energy of sperm to move. to its normal flaccid position covering the glans penis. Normal Number : 60 – 120 million / ml  If the condition persists for several hours or there is any Normal Amount of Semen : 2 -6 ml sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result inParts & Functions gangrene or other serious complications. 1. Head (acrosome, nucleus): contains DNA Acrosome – a vesicle that contains hyaluronidase and proteinases, enzymes that aid penetration of the sperm cell into the secondary oocyte 2. Midpiece (mitochondria) – carry on metabolism that provides ATP for locomotion 3. Tail – a typical flagellum that propels the sperm cell along its way.Medical and Surgical Nursing 2 Abejo
  3. 3. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANMedical Management Risk Factors  This involves compressing the glans and moving the Hypospadias is a congenital (present at birth) anomaly foreskin back to its normal position, perhaps with the aid (abnormality), which means that the malformation occurs of a lubricant. during fetal development.  If this fails, the foreskin may need to be cut (dorsal slit As the fetus develops, the urethra does not grow to its procedure) or removed by circumcision complete length. Also during fetal development the foreskin does notNursing Management develop completely, which typically leaves extra foreskin  Prevention of recurrence is through education of the on the topside of the penis and no foreskin on the patient and his caregivers on the need to pull back the underside of the penis. foreskin over the glans after it has been retracted (for example, when cleaning the glans or passing a Foley Signs and Symptoms catheter) Abnormal appearance of foreskin and penis on exam. Abnormal direction of urine stream. The end of the penis may be curved downward.EPISPADIAS Opening of the penis is NOT at the tip of the penis but is  Is a rare type of malformation of the penis in which the displaced to the downward side or bottom of the penis urethra ends in an opening on the upper aspect (the Penis looks hooded due to malformation of the foreskin dorsum) of the penis. Child has to sit down to void  Epispadias occurs in one of three forms. (1)The urethra may open on top of the head of the penis (2) The entire urethra may be open the full length of the Medical Management penis  Usually, the surgical repair is done when the child is between 6 and 12 months, when penile growth is minimal. (3) The entire urethra may be open with the bladder  At birth, your male child will not be able to undergo opening on the abdominal wall. circumcision, as the extra foreskin may be needed for theExstrophy is a condition where the bladder may appear to be inside surgical repair. The surgical repair can usually be done on an outpatient basis.out and the abdominal wall is partially open leaving the bladderexposed to the exterior of the bodyTreatment  The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora.  The most popular and successful technique is known as the Modified Cantwell-Ransley ApproachHYPOSPADIAS  Is a malformation that affects the urethral tube and the foreskin on a males penis.  The urethra is the tube that carries urine from the bladder to the outside of the body.  Hypospadias is a disorder in which the male urethral opening is not located at the tip of the penis.  The urethral opening can be located anywhere along the urethra.  Most commonly with hypospadias, the opening is located along the underside of the penis, near the tip. CRYPTOCHIDISM (undescended testes)  Is the absence of one or both testes from the scrotum.  This usually represents failure of the testis to move, or "descend," during fetal development from an abdominal position, through the inguinal canal, into the ipsilateral scrotum Causes and Risk Factors Severely premature infants Low birthweight due to either prematurity or intrauterine growth retardation Environmental chemicals — endocrine disruptors — that interfere with normal fetal hormone balance has been proposed and is rarely possible to implicate a specific chemical exposure for an individual child. Hernia repair or other surgery in the inguinal area resulted in trapping of a testis above the scrotum. Exposure to regular alcohol consumption during pregnancy (5 or more drinks per week Exposure to pesticides Gestational diabetes Being a twin Women who drink caffeine (at least 3 drinks per day) [2].Medical and Surgical Nursing 3 Abejo
  4. 4. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MAN SCROTAL / TESTICULAR DISODERS HYDROCELE  A painless collection of clear yellow to amber fluid within the scrotum  Leads to scrotal swelling  Can be transilluminated, ruling out the presence of a fluid or mass.  May be associated with infections, trauma, systemic infections (e.g., mumps  Hydroceles are usually not painfulSign and Symptoms The testicles are noted to be absent in the scrotum by the parent or healthcare provider.Medical Management  The primary management of cryptorchidism is surgery, called orchiopexy.  It is usually performed in infancy, if inguinal testes have not descended after 4–6 months, often by a pediatric urologist or pediatric surgeon  Often, a child is watched until the age of one to see if the testicle will move into the scrotum by itself. If not, affected testicles can be brought down into the scrotum using surgery.  Surgery improves cosmetic appearance and makes examination of the testicles to check for cancer easier.  Surgery may also improve the chance of future fertility in Collaborative Management some cases.  USUALLY NONE unless there is compromised testicular circulation  Surgery is recommended during 12-18 months if hydrocele still present  They should be repaired when they cause symptoms or if they are present during an inguinal hernia repair unless there is compromised testicular circulation and pain embarrassment from increased scrotal size Hydrocele Repair  Hydrocele repair involves surgical correction of a birth defect in which there is an open passageway between the abdomen and scrotum which causes fluid collection around the testicle (Hydrocele) An incision is made just above the groin. The open communication between the abdominal cavity and scrotum is repaired, the fluid is removed from the scrotum, and the incision is closed. In some circumstances, the procedure can be done laparoscopically VARICOCELE  Is an abnormal enlargement of the vein that is in the scrotum draining the testicles.  The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis Cause Thought to be incompetent venous valves or obstruction of the gonadal vein Signs and Symptoms Ragging-like or aching pain within scrotum. Feeling of heaviness in the testicle(s) Atrophy (shrinking) of the testicle(s)Nursing Management Visible or palpable (able to be felt) enlarged vein, likened  Prevent trauma to the incision site to feeling a bag of worms.  Watch out for any signs of bleeding Infertility or decrease sperm count and cause atrophy of  Bed rest and limit movement until wound is heal the testicle, resulting in infertility  Continue medication Pulling" sensation, dull ache in scrotum Scrotal swellingMedical and Surgical Nursing 4 Abejo
  5. 5. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANDiagnosis Clinical Manifestations/Assessment Can be felt upon scrotal palpation (feels like a "bag of Painful scrotal swelling worms) Pain along the inguinal canal & along the vas deferens Ultrasound of scrotum Reddened scrotum Doppler Fever, chills Pyuria, bacteriuria Development of an abscess "Duck waddle" walk Diagnosis Increased WBC count Nuclear med scan with injection of radioactive dye Collaborative Management  Bedrest with scrotum elevated on towel to prevent traction on the spermatic cord, to facilitate venous drainage, and to relieve pain (usually about 3-5 days)  Antibiotics  Intermittent ice packs/cold compresses may help decrease swelling & pain  **Avoid heatCollaborative Management  Avoid lifting, straining, sexual excitement until infection  Usually treated in younger pts (to prevent infertility) and completely resolved (may take 3 - 4 weeks) in pts with pain  Epididymectomy for recurrent/chronic epididymitis  Spermatic vein ligation  Varicocelectomy, the surgical correction of a varicocele, is performed on an outpatient basis. ORCHITIS or ORCHIDITIS  The three most common approaches are inguinal (groin),  Is a condition of the testes involving inflammation. retroperitoneal (abdominal), and  It can also involve swelling and frequent infection. infrainguinal/subinguinal (below the groin).  Post Op Nursing Care Causes / Risk Factors  Ice packs should be kept to the area for the first 24 Epididymitis hours after surgery to reduce swelling. Infection  The patient may be advised to wear a scrotal support Sexually transmitted diseases chlamydia and gonorrhea. for some time after surgery. It can also be seen during active mumps Inadequate immunization against mumpsEPIDIDYMITIS Being older than age 45  Is a medical condition in which there is inflammation of Recurrent urinary tract infections the epididymis (a curved structure at the back of the Congenital problems of the urinary tract testicle in which sperm matures and is stored). Genito-urinary surgery  This condition may be mildly to very painful, and the Long term use of a Foley catheter (tube inserted into the scrotum (sac containing the testicles) may become red, bladder to drain urine) warm and swollen. It may be acute (of sudden onset) or rarely chronic. Clinical Manifestation Scrotal swelling Tender, swollen, heavy feeling in the testicle Tender, swollen groin area on affected side Fever Discharge from penis Pain with urination (dysuria) Pain with intercourse or ejaculation Groin pain Testicle pain aggravated by bowel movement or straining Blood in the semen Diagnostic Procedure Urinalysis Urine culture (clean catch) -- may need several samples, including initial stream, mid-stream, and after prostate massage Tests to screen for chlamydia and gonorrhea (urethralCauses smear) Infection of the prostate CBC Long term use of catheter Doppler ultrasound Prostatic surgery Testicular scan (nuclear medicine scan) Cystoscopic examination Trauma Collaborative Management Urinary tract infection  Antibiotics Chlamydia (most common cause in men under age 35)  In the case of gonorrhea or chlamydia, sexual partners **The causative organism passes upward thru the urethra must also be treated. & the ejaculatory duct, then along the vas deferens to the  Pain medications and anti-inflammatory medications epididymis  When orchitis is caused by a virus, only analgesics (pain relievers) are prescribed.  Bed rest, with elevation of the scrotum and ice packs applied to the area, is recommended.Medical and Surgical Nursing 5 Abejo
  6. 6. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANTESTICULAR CANCER  Cancer that develops in the testicles, a part of the male reproductive system.  It is most common among males aged 15–40 years, particularly those in their mid-twenties.Causes / Predisposing Factors Caucasian men Men aged 15 – 35 Hereditary Sedentary lifestyle Early onset of male secondary characteristics Conditions such as:  Cryptorchidism  Hx of mumps orchitis  Inguinal hernias Hx of testicular ca on the other testesClinical Manifestation a lump in one testis or a hardening of one of the testicles abnormal sensitivity (either numbness or pain) loss of sexual activity or interest sexual withdrawal TESTICULAR TORSION A burning sensation, especially following physical  The spermatic cord that provides the blood supply to a activity. testicle is twisted, cutting off the blood supply, often build-up of fluid in the scrotum or tunica vaginalis, causing orchialgia (pain in the testicle ) known as a hydrocele  Prolonged testicular torsion will result in the death of the a dull ache in the lower abdomen or groin, sometimes testicle and surrounding tissues. described as a "heavy" sensation lumbago - lower back pain An increase, or significant decrease, or sudden decrease in the size of one or both testes. blood in semen general weak and tired feelingStaging  Stage I: the cancer remains localized to the testis.  Stage II: the cancer involves the testis and metastasis to retroperitoneal and/or Paraaortic lymph nodes (lymph nodes below the diaphragm).  Stage III: the cancer involves the testis and metastasis beyond the retroperitoneal and Paraaortic lymph nodes. Stage III is further subdivided into nonbulky stage III and bulky stage III. [11]  Stage IV: if there is liver and/or lung secondariesCollaborative Management  The three basic types of treatment are surgery, radiation therapy, and chemotherapy. Causes / Risk Factors  Surgery: Orchiectomy is a relatively minor surgical Torsions are sometimes called "winter syndrome". procedure to remove a testicle. The procedure is This is because they often happen in winter, when it is generally performed by a urologist. Often it is performed cold outside. ( The scrotum of a man who has been lying as same-day surgery, with the patient returning home in a warm bed is relaxed. When he arises, his scrotum is within hours of the procedure. Some patients elect to exposed to the colder room air. If the spermatic cord is have a prosthetic testicle inserted into their scrotum twisted while the scrotum is loose, the sudden contraction  Prevention: Perform a Monthly Testicular Self that results from the abrupt temperature change can trap Examination the testicle in that position. The result is a testicular Men from puberty onwards should examine torsion.) their testes after a hot shower or bath, when the scrotum is looser. They should first examine Clinical Manifestation each testicle separately, feeling for lumps, and Testicular pain then compare them to see whether one is larger Tenderness of less than 6 hrs of duration. than the other. Reddened scrotum By doing this each month, males will become Fever, chills familiar with what is normal for them. Their testicles should be examined by a doctor Collaborative Management if they notice any of the following:  Testicular torsion is a surgical emergency that needs  a lump in one testicle immediate surgical intervention. If treated within 6 hours,  pain or tenderness there is an excellent chance of saving the testicle. Within  blood in semen during ejaculation 12 hours the rate decreases to 70%, within 24 hours is  build-up of fluid in the scrotum 20%, and after 24 hours the rate approaches 0%  a change in the size of one testicle or the  Once the testicle is dead it must be removed to prevent relative sizes of the two gangrenous infection.Medical and Surgical Nursing 6 Abejo
  7. 7. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANINGUINAL HERNIA Clinical Manifestations  Is a protrusion of abdominal-cavity contents through the Abacterial Prostatitis inguinal canal. urgency, frequency  They are very common (lifetime risk 27% for men, 3% nocturia for women dysuria  There are two types of inguinal hernia, direct and indirect: dull pain in perineum/rectal area back pain Direct inguinal hernias painful ejaculation - occur medial to the inferior epigastric vessels when Bacterial Prostatitis abdominal contents herniate through the external same as Abacterial AND inguinal ring. fever, chills Indirect inguinal hernias urethral discharge upon prostate massage - occur when abdominal contents protrude through the boggy, tender prostate deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis Complications epididymitis cystitis decreased sexual functioning b/o pain Collaborative Management  Medications: Antibiotics---Carbenicillin (Geocillin); Ciprofloxacin (Cipro) Analgesic Stool softeners  Pt TeachingCauses / Risk Factors Comfort Measures---sitz baths Obesity Force Fluid to decrease chance of prostatitis causing Heavy lifting UTI Coughing Importance of completing entire ABC (abstinence, Straining during a bowel movement or be faithful, use condom ) regimen urination Chronic lung disease BENIGN PROSTATIC HYPERPLASIA (BPH) Fluid in the abdominal cavity  An abnormal increase in the number of prostatic cells A family history of hernias can make you  NOT an increase in cell size more likely to develop a hernia.  When the prostate enlarges, it extends upward, into the bladder, and inwardClinical Manifestation  Approx 80% of men over age 50 have some signs of BPH Bulge in the groin or scrotum. The bulge may appear  Cause ---unknown, but believed to be hormone related gradually over a period of several weeks or months, or it may form suddenly after you have been lifting heavy weights, coughing, bending, straining, or laughing. Many hernias flatten when you lie down. Groin discomfort or pain. The discomfort may be worse when you bend or lift. Although you may have pain or discomfort in the scrotum, many hernias do not cause any pain. Heaviness, swelling, and a tugging or burning sensation in the area of the hernia, scrotum, or inner thigh. Males may have a swollen scrotum, and females may have a bulge in the large fold of skin (labia) surrounding the vagina. Discomfort and aching that are relieved only when you lie down.Collaborative Management  Surgical correction of inguinal hernias, called a herniorrhaphy or hernioplasty is a surgical procedure Pathophysiology for correcting hernia. Although androgen levels decrease with aging, the aging prostate appears to become more sensitive to available androgen The expanding tissue compresses surrounding tissue, narrowing the urethra PROSTATE GLAND DISODERS Clinical Manifestation Urinary frequencyPROSTATITIS Nocturia  Inflammation of the prostate gland Hesitancy, decreased force of stream  Two types: Abacterial and bacterial Abd straining upon urination  Abacterial Prostatitis Post-void dribbling can occur after a viral illness Sensation of incomplete emptying can occur after a sudden decrease in sexual activity, Dysuria especially young males Urinary retention (can be complete) many times cause unknown Bladder distention  Bacterial Prostatitis Enlarged prostate (upon rectal exam) usually associated with a lower UTI most common organism= E-coliMedical and Surgical Nursing 7 Abejo
  8. 8. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANComplications B. Suprapubic Prostatectomy UTI (upper & lower)  incision is made into the lower abd & bladder Hydroureter, Hydronephrosis  prostate removed thru the bladder Urinary Calculi  with cystostomy tube and 2-way foley catheter postop Possibly renal failure Epididymitis C. Retropubic Prostatectomy Prostatitis  low abd incision made, bladder is retracted, & prostate is reached directly.Diagnostic HX of S/S D. Perineal Prostatectomy  prostate is removed thru a perineal incision between UA (bacteria, WBC, protein, blood) scrotum & rectum Urine C&S BUN, Creatinine E. Transurethral Incision of Prostate (TUIP) Cath for residual  small incisions are made in the prostate to enlarge the IVP prostatic urethra and relieve obstruction Cystoscopy Rectal exam to palpate prostate Nursing Management Prostate-specific antigen (PSA) to help r/o prostate Postop Care cancer  Care of the patient with CBI Serum Acid Phosphatase Maintain patency of the catheter BX of prostate If drainage is reddish: increase flow rate ( by MD) If drainage is clear: decrease flow rate (by MD )Medical Management Practice asepsis  Pharmacologic Management Use sterile NSS to prevent water intoxication Alpha blockers used for BPH include doxazosin, Monitor for hemorrhage terazosin, alfuzosin, tamsulosin, and silodosin. Client Teaching - Alpha blockers relax smooth muscle in the prostate  Red to light pink urine during the 1st 24 hours and the bladder neck, thus decreasing the blockage  Amber after 3 days postop of urine flow.  Advise not to void around the catheter Finasteride and dutasteride, this medications inhibit  Increase fluid intake 5a-reductase, which in turn inhibits production of  Relieve pain DHT, a hormone responsible for enlarging the  Avoid the following: prostate.  Vigorous exercise Flutamide, Proscar (antiandrogens)  Heavy lifting Antibiotics to tx UTI, other infections  Sexual intercourse, 3-6 weeks after discharge  Release of prostatic fluid  Driving, 2 weeks after discharge prostatic massage  Straining with defecation frequent intercourse  Prolong sitting / standing masturbation  Crossing legs  Prevention of overdistention of bladder  Long trips and travel Avoid drinking large amount in short time  Observe the following complications: Avoid diuretics, caffeine  Hemorrhage Void as soon as urge felt  Shock Avoid meds that can cause urinary retention :  Obstruction in lower UT with anticholinergics, antihistamines, decongestants clots/swelling/stricture (with TURP)  Electrolyte imbalanceSurgical Management  Thrombus/EmbolusType of Surgical Procedure  Pain, bladder spasmsDepends on  UTI, epididymitis size of prostate location of enlargement PROSTATE CANCER whether surgery on the bladder is also needed  Most common male Ca pt’s age/physical condition  Androgen – dependent adenocarcinomasA. Transurethral Resection Prostatectomy (TURP)  very common approach  no incision  resectoscope inserted thru urethra & scrapes out the enlarged portion of the gland  CBI ( continuous bladder irrigation or cystoclysis is done postopMedical and Surgical Nursing 8 Abejo
  9. 9. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANCauses / Risk Factors PEYRONIE’S DISEASE 50 years of age and above  Is a condition in which a plaque, or hard lump, forms on Genetic tendency the penis. The plaque may develop on the upper (more Hormonal factors common) or lower side of the penis, in the layers that  late puberty contain erectile tissue.  high frequency of sexual experience  The plaque often begins as a localized area of irritation  history of multiple sexual partners and swelling (inflammation), and can develop into a  high fertility hardened scar. High fat diet  The scarring reduces the elasticity of the penis in the area Air pollutant affected. Exposure to fertilizers, rubber, textile, batteries  The hardened plaque reduces flexibility, causing pain and viruses, STDs forcing the penis to bend or arc during erection.Clinical Manifestation urinary hesitancy hematuria urinary retention stool changes pain radiating down hips and legs cystitis dribbling sensation nocturia hard, enlarge prostate pain in defecation elevated PSA ( prostatic specific antegin ) Causes / Risk FactorsCollaborative Management Unknown cause  Tx depends on staging of disease Predisposing Factors  Total prostatectomy - Vasculitis perineal or retropubic approach usually used - Connective tissue disorder common complications— impotence, incontinence - Hereditary  Radiation  Chemotherapy Collaborative Management  Hormone Therapy (palliative)  A combination of Vitamin E and colchicine has shown some promise in delaying progression of the condition.  Injections to plaques (scar tissue formed by the inflammation) with Verapamil may be effective in some patients. PENILE DISODERS  Surgery, such as the "Nesbit operation",is considered a last resort and should only be performed by highly skilled urological surgeons knowledgeable in specialized corrective surgical techniquesPRIAPISM  Vacuum therapy devices (or penis pumps), which have  Is a persistent, often painful erection that can last from traditionally been used to treat erectile dysfunction, are several hours to a few days. currently being prescribed to help correct the curvature of  The priapism erection is not associated with sexual the penis activity and is not relieved by orgasm.  Injecting medication directly into the plaque in an  It occurs when blood flows into the penis but is not attempt to soften the affected tissue, decrease the pain adequately drained and correct the curvature of the penis.  Penile implants can be used in cases where Peyronie’sCauses / Risk Factors disease has affected the man’s ability to achieve or Alcohol or drug abuse (especially cocaine) maintain an erection. Certain medications, including some antidepressants and blood pressure medications Spinal cord problems Injury to the genitals Anesthesia Penile injection therapy (a treatment for erectile dysfunction) Blood diseases, including leukemia and sickle cell anemiaCollaborative Management  Goal of treatment is to relieve the erection and preserve penile function. In most cases, treatment involves draining the blood using a needle placed in the side of the penis.  Medications that help shrink blood vessels, which decreases blood flow to the penis, also may be used  Surgery may be required to avoid permanent damage to the penis. If the condition is due to sickle cell disease, a blood transfusion may be necessary.  Treating any underlying medical condition or substance abuse problem is important to preventing priapism.Medical and Surgical Nursing 9 Abejo
  10. 10. Lecture Notes on Male Reproductive System SystemPrepared By: Mark Fredderick R Abejo R.N, MANBALANITIS  Exercise, particularly aerobic exercise is an effective  Is an inflammation of the skin covering the head of the cheap treatment for erectile dysfunction penis.  Counseling  A similar condition, balanoposthitis, refers to  A purpose-designed external vacuum pump can be used inflammation of the head and the foreskin to attain erection, with a separate compression ring fitted to the penis to maintain itCauses / Risk Factors uncircumcised poor hygiene irritation by a foul-smelling substance (smegma) that can accumulate under the foreskin. Other condition such as: - Dermatitis - Allergy - Yeast infectionClinical Manifestation First signs – small red erosions on the glans Redness of the foreskin Redness of the penis Other rashes on the head of the penis Foul smelling discharge Painful foreskin and penis EJACULATORY DISODERSCollaborative Management  If there is an infection, treatment will include an appropriate antibiotic or antifungal medication. SPERM CELL / SEMEN DISORDER  In cases of severe or persistent inflammation, a circumcision may be recommended. Aspermia: absence of semen  Taking appropriate hygiene measures can help prevent Azoospermia: absence of sperm future bouts of balanitis. Oligospermia: low semen volume  Avoid strong soaps or chemicals, especially those known Oligozoospermia: low sperm count to cause a skin reaction. Asthenozoospermia: poor sperm motility Teratozoospermia: sperm carry more morphological defects than usualERECTILE DYSFUNCTION  Is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient RETROGRADE EJACULATION for satisfactory sexual performance.  Occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder.Cause / Risk Factors  Normally, the sphincter of the bladder contracts before Drugs (Anti-depressants (SSRIs) and Nicotine are most ejaculation forcing the semen to exit via the urethra, the common. path of least pressure. When the bladder sphincter does Other drugs such as alcohol, cocaine, and heroin not function properly, retrograde ejaculation may occur. negatively impact male sexual libido.) Neurogenic Disorders (spinal cord and brain injuries, Causes / Risk Factors nerve disorders such as Parkinsons disease, Alzheimers Malfunctioning bladder sphincter disease, multiple sclerosis, and stroke.[4]) Common side effect of medications, such as tamsulosin, Hormonal Disorders (pituitary gland tumor; low or that are used to relax the muscles of the urinary tract abnormally high levels of the hormone testosterone). Diabetes due to neuropathy Arterial Disorders (peripheral vascular disease, hypertension; reduced blood flow to the penis). Treatment Venous leak  These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder: Cavernosal Disorders (Peyronies disease.[5]) Tricyclic antidepressants like Imipramine. Psychological causes: performance anxiety, stress, mental disorders (clinical depression, schizophrenia, substance Antihistamines like Chlorphenamine. abuse, panic disorder, generalized anxiety disorder, Decongestants like Ephedrine and Phenylephrine. personality disorders or traits.), psychological problems, negative feelings Surgery (radiation therapy, surgery of the colon, prostate, PREMATURE EJACULATION bladder, or rectum may damage the nerves and blood  is a condition where a man ejaculates earlier than he or vessels involved in erection. Prostate and bladder cancer his partner would like him to. surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for DELAYED EJACULATION impotence.  Is the inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual Aging. desire and sexual stimulation. Lifestyle: alcohol and drugs, obesity, cigarette smoking  Normally a man can achieve orgasm within 2–4 minutes (Incidence of impotence is approximately 85 percent of active thrusting during sexual intercourse, whereas a higher in male smokers compared to non-smokers. man with delayed ejaculation either does not have Smoking is a key cause of erectile dysfunction. Smoking orgasms at all or cant have an orgasm until after causes impotence because it promotes arterial narrowing. prolonged intercourse which might last for 30–45 Overtraining minutes or more.  n most cases delayed ejaculation presents the condition inCollaborative Management which the man can climax and ejaculate only during  Testosterone supplements may be used for cases due to masturbation, but not during sexual intercourse. hormonal deficiencyMedical and Surgical Nursing 10 Abejo