Medical-Surgical Nursing: An

Integrated Approach, 2E
Chapter 31
NURSING CARE OF THE
CLIENT: MALE
REPRODUCTIVE SYSTEM

NVOC 22C
Eliza Rivera-Mitu, RN, MSN

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 Anatomy and Physiology
 The scrotum (two parts;
each contains a testis, an
epididymis, and a portion
of the spermatic cord,
otherwise known as vas
deferens).
 The prostate (an
encapsulated gland that
encircles the proximal
portion of the urethra).
 The penis.

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Common Diagnostic Tests for
Reproductive System Disorders
Laboratory Tests
Type Title Here
Alpha-fetoprotein; Cultures; Human chorionic gonadtropin;Serum calcim;Serum analysis
Prostate-specific antigen; Prostatic smear;Serum alkaline phosphatase;

Radiologic Tests
Dynamic infusion cavernosometry and cavernosography

Surgical Tests
Prostatic biopsy; Testicular biopsy

Other Tests
Nocturnal tumescence penile monitoring
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Inflammatory Diseases:
Epididymitis
 A sterile or nonsterile
inflammation of the epididymis.
 A sterile inflammation may be
caused by direct injury or reflux
or urine down the vas deferens.
 Nonsterile inflammation may
occur as a complication of
gonorrhea, chlamydia, mumps,
tuberculosis, prostatitis, or
urethritis.
 Symptoms include sudden,
severe pain in the scrotum,
scrotal swelling, fever, dysuria,
and pyuria.

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Inflammatory Diseases:
Orchitis  An inflammation of the testes
that most often occurs as a
complication of a bloodborne
infection originating in the
epididymis.
 Causes include gonorrhea,
trauma, surgical manipulation,
and tuberculosis and mumps
that occur after puberty.
 Symptoms include sudden
scrotal pain, scrotal edema,
chills, fever, nausea, and
vomiting.

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Inflammatory Diseases:
Prostatitis

 An inflammation of the prostate which is a

common complication of urethritis caused by
chlamydia or gonorrhea.
 Symptoms include perineal pain, fever,dysuria,
and urethral discharge.
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Nursing Interventions
 Inflammatory Disorders:
 Encourage bed rest
 Monitor VS, esp. temp for fever

 Monitor I & O

 Assess pain

 Sitz bath – provide comfort = PROSTATITIS

 Provide ice pack to scrotum to decrease

swelling
 Elevate or provide scrotal support

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Inflammatory disorders
 Interventions
 Analgesic
 Antibiotic

 Procaine = anesthetic

 Stool softeners

 Digital massage – rectally – release infected

fluid

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Benign Prostatic Hyperplasia
 BPH is a progressive
adenomatous enlargement of
the prostate gland that occurs
with aging.
 More than 50% of men over the
age of 50 and 75% of men over
the age of 70 demonstrate
some increase in the size of the
prostate gland.
 Although this disorder is not
harmful, the urinary outlet
obstruction is a problem.
 Early symptoms include
hesitancy, decreased force of
stream, urinary frequency, and
nocturia.

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Benign Prostatic Hyperplasia
 Diagnosis:
 PSA – prostate specific antigen = high
 Rectal examination – most reliable
 Ultrasound
 Cystoscopy – visualization of bladder
 IVP – Intravenous Pyelography – inject a dye through
vein – visualize bladder, ureters, kidney – allergic to
shellfish or iodine?
 BUN – blood, urea, nitrogen – urine, blood – increase
 Serum creatinine – Increased

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 TURP
•Transurethral Resection of the
Prostate
•Continuous irrigation = reduce or
prevent clot formation = clogs
urethra = urinary retention =
kidney damage
•Monitor I & O
•3-way f/c
•Monitor fluid overload=water
intoxication
•Edema, mental status =
agitation, lethargy

•Monitor for distention -

bladder
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Benign Prostatic Hyperplasia
 Management
 Stent
 Balloon
 Surgical
 TURP
 TULIP – Transurethal Ultrasound-guided Laser-induced
prostatectomy
• Less invasive
 PROSTATECTOMY
 Perineal prostectomy – incision through perineum
 Suprapubic resection – lower abdomen – incision through the
bladder – urethrotomy
 Retropubic – lower abdomen – does not go through the bladder

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Benign Prostatic Hyperplasia
 Pharmacological
 Alpha blockers – relax the smooth muscles
along urinary tract (Hytrin, Cardura) – p. 852
• S/E: dizziness – orthostatic hypotension
 Belladonna & Opium suppository – reduce
post-op bladder spasm
 Narcotic analgesic – relieve p-op pain –
Vicodin, Morphine, Codeine – S/E constipation
 Proscar – androgen hormone inhibitor – may
arrest prostate enlargement

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Benign Prostatic Hyperplasia
 Nsg. Interventions
 Increased fluids – monitor I & O
 Maintain gravity drainage of F/C
 Monitor blood clots and color = bright red = bleeding
 Keep irrigation flowing, note clots
 Monitor VS – pain level, temp – orally, NOT rectal
 Avoid straining, provide stool softeners
 Teach deep breathing, relaxation technique
 Avoid straining
 Observe bladder distention & spasms = ask for
antispasmodic – stops spasms = pain, increase blood
clots

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Malignant Neoplasms:
Breast Cancer
 Breast cancer in males is
an uncommon disorder.
Because it is so
uncommon, it is all the
more dangerous as it is
not considered a threat.
 Late diagnosis is quite
common; therefore, males
need to be educated in
self-examination.
 Signs and symptoms
include breast lumps, pain,
or discharge from nipple.
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 Malignant Neoplasms:
Breast Cancer
Management
•Chemo, radiation, surgical removal
•Subjective data assessment
•pain,emotional & educational needs
•Objective data assessment
•Rating scale, drainage, VS –temp increase, BP,
Pulse, Resp – increased d/t pain
•Nursing management
•P-op: elevate affected arm, not to apply
pressure, B/P, drawing blood, IVs

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 Malignant Neoplasms:
Prostate Cancer

 The second leading cause of cancer deaths in men.

 Risk factors include: advancing age (over 55); first-degree
relative with prostate cancer; African-American heritage; high
level of serum testosterone.
 Five-year survival rate is 89%.

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Prostate Cancer
 S/S
 Early tumor – no symptoms
 Subjective
• Back pain, same symptoms as BPH – hesitancy,
decrease pressure, frequency, dysuria, urinary
retention
 Objective
• Symptoms from metastasis
• Lumps – inguinal
• Enlarged lymph nodes
• Blockage of urethra, and rectal dysfunction

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Diagnostic Test – Prostate CA
 Rectal examination
 PSA- prostate specific antigen – elevated
 Prostatic smear – abnormal cells, dysplasia
 Acid phosphatase – prostate – 100x higher than
normal – PAP – prostatic acid phosphatase
 Serum alkaline phosphatase – increased if bone
metastasis
 Bone scan – metastasis
 MRI, CT scan

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Treatment – Prostate CA
 Radiation, chemo, surgical removal
 Radical perineal prostatectomy – removal of prostate,
surrounding tissues, lymph nodes – inguinal area
 Urethra is anastomosed to the bladder
 Urostomy
 Bilateral orchiectomy (removal of testes)
 TURP
 Estrogen therapy – inhibits serum testosterone =
contradicts
 Agonists of LH – estrogen
 Radioactive seed implant – rectally

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Nsg interventions – Prostate CA
 BPH interventions
 Be supportive – expect feminization, more
emotional, educate
 Gynecomastia – enlargement of the breast
 Control pain – terminally ill = hospice,
palliative care

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Malignant Neoplasms:
Testicular Cancer
 Although it accounts for only 1% of all cancer
in men, it is the most common cancer in young
men between the ages of 15 and 35.
 Essential for clients to learn TSE (testicular
self-examination). – monthly
 During shower
 Five-year survival rate is 95%.
 Management same as prostate cancer

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Assessment
 Subjective data
 Heaviness in scrotum
 Weight loss
 Scrotal pain
 Emotional and educational needs
 Anxiety or depression
 Objective data
 Palpation of abdomen and scrotum – enlarged
 Gynecomastia – enlarged breasts
 Mass in testes
 Drainage, swelling, hemorrhage – post-op

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Malignant Neoplasms:
Testicular Cancer

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Malignant Neoplasms:
Penile Cancer
 A rare cancer that
has a high
correlation with poor
hygiene and delayed
or no circumcision.
 Males with a history
of STDs are also
predisposed to Symptoms include a painless,
developing penile nodular growth on the foreskin,
cancer. fatigue, and weight loss

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Penile cancer
 Surgery – primary treatment
 Penectomy – removal of the penis
 Urostomy – suprapubic or perineal
 No catheterization

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Crytorchidism

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Hydrocele
•Collection of amber
fluid within the testes,
tunica vaginalis, and
spermatic cord
•Painful
•Swelling
•Hydrocelectomy – remoal of the sac
•Discomfort in sitting
and walking •Nsg Interventions:
•Treatment: aspiration •Preoperative and postoperative
(usually in children) management
•Inject a sclerosing •Scrotal support (elevation)
solution – decrease
•Supportive to parents/patient
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 Hypospadias
Classes of hypospadias by
location of the meatus.
 (A) Anterior, on the inferior
surface of the glans penis.
 (B) Coronal, in the
balanopenile furrow.
 (C) Distal, on the distal third
of the shaft.
 (D) Penoscrotal, at the base
of the shaft in front of the
scrotum.
 (E) Scrotal, on the scrotum
or between the genital
swellings.
 (F) Perineal, behind the
scrotum or genital swellings. Abnormal placement of the urethral
opening
Tx: repair of the foreskin, surgery
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Spermatocele – herniation,
protrusion
-non-tender cyst, epididymis, rete testis
Contains milky fluid and sperm

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 Varicocele
-Vein- dilation
-Spermatic cord = Vas
deferens
-Occurs when incompetent or
absent valves in the spermatic
venous system permits blood
to accumulate and increase
hydrostatic pressure
-Hyperthermia – decrease
spermatogenesis = fertility
-Bluish discoloration
-Wormlike mass
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Torsion of the spermatic cord
-Abnormal scrotal
pain
-Scrotal edema
-Nausea &
vomiting, sl. Fever
-Treatment:
-immediate surgery
to untwist the cord,
suturing of the
testicle to the
scrotum
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Impotence
 The inability of an adult male to have an
erection firm enough or to maintain it long
enough to complete sexual intercourse.
 Three types: functional (psychosocial
factors); atonic (result of medications and
disease) and anatomic (Peyronie’s disease,
which causes development of nonelastic,
fibrous tissue just beneath the penile skin).

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Peyronie’s disease
•Fibrous plaque
•Can not penetrate vagina
•Atonic impotence
•Antihypertensive,
sedatives, antidepressants,
tranquilizers, nicotine,
drugs & alcohol
•Diabetes, vascular
neurological disorder Sx – silicone cylinder flexible or
•Functional inflexible

•Decreased libido Hydraulic implant, has pump

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Infertility
 Causes of infertility in males include
varicoceles, cryptorchidism, impaired
sperm, insufficient number of sperm, and
hormonal imbalance.
 Tight-fitting underwear and use of hot tubs
or saunas may decrease the sperm count.
 Treatment includes counseling,
medications, circulatory aids, and surgery.

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Contraception
 Contraceptive options available to males
include abstinence, coitus interruptus -
withdrawal, condoms, or voluntary surgical
sterilization (vasectomy)
 Coitus – sexual intercourse

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Vasectomy
 http://www.vasectomymedical.com/features/
vasectomy-videos.html

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