Health Problems of

the Male
Reproductive System

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 PENILE PROBLEMS
Hypospadias
- a condition in which the urethral opening (meatus) is located
behind glans penis (rounded head or tip of the penis) or anywhere along
ventral surface of penile shaft
Cause
• Unknown
• May be attributed to the malfunction of the
action of estrogens & androgens in the
formation of the urethra & foreskin
Risk factors
• Family hx
• Genetics- recurrence rate is approximately 13
times greater in 1st degree relatives, including
father, brother or son.
• Environmental- exposure to certain substances
during pregnancy
 Signs:
• Urethral opening
not present at tip
of the penis
• Abnormal spraying
(of urine) during
urination
Signs:
• Chordee- downward curve of the penis
 Signs:
• Incompletely formed foreskin (hooded appearance of the penis
because only the top half of the penis is covered by foreskin)
Signs:
-an abnormal appearance of the
tip of the penis (open glans)
Diagnosis
Physical examination:
Opening of the urethra at a location other than
the tip of the penis
Management: Objectives of surgical
correction:
Surgery • Enable child to void
in standing position
& direct stream
voluntarily in usual
manner
• Improve physical
appearance of
genitalia
• Produce a sexually
adequate organ
Management
• Neonatal circumcision is avoided
• Care for urinary catheter inserted
• Antibiotics
• Pain meds
• Anticholinergic medication
• Increase fluid intake
• Applying petroleum jelly
• Encourage quiet play. Avoid straddle toys, sandboxes, swimming activities until
allowed
PENILE PROBLEMS

Epispadias
- a condition in which
the meatal opening
is located on dorsal
surface (top) of
penis
Signs:
• Abnormal meatal opening (above the tip of the
penis)
• Backward flow of urine into the kidney (
vesicoureteral reflux) leading to reflux
nephropathy
• Short, widened penis with an abnormal
curvature
• Prone to UTI
Epispadias can be associated with
bladder exstrophy – a birth defect in which the bladder is
inside out & sticks through the abdominal wall
Diagnostic Evaluation
• P.E.
• Laboratory exams/Blood Tests
• Urine tests
• Imaging studies (MRI & CT scans,
pelvic X-ray, ultrasound, IVP)
Therapeutic Management
Surgery
Objectives of treatment:
Preservation of renal function
Attainment of urinary control
Adequate reconstructive repair
Prevention of UTIs
Preservation of optimum external genitalia with continence & sexual
function
 SURGERY
The Modified Cantwell- The Mitchell
Ransley Technique Technique
•involves • involves taking the
rebuilding" the penis apart
penis completely, then
putting it back together
• taking some of
• done so the urethra is
the penis apart
in the most functional
to move the & normal position, &
urethra to a more dorsal bend (chordee)
normal position is corrected
 Surgery for Bladder Exstrophy

• Complete Repair
• Staged Repair
Care after Surgery
Focused on pain management, immobilization & prevention of
infection

• IVF pain medications (for pain relief)

• Traction -modified Bryant’s traction (for immobilization)
• Prevention of skin breakdown (due to immobilization)
• Routine wound care (to prevent infection)
• I&O monitoring
• Care for urinary catheter inserted (to prevent infection)
• Avoidance of straddle toys, sand boxes, swimming, & rough
activities until allowed (to prevent infection & undue pressure on the repair)
Modified Bryant’s traction
 PENILE
PROBLEMS
Phimosis
-a condition in which the foreskin of the penis is so
tight that it cannot be pulled back off the head of
the penis
• Normal findings in infants & young boys & disappears as the
child grows
• occur in less than 1 percent of teenagers between 16 & 18
S/Sx of Phimosis
• Ballooning of the foreskin with accumulated urine during voiding
• Hematuria
• Painful urination
• Weak urine stream
• Swelling, redness & tenderness of the foreskin
• Recurrent UTIs
• Painful erection
Complications
• Balanitis- infection of the phimotic foreskin
Complications
• Paraphimosis – inability to return the foreskin back to
its normal position over the tip of the penis
Dx:
•History taking
•P.E
Therapeutic Management
• Mild cases: manual retraction of foreskin &
proper cleansing of area
• Application of steroid cream 2x/day for 1 month
• Severe cases: circumcision
Nursing Care Management

• Proper hygiene of the phimotic foreskin

• Advise that foreskin should not be forcibly retracted, since it
may create scarring that can prevent future retraction

 
 HYDROCELE
• occurs in males when fluid fills the scrotum (sac under the penis
that contains the testicles)
• common in newborns & often resolve spontaneously usually by 12
months of age
Causes:
• Reopening of the peritoneal sac in the inguinal canal causing fluid to
leak from the belly into the scrotum
• Blockage in the spermatic cord
• Inguinal hernia surgery
• Infection or injury of the scrotum or a testicle
 Types of Hydrocele

Communicating - the sac does not close, the fluid around the testicle can
flow back up into the abdomen
Non-communicating - there is no connection between the abdominal
cavity & the sac around the testicle in the scrotum
S/Sx
• Swollen scrotum
• Feeling of heaviness in the scrotum
• * should be painless
HYDROCELE
Diagnostic Evaluation
• History Taking
• PE
• Imaging Test-Sonography
• Transillumination
• Blood Tests
• Urine tests
 HYDROCELE
Treatment & Management
• Surgical repair (hydrocelectomy)
• Preoperative preparation of the infant
& appropriate explanation of the
procedure
• Postoperatively, the wound is kept
clean & dry
• Change diaper as soon as it is damped
• Older adults are cautioned to perform
strenuous activity
HYDROCELE
Treatment & Management
• Needle Aspiration
 Buried Penis
• Penis is usually of
• a penis that is covered by normal length &
excess skin in the pubic area function, but is
or scrotum hidden
 Causes
• complications after a
circumcision
• problems with ligaments
• fluid retention
• excess fat
 Complication
s
• problem in urination
• skin irritation
• UTIs
• balanitis
• difficulty achieving erection
• difficulty having sexual intercourse
• psychological problems
(low self-esteem, anxiety, &
depression)
Diagnosis:
PE:
-To distinguish buried
penis from a different
condition, known as
micropenis
 Therapeutic Management
• In very young children, the condition may resolve without any
intervention
• For obese children & adults, weight loss may help
• Antibiotics if infection has developed
• Psychological counselling
• Surgery if necessary is recommended to be done at young age
 TESTICULAR
TUMORS
• occurs in the testicles (testes),
located inside the scrotum
• Uncommon condition but are
usually malignant when found in
adolescence
• most common solid tumor in
males 15 to 34 years of age
 TESTICULAR TUMOR

Clinical Manifestations:
• heavy, hard, painless mass on testis

• does not transilluminate unless

accompanied by a hydrocele

• involved testicle hangs lower

Diagnostic Evaluation

•PE
•UTZ
•CT scan
•Blood tests
(Tumor markers)
 TESTICULAR
TUMORS
Therapeutic Management:
• Orchiectomy & removal of
adjacent lymph nodes if
affected
• Chemotherapy
• Radiotherapy
• Advise to do monthly testicular self-examination
(TSE)
• sperm banking may be appropriate for younger men
who still plan to have children
• hormone supplements – Testosterone (as needed)
 VARICOCELE
• enlargement of the veins within the
loose bag of skin that holds your
testicles (scrotum)
• Characterized by elongation,
dilation, & tortuosity of the veins of
the spermatic cord superior to the
testicle (veins dilate greater than 2 mm)

• incidence increases dramatically at the

onset of puberty
• found most often on the left side
CAUSE

• Defective valves inside the veins in the

spermatic cord prevent the blood from
flowing properly causing backup which theb
causes the veins to widen (dilate)
 VARICOCELE
Clinical Manifestations:
• wormlike mass, situated above the testicle is palpated
• discomfort during sexual stimulation
• left testicle is usually smaller than the right
• decreasing testicular size
• decreasing levels of dihydrotestosterone in seminal plasma
VARICOCELE
Diagnostic Procedure
• Doppler ultrasound – shows dilatation of
the vessels of the pampiniform plexus
VARICOCELE

Treatment & Nsg. Care:

• Varicocelectomy

• Provision of careful
explanations of
infertility evaluation
 TESTICULAR TORSION

• a condition in which the tunica

vaginalis, which normally
encases the testicle, fails to do
so & the testis hangs free from
its vascular structures
• results in partial or complete
venous occlusion with rotation
around the vascular axis
• can cause the testes to twist
around the spermatic cord
TESTICULAR TORSION

• peak onset at 13 years

of age

• most common cause

of testicular loss in
young males
 TESTICULAR TORSION

Clinical Manifestations:
• Testicular pain
• scrotum is swollen & painful
(red, warm, edematous, &
appears to be immobile or fixed)
• n/v
• abdominal pain
• absence of cremasteric reflex
 TESTICULAR
TORSION
Diagnostics

•PE
•X-ray
•Doppler ultrasound –
avascular testicle
•Urine Test
 TESTICULAR TORSION
Therapeutic Management:
• Nurses should be alert to the possibility
of testicular torsion in adolescents who
complain of scrotal pain
• School nurses are likely to encounter
such injuries & should refer the
adolescent for medical evaluation
immediately
• Detorsion
• Surgery
 EPIDIDYMITIS
• an inflammatory reaction of the epididymis
CAUSES:
• bacterial or viral infection (causative factors: Chlamydia trachomatis
& Neisseria gonorrheae)
• a chemical irritant
• or a nonspecific cause
(local trauma)
 EPIDIDYMITIS

Clinical Manifestations:
• slow onset of unilateral scrotal
pain, redness, & swelling
• urethral discharge
• dysuria
• fever
• pyuria
EPIDIDYMITIS

Diagnostic Evaluation
• PE
• Urinalysis
• Ultrasound
• Rectal exam
• Blood tests
• Tests for syphilis & HIV
Complications
• chronic epididymitis
• abscess
• permanent damage of epididymis
leading to infertility &
hypogonadism
• Spread of infection to any other
organ
Therapeutic Management: EPIDIDYMITIS
• antibiotic therapy- azithromycin &
cefixime
• analgesics/anti-inflammatory meds
• scrotal elevation
• scrotal support
• cold compress
• bed rest
• limitation of activity
• surgery if necessary
 GYNECOMASTIA
-an enlargement or swelling of breast tissue in
males
- Maybe unilateral or bilateral
 Incidence & Causes
• occurs frequently in young boys during puberty
• If prepubertal onset-should be evaluated for rare adrenal or gonadal
tumors or Klinefelter syndrome
• can be drug induced:
• Calcium blockers
• Ketoconazoles
• Spinorolactone
• Estrogens
• Cimetidine
• Antiandrogens
• Street drugs - amphetamines, marijuana, heroin, methadone
GYNECOMASTIA
Therapeutic management:
• Stopping of medication if it is the cause/prescription of
different medication
• Plastic surgery for cosmetic & psychologic reasons
• Assurance that situation is benign &temporary
• Counselling
THANK YOU!