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Penis
Penis
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 spongiosum
Epididymis
1st portion of a ductal system that transports sperm from CONGENITAL DISORDERS
the testes to the urethra
Provides for storage, transport & maturation of sperm
PHIMOSIS
Vas 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 duct
Ejaculatory Ducts
Two ducts that descend thru the prostate gland, ending
in the prostatic
Prostate 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 Management
Urethra 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 circumcision
Sperm 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 in
Parts & 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
Treatment
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 Approach
HYPOSPADIAS
Is a malformation that affects the urethral tube and the
foreskin on a male's 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.
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 painful
Sign 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
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 heat
Collaborative 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 mumps
EPIDIDYMITIS 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 (urethral
Causes 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.
TESTICULAR 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.
Clinical 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 feeling
Staging
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 secondaries
Collaborative 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.
Collaborative Management
Medications:
Antibiotics---Carbenicillin (Geocillin);
Ciprofloxacin (Cipro)
Analgesic
Stool softeners
Pt Teaching
Causes / 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 inward
Clinical 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 frequency
PROSTATITIS 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-coli
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 Factors
Collaborative 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 techniques
PRIAPISM
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’s
Causes / 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
anemia
Collaborative 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.
Clinical 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 DISODERS
Collaborative 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
usual
ERECTILE 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 Parkinson's disease, Alzheimer's 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 (Peyronie's 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 can't 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 in
Collaborative 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 deficiency