Male reproductive system. Organs of the urinary system are also shown.  

Overview of Anatomy and Physiology

Organs of the male reproductive system include:

the testes, the ductal system, the accessory glands and the penis

Functions include: producing and storing sperm, depositing sperm for fertilization and developing the make secondary sex

characteristics

Testes (gonads) - 2 oval structures enclosed in the scrotum ( a sac like structure that lies suspended fro the abdominal wall).

This position keeps the temperature win the testes below

normal body temperature which is necessary for viable

sperm production and storage. - Seminiferous Tubules

-each testis contains 1-3 coiled seminiferous tubules that produce the sperm cells

-Produce testosterone which is responsible for the development of male secondary sex characteristics

Ductal System

-includes the epididymis, rete testes, ductus deferens (vas deferens), ejaculatory duct and

urethra -Process: Sperm produced in the seminiferous

tubules immediately travels through a network of ducts called the rete testes. These passageways contain cilia that sweep sperm out of the testes

into the epididymis (a tightly coiled tube structure).

Epididymis -With sexual stimulation, the walls of the

epididymis contract forcing the sperm along the seminiferous tubules to the vas deferens

Ductus Deferens ( vas deferens) -Approximately 18 inches long

-Rises along the posterior wall of the testes which moves

upward to pass through the inguinal canal into the pelvic

cavity and loops over the bladder -The ductus deferens, nerves and blood vessels are

enclosed in a connective sheath called the spermatic cord. (Vasectomy-severing of the ductus deferens.)

Ejaculatory duct and urethra

-Behind the urinary bladder, the ejaculatory duct

connects with the ductus deferens. It unites with

the urethra to pass through the prostate gland. -Only 1 inch long

-The urethra extends the length of the penis with

the urinary meatus. The urethra carries both sperm and urine but because of the urethral sphincter, it does not do so at the same time.

Accessory Glands

-With each ejaculation (2-5 mL fluid), approximately 200- 500 million sperm are released

-Seminal Vesicles: paired structures that lie at the base of

the bladder and produce 60% of the volume of semen. Fluid is released into the ejaculatory ducts to meet the

sperm -Prostate Gland: surrounds the neck of the bladder and urethra. Composed of muscular and glandular tissue. -Cowper’s Glands: 2 pea sized glands under the male

urethra, provide lubrication during sexual intercourse

Urethra and Penis

-Urethra: conveys urine from the bladder and carries sperm to the outside

-Penis: organ of copulation. The shaft ends with an enlarged tip called the glans penis. The skin covering

the glans penis is called the prepuce or foreskin. -Circumcision: removal of foreskin. Preventative for

phimosis- a tightness of the prepuce (tightness of the prepuce prevents retraction of the foreskin over the

glans). -3 masses of erectile tissue containing numerous sinuses fill the shaft of the penis. These fill with

blood during sexual stimulation causing an erection. After ejaculation, it returns to a flaccid state.

A

Sperm

-3 distinct parts; the head, midpiece and tail -Mature sperm live approximately 48 hours in

the female reproductive system

-If comes in contact with a mature egg, the enzyme on the head of each sperm bombards

the egg in an attempt to breakdown the coating

-Only one sperm enters and causes fertilization.

The remaining sperm disintegrate.

Epididymitis-an infection of the cordlike excretory duct of the testicle

Can be sterile or nonsterile inflammation

-Sterile inflammation can be caused by direct injury, reflux of urine down the vas deferens (reflux is related to

a strain while the bladder is full).

-Nonsterile inflammation can be caused by gonorrhea,

chlamydia, mumps, TB, prostatitis or prolonged use of

a catheter

-Common causative organisms are: Staph. Aureus, E.

Coli, Streptococcus and N. Gonorrhea

INFLAMMATORY DISORDERS

Signs and Symptoms

-Sudden severe pain in the scrotum; radiates

along the spermatic tube; increased sensitivity

and pain with walking -Edema; scrotal area becomes tender

-Chills and fever

Treatment -Diagnostic Tests: UA to check for

pyuria, CBC for WBC check -Epididymis is massaged by the physician, the fluid is expelled and sent to the lab -Bed rest, scrotal support and cold packs

-Antibiotics -If abscess forms, incision and drainage

(I & D)

Nursing Interventions

-Monitor bed rest -Scrotal support (elevate on folded towel; use

athletic support when ambulatory) -Cold compresses

-Patient teaching-medications, signs of inflammatory resolution

Orchitis-inflammation of the testes

-May follow from infection of the urinary or

reproductive tract -Most often occurs as a complication of a blood borne infection origination in the

epididymis -Other causes: secondary to mumps of

viral infection of a salivary gland, trauma of

metastasis

Signs and Symptoms -Swelling

-Severe pain -Chills, fever, vomiting

-Hiccoughs -sometimes delirium

Treatment -Bed rest, scrotal support

-Cold compresses -NSAIDS

-Antibiotics

Nursing Interventions- Same as for epididymis

Prostatitis

Common complication of urethritis caused by Chlamydia or Gonorrhea

Bacterial invasion originates in the bloodstream

or from a descending infection from the kidneys

Acute or Chronic

Signs and Symptoms

INFLAMMATORY DISORDERS

Medical: when urethritis suspected

Should not be catheterized

Possible cultures

MEDICAL-SURGICAL MANAGEMENT

• Pharmaceutical– Antibiotics, Procaine: epididymis, orchitis– Antibiotics, analgesics, and stool softeners:

prostatitis

Activity: Treatment for prostatitis

Bed rest

Scrotum elevated

Cold packs to area

Increase fluids

Sitz baths

MEDICAL-SURGICAL

MANAGEMENT

Monitor vital signs, especially temperature and I&OEncourage intake of fluids

Assess painMaintain bed rest

Keep scrotum elevated while in bedUse of athletic support while ambulatory

Cold pack, as ordered

NURSING MANAGEMENT

Benign Prostatic Hyperplasia (BPH)

Early symptoms: hesitancy, nocturia, eventually unable to completely empty bladder which could lead to infection.

BENIGN NEOPLASMS

Medical: digital rectal exam, diagnostic tests, monitor for increased symptoms.

Non-surgical treatment: Balloon dilatation, a prostate urethral stent, and thermotherapy.

These treatments do not correct the problem of incomplete bladder emptying.

Surgical: Transurethral resection of the prostate, or open surgery (suprapubic or retro pubic ) and perineal prostatectomy.

MEDICAL-SURGICAL

MANAGEMENT

Laser prostatectomy: based on thermal action: transurethral ultrasound-guided laser-induced prostatectomy.

Pharmacological: Finasteride (Procar), Alpha Blockers i.e.. terazosin hydrochloride, doxazocin mesylate, tamulosin

hydrochloride.

Post-op pain: belladonna and opium, and narcotic analgesics.

MED-SURG MANAGEMENT

Foley catheter considerations

Pre-op care as ordered

Monitor and accurately record I&O

Monitor Vital signs and color of urine

Routine post-op care

After catheter removed, encourage voiding at first urge.

NURSING MANAGEMENT

Prostate Cancer:

Second leading cause of cancer deaths in men

Most are adenocarcinomas: slow growing tumors that spread through the lymphatics.

Early symptoms: dysuria, weak urinary stream, increased urinary frequency

Later symptoms: hematuria, urethra obstruction

MALIGNANT NEOPLASMS

Medical: Treatment depends on extent of disease. radiation is alternative to surgery. Not always effective depending on

condition of patient. Also radioactive seed planting is an alternative.

Surgical: Removal of entire prostate gland, including the capsule and adjacent tissue. The urethra is anastomosed to

the bladder neck. Usual approach is perineal.

MED-SURG MANAGEMENT

Medical, con’t: complications of surgery include urinary incontinence, sexual dysfunction, hemorrhage, infection,

thrombosis, and strictures.

Removal of testes (orchiectomy) may be done as palliative measure

Cryosurgery

MED-SURG MANAGEMENT

Pharmacological:

Hormonal agents: diethylstilbestrol, goserelin acetate, or leuprolide acetate

Systemic chemotherapy: not very effective

MED-SURG MANAGEMENT

Encourage all male clients over 40 years of age to have annual rectal exam of the prostate and a PSA serum level.

Monitor vital signs, I&O, signs of bleeding, assess for pain, administer analgesics as ordered

NURSING MANAGEMENT

Testicular Cancer: Most common cancer in young men ages 15-35. Etiology unknown. Usually a small, hard, painless

lump is first sign noticed.

Early intervention is essential: need to teach clients how to perform self testicular exam.

MALIGNANT NEOPLASMS

Medical: Testicular ultrasound, serum acid or alkaline phosphatase test.

Surgical: Biopsy contraindicated

Removal of testis, spermatic cord, and inguinal contents, with exam of nodes

Teaching plan for TSE

MED-SURG MANAGEMENT

• Pharmacological: combination chemotherapy with cisplatin, vinblastine sulfate, and bleomycin sulfate. All in conjunction with a radical inguinal orchiectomy.

ENCOURAGE ALL MALES OVER 15 YEARS OF AGE TO PERFORM TSE!

Post-op: monitor vital signs and incisional drainage. Maintain strict asepsis when changing dressings. Provide client to

voice fears and concerns.

NURSING MANAGEMENT

Penile Cancer: rare; high correlation with poor hygiene or no circumcision, hx of STDs

Symptoms: painless nodular growth on foreskin, fatigue and weight loss.

Metastases common in inguinal nodes and adjacent organs.

MALIGNANT NEOPLASMS

Medical: primary treatment is surgical.

Surgical: If not extensive with no metastases, remaining penis should be long enough for client to void standing.

If penectomy necessary, a suprapubic catheter may be inserted or an ileoconduit may be performed.

MED-SURG MANAGEMENT

Provide emotional support

Monitor vital signs and I&O

Elevate scrotum to prevent edema

Assess pain and administer analgesics as ordered.

NURSING MANAGEMENT