1. Elsevier items and derived items © 2006 by Elsevier Inc. Interventions for Male Clients with Reproductive Problems

2. Elsevier items and derived items © 2006 by Elsevier Inc.

3. Benign Prostatic Hyperplasia Glandular units in the prostate that undergo an increase in the number of cells resulting in enlargement of the prostate gland Hyperirritable bladder, urgency and frequency, hypertrophied bladder wall muscles, cellules and diverticula, hydroureter, hydronephrosis, and overflow urinary incontinence Glandular units in the prostate that undergo an increase in the number of cells resulting in enlargement of the prostate gland Hyperirritable bladder, urgency and frequency, hypertrophied bladder wall muscles, cellules and diverticula, hydroureter, hydronephrosis, and overflow urinary incontinence

4. Elsevier items and derived items © 2006 by Elsevier Inc. Assessment Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction Lower urinary tract symptoms Hesitancy, intermittency, reduced force and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling Hematuria DRE (size, consistency) Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction Lower urinary tract symptoms Hesitancy, intermittency, reduced force and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling Hematuria DRE (size, consistency)

5. Elsevier items and derived items © 2006 by Elsevier Inc. Laboratory Assessment Urinalysis Complete blood count Blood urea nitrogen and creatinine levels Prostate-specific antigen Urinalysis Complete blood count Blood urea nitrogen and creatinine levels Prostate-specific antigen

6. Elsevier items and derived items © 2006 by Elsevier Inc. Drug Therapy Finasteride to shrink the prostate gland and improve urinary flow Terazosin hydrochloride Doxazosin mesylate Tamsulosin hydrochloride Estrogens and androgens Finasteride to shrink the prostate gland and improve urinary flow Terazosin hydrochloride Doxazosin mesylate Tamsulosin hydrochloride Estrogens and androgens

7. Elsevier items and derived items © 2006 by Elsevier Inc. Surgical Procedures Transurethral resection of the prostate Suprapubic prostatectomy Retropubic prostatectomy Perineal prostatectomy Transurethral resection of the prostate Suprapubic prostatectomy Retropubic prostatectomy Perineal prostatectomy

8. Elsevier items and derived items © 2006 by Elsevier Inc. Continuous Bladder Irrigation Three-way urinary catheter with a 30- to 45-mL retention balloon through the urethra into the bladder Traction via taping to client’s abdomen or thigh Uncomfortable urge to void continuously Antispasmodic medications Three-way urinary catheter with a 30- to 45-mL retention balloon through the urethra into the bladder Traction via taping to client’s abdomen or thigh Uncomfortable urge to void continuously Antispasmodic medications

9. Elsevier items and derived items © 2006 by Elsevier Inc. Postcatheterization Care Client feels burning on urination as well as some urinary frequency, dribbling, and leakage. Symptoms are normal and will subside. Monitor fluid intake. Client feels burning on urination as well as some urinary frequency, dribbling, and leakage. Symptoms are normal and will subside. Monitor fluid intake.

10. Elsevier items and derived items © 2006 by Elsevier Inc. Prostate Cancer Most common invasive cancer among men in the U.S. One of the slowest growing malignancies; metastasizes in a predictable pattern First symptoms related to bladder neck obstruction (Continued) Most common invasive cancer among men in the U.S. One of the slowest growing malignancies; metastasizes in a predictable pattern First symptoms related to bladder neck obstruction (Continued)

11. Elsevier items and derived items © 2006 by Elsevier Inc. Prostate Cancer (Continued) Digital rectal examination Prostate-specific antigen Biopsy necessary to confirm suspected prostatic cancer Digital rectal examination Prostate-specific antigen Biopsy necessary to confirm suspected prostatic cancer

12. Elsevier items and derived items © 2006 by Elsevier Inc. Postoperative Care of Radical Prostatectomy Hydration with intravenous therapy Caring for wound drains Preventing emboli Preventing pulmonary complications Antibiotics Analgesics (Continued) Hydration with intravenous therapy Caring for wound drains Preventing emboli Preventing pulmonary complications Antibiotics Analgesics (Continued)

13. Elsevier items and derived items © 2006 by Elsevier Inc. Postoperative Care of Radical Prostatectomy (Continued) Laxative and stool softener Indwelling urinary catheter Antispasmotic Laxative and stool softener Indwelling urinary catheter Antispasmotic

14. Elsevier items and derived items © 2006 by Elsevier Inc. Complications Urinary incontinence Erectile dysfunction Urinary incontinence Erectile dysfunction

15. Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management Radiation therapy Hormonal therapy Chemotherapy Targeted therapy Radiation therapy Hormonal therapy Chemotherapy Targeted therapy

16. Elsevier items and derived items © 2006 by Elsevier Inc. Erectile Dysfunction Inability to achieve or maintain an erection for sexual intercourse Organic erectile dysfunction Functional erectile dysfunction Assessment –Medical, social, sexual history –Complete physical examination –Duplex Doppler ultrasonography test Inability to achieve or maintain an erection for sexual intercourse Organic erectile dysfunction Functional erectile dysfunction Assessment –Medical, social, sexual history –Complete physical examination –Duplex Doppler ultrasonography test

17. Elsevier items and derived items © 2006 by Elsevier Inc. Interventions Drug therapy includes sildenafil, vardenafil, tadalafil. Avoid alcohol before sexual intercourse. Common side effects include headaches, facial flushing, diarrhea. Men who take nitrates should not take these drugs in addition. Drug therapy includes sildenafil, vardenafil, tadalafil. Avoid alcohol before sexual intercourse. Common side effects include headaches, facial flushing, diarrhea. Men who take nitrates should not take these drugs in addition.

18. Elsevier items and derived items © 2006 by Elsevier Inc. Vacuum Devices Cylinder fits over the penis and sits firmly against the body. Vacuum is created to draw blood into the penis to maintain an erection. Rubber ring (tension band) is placed around the base of the penis to maintain the erection; cylinder is removed. Cylinder fits over the penis and sits firmly against the body. Vacuum is created to draw blood into the penis to maintain an erection. Rubber ring (tension band) is placed around the base of the penis to maintain the erection; cylinder is removed.

19. Elsevier items and derived items © 2006 by Elsevier Inc. Intraurethral Applications Prostglandin E is a self-administered suppository that is placed in the urethra with an applicator. Erection occurs in about 10 minutes and lasts 30 to 60 minutes. Burning of the urethra occurs after application. Prostglandin E is a self-administered suppository that is placed in the urethra with an applicator. Erection occurs in about 10 minutes and lasts 30 to 60 minutes. Burning of the urethra occurs after application.

20. Elsevier items and derived items © 2006 by Elsevier Inc. Prosthesis Penile implants are used when other modalities fail. Implants are semirigid, malleable, or hydraulic inflatable and multicomponent or one-piece instruments. Reservoir is placed in the scrotum. Major disadvantages are device failure and infection. Penile implants are used when other modalities fail. Implants are semirigid, malleable, or hydraulic inflatable and multicomponent or one-piece instruments. Reservoir is placed in the scrotum. Major disadvantages are device failure and infection.

21. Elsevier items and derived items © 2006 by Elsevier Inc. Testicular Cancer Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age. With early detection by testicular self- examination and treatment with combination chemotherapy, testicular cancer can be cured. Germ cell tumors arise from sperm-producing cells. Non-germ cell tumors Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age. With early detection by testicular self- examination and treatment with combination chemotherapy, testicular cancer can be cured. Germ cell tumors arise from sperm-producing cells. Non-germ cell tumors

22. Elsevier items and derived items © 2006 by Elsevier Inc. Diagnostics Alpha-fetoprotein Beta subunit of hCG Ultrasound Computed tomography Magnetic resonance imaging Lymphangiograms Alpha-fetoprotein Beta subunit of hCG Ultrasound Computed tomography Magnetic resonance imaging Lymphangiograms

23. Elsevier items and derived items © 2006 by Elsevier Inc. Risk for Sexual Dysfunction Interventions include: –Oligospermia, azoospermia –Health teaching about reproduction, fertility, and sexuality –Sperm storage –Other reproductive options Interventions include: –Oligospermia, azoospermia –Health teaching about reproduction, fertility, and sexuality –Sperm storage –Other reproductive options

24. Elsevier items and derived items © 2006 by Elsevier Inc. Potential for Metastasis Interventions include: –Surgical management –Preoperative care –Operative procedures: radical retroperitoneal lymph node dissection, orchiectomy (Continued) Interventions include: –Surgical management –Preoperative care –Operative procedures: radical retroperitoneal lymph node dissection, orchiectomy (Continued)

25. Elsevier items and derived items © 2006 by Elsevier Inc. Potential for Metastasis (Continued) –Postoperative care; expected problems include: Pain from surgical incisions Immobility Injuries related to invasive catheters or tubes –Postoperative care; expected problems include: Pain from surgical incisions Immobility Injuries related to invasive catheters or tubes

26. Elsevier items and derived items © 2006 by Elsevier Inc. Nonsurgical Management Chemotherapy Radiation therapy Stem cell transplantation Chemotherapy Radiation therapy Stem cell transplantation

27. Elsevier items and derived items © 2006 by Elsevier Inc. Hydrocele Cystic mass is usually filled with straw-colored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing a swelling of the tissue surrounding the testes. Hydrocele may be drained via needle and syringe or it may be removed surgically. Cystic mass is usually filled with straw-colored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing a swelling of the tissue surrounding the testes. Hydrocele may be drained via needle and syringe or it may be removed surgically.

28. Elsevier items and derived items © 2006 by Elsevier Inc. Spermatocele A sperm-containing cyst develops on the epididymis alongside the testicle. Normally, spermatoceles are small and asymptomatic, and require no interventions. If they become large enough to cause discomfort, a spermatocelectomy is performed. A sperm-containing cyst develops on the epididymis alongside the testicle. Normally, spermatoceles are small and asymptomatic, and require no interventions. If they become large enough to cause discomfort, a spermatocelectomy is performed.

29. Elsevier items and derived items © 2006 by Elsevier Inc. Intracorporal Injections Injecting the penis with vasoconstricting drugs Phentolamine and alprostadil Adverse effects include: –Priapism –Penile scarring –Fibrosis –Bleeding (Continued) Injecting the penis with vasoconstricting drugs Phentolamine and alprostadil Adverse effects include: –Priapism –Penile scarring –Fibrosis –Bleeding (Continued)

30. Elsevier items and derived items © 2006 by Elsevier Inc. Intracorporal Injections (Continued) –Bruising –Pain –Infection –Vasovagal responses –Bruising –Pain –Infection –Vasovagal responses

31. Elsevier items and derived items © 2006 by Elsevier Inc. Varicocele A cluster of dilated veins occur behind and above the testis. Varicoceles can also cause infertility. Varicocelectomy is performed through an inguinal incision in which the spermatic veins are ligated in the cord. A cluster of dilated veins occur behind and above the testis. Varicoceles can also cause infertility. Varicocelectomy is performed through an inguinal incision in which the spermatic veins are ligated in the cord.

32. Elsevier items and derived items © 2006 by Elsevier Inc. Scrotal Trauma Torsion of the testes involves twisting of the spermatic cord and occurs most often during puberty. Because the testes are sensitive to any decrease in blood flow, torsion of the testis is a surgical emergency. Surgical intervention may be required. Torsion of the testes involves twisting of the spermatic cord and occurs most often during puberty. Because the testes are sensitive to any decrease in blood flow, torsion of the testis is a surgical emergency. Surgical intervention may be required.

33. Elsevier items and derived items © 2006 by Elsevier Inc. Cryptorchidism Results when the testicles fail to descend; mainly a pediatric problem Injections of B-HCG luteinizing hormone- releasing hormone or testosterone optional to promote descent of the testicles Orchidopexy surgical procedure optional Results when the testicles fail to descend; mainly a pediatric problem Injections of B-HCG luteinizing hormone- releasing hormone or testosterone optional to promote descent of the testicles Orchidopexy surgical procedure optional

34. Elsevier items and derived items © 2006 by Elsevier Inc. Cancer of the Penis Epidermoid (squamous) carcinomas developing from squamous cells Circumcision in infancy—almost always eliminates the possibility of penile cancer Painless wartlike growth or ulcer Excisional biopsy Radiation therapy Penectomy Epidermoid (squamous) carcinomas developing from squamous cells Circumcision in infancy—almost always eliminates the possibility of penile cancer Painless wartlike growth or ulcer Excisional biopsy Radiation therapy Penectomy

35. Elsevier items and derived items © 2006 by Elsevier Inc. Phimosis and Paraphimosis Constricted prepuce that cannot be retracted over the glans; prepuce remains down around the tip of the penis Emergency requiring immediate treatment Circumcision Warm bath to allow dressing to loosen Barbiturate sleeping medications Constricted prepuce that cannot be retracted over the glans; prepuce remains down around the tip of the penis Emergency requiring immediate treatment Circumcision Warm bath to allow dressing to loosen Barbiturate sleeping medications

36. Elsevier items and derived items © 2006 by Elsevier Inc. Priapism Uncontrolled and long-maintained erection without sexual desire; causes the penis to become large and painful Can occur from: –Thrombosis of veins of corpora cavernosa –Leukemia –Sickle cell disease (Continued) Uncontrolled and long-maintained erection without sexual desire; causes the penis to become large and painful Can occur from: –Thrombosis of veins of corpora cavernosa –Leukemia –Sickle cell disease (Continued)

37. Elsevier items and derived items © 2006 by Elsevier Inc. Priapism (Continued) –Diabetes mellitus –Malignancies –Abnormal reflex –Some drug effects –Recreational drugs –Prolonged sexual activity –Diabetes mellitus –Malignancies –Abnormal reflex –Some drug effects –Recreational drugs –Prolonged sexual activity

38. Elsevier items and derived items © 2006 by Elsevier Inc. Collaborative Management Urologic emergency Goal of intervention: to improve the venous drainage of the corpora cavernosa Meperidine Warm enemas Urinary or suprapubic catheterization Large-bore needle or surgical intervention Urologic emergency Goal of intervention: to improve the venous drainage of the corpora cavernosa Meperidine Warm enemas Urinary or suprapubic catheterization Large-bore needle or surgical intervention

39. Elsevier items and derived items © 2006 by Elsevier Inc. Bacterial Prostatitis Often occurs with urethritis or an infection of the lower urinary tract Fever, chills, dysuria, urethral discharge, and boggy, tender prostate Urethral discharge with white blood cells in the prostatic secretions Chronic bacterial prostatitis Often occurs with urethritis or an infection of the lower urinary tract Fever, chills, dysuria, urethral discharge, and boggy, tender prostate Urethral discharge with white blood cells in the prostatic secretions Chronic bacterial prostatitis

40. Elsevier items and derived items © 2006 by Elsevier Inc. Nonbacterial/Chronic Pelvic Pain Syndrome Can occur after viral illness or may be associated with sexually transmitted diseases Other causes: autoimmune, neuromuscular etiologies, allergy-mediated reactions, psychosexual problems Prostatodynia or pelvic floor pain Treatment Can occur after viral illness or may be associated with sexually transmitted diseases Other causes: autoimmune, neuromuscular etiologies, allergy-mediated reactions, psychosexual problems Prostatodynia or pelvic floor pain Treatment

41. Elsevier items and derived items © 2006 by Elsevier Inc. Epididymitis Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma Treatment: bedrest with scrotum elevated on a towel, scrotal support when ambulating Comfort measures Epididymectomy Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma Treatment: bedrest with scrotum elevated on a towel, scrotal support when ambulating Comfort measures Epididymectomy

42. Elsevier items and derived items © 2006 by Elsevier Inc. Orchitis (Mumps) Acute testicular inflammation resulting from trauma or infection Treatment: bedrest with scrotal elevation, application of ice, and administration of analgesics and antibiotics Mumps orchitis Acute testicular inflammation resulting from trauma or infection Treatment: bedrest with scrotal elevation, application of ice, and administration of analgesics and antibiotics Mumps orchitis