Chapter 53: Managing Male Reproductive Disorders

Managing Male Reproductive Disorders focuses on the expert assessment and management of patients presenting with diverse male reproductive disorders, which often overlap significantly with the urinary system. It begins by detailing the normal anatomy and dual function of the male genitalia, including the testes' role in spermatogenesis and testosterone secretion, and notes the gerontologic changes impacting function and increasing risks for conditions like benign prostatic hyperplasia (BPH) and genitourinary cancers. Core assessment practices involve obtaining a targeted health history, evaluating urinary symptoms (prostatism), and performing essential physical examinations, namely the Digital Rectal Examination (DRE) for prostate screening and the instruction on Testicular Self-Examination (TSE) for early cancer detection. Diagnostic testing relies on Prostate-Specific Antigen (PSA) levels, Transrectal Ultrasound (TRUS), and nocturnal penile tumescence studies to differentiate causes of sexual dysfunction. Disorders of sexual function are covered extensively, starting with erectile dysfunction (ED, or impotence), detailing its psychogenic and organic etiologies, and reviewing medical treatments such as PDE-5 inhibitors, penile injections, vacuum devices, and surgical penile implants. Ejaculation problems like premature, inhibited, and retrograde ejaculation are also addressed, emphasizing behavioral and pharmacological treatments. The chapter then addresses infections, including prostatitis (categorized into four types, frequently treated with antibiotics and alpha-adrenergic blockers), epididymitis, orchitis, and sexually transmitted infections (STIs), stressing the importance of partner treatment, education, and preventative measures like HPV vaccination. Major focus is placed on prostatic disorders, particularly BPH, describing its hypertrophy and obstructive symptoms, which are managed via watchful waiting, alpha-blockers, 5-alpha-reductase inhibitors, minimally invasive procedures, or surgical Transurethral Resection of the Prostate (TURP). Prostate cancer, the most common male cancer excluding skin cancer, is discussed in terms of risk factors (e.g., age, African American ethnicity, genetics), staging (Gleason score), and varied treatment options: radical prostatectomy (often robotic-assisted), radiation therapy (teletherapy and brachytherapy), and hormonal strategies like androgen deprivation therapy. Nursing care for prostate surgery patients is outlined, focusing on pre- and post-operative goals, maintaining fluid balance, managing hemorrhage and clotting, relieving bladder spasms, teaching catheter care, and educating patients on regaining continence through perineal exercises. Finally, the text details various conditions affecting the testes and penis, including acute surgical emergencies like testicular torsion, fluid collections (hydrocele), venous dilation (varicocele), and penile disorders such as phimosis and priapism. It concludes with a discussion of testicular cancer—the most frequent cancer in young men—highlighting its curability, the role of tumor markers (AFP, beta-hCG), and the necessity of pre-treatment counseling for fertility preservation via sperm banking.