Ch. 53 Male Reproductive Process

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Questions and Answers

What changes occur in male reproductive health as men age?

Decreased risk of urinary incontinence

Increased sexual function

Enlargement of the prostate gland (correct)

Increased frequency of erections

Which of the following medications is known to affect urinary and sexual functions?

Non-steroidal anti-inflammatory drugs

Antibiotics

Beta blockers (correct)

Antacids

At what age should men begin digital rectal exams for prostate assessment?

50 years (correct)

45 years

55 years

40 years

What is considered an elevated Prostate Specific Antigen (PSA) level in men aged 60 and younger?

Greater than 4.0 ng/mL Signup and view all the answers

Which of the following is a psychogenic cause of erectile dysfunction?

Anxiety Signup and view all the answers

Which procedure may cause infection due to the number of biopsies taken during a TRUS-guided biopsy?

TRUS-guided biopsy Signup and view all the answers

What is the role of nitric oxide in the process of achieving an erection?

It promotes smooth muscle relaxation Signup and view all the answers

What is the primary indicator of urinary incontinence in older males?

Prostate enlargement Signup and view all the answers

What is one of the first steps in evaluating a man's sexual function?

Considering the frequency of sexual activity Signup and view all the answers

What can be a physical examination finding during a testicular examination?

Hydrocele Signup and view all the answers

What is the most common age group for testicular cancer?

15-35 years old Signup and view all the answers

Which of the following is a known risk factor for testicular cancer?

Undescended testicle Signup and view all the answers

What clinical manifestation is characteristic of testicular cancer?

Painless enlargement of the testes Signup and view all the answers

What is the role of tumor markers in testicular cancer management?

To stage and monitor treatment response Signup and view all the answers

What is the recommended follow-up procedure for a male after undergoing a vasectomy?

10-20 ejaculations to reach full sterility Signup and view all the answers

Which of the following is NOT a complication associated with a vasectomy?

Severe depression Signup and view all the answers

Which statement about the effects of a vasectomy is TRUE?

It has no change on the amount of ejaculate Signup and view all the answers

What should be monitored after surgery for testicular cancer?

Renal function for potential kidney damage Signup and view all the answers

What is the significance of the Gleason Score in prostate cancer management?

It helps in grading and staging cancer based on architectural patterns. Signup and view all the answers

What is a common complication of a radical prostatectomy?

Urinary incontinence Signup and view all the answers

Which of the following should be avoided after receiving brachytherapy?

Contact with pregnant women and infants Signup and view all the answers

What best describes transurethral resection of the prostate (TURP)?

Removal of the prostate in small portions with an electrical cutting loop. Signup and view all the answers

What is the primary role of continuous bladder irrigation (CBI) following prostate surgery?

To clear blood clots and maintain bladder patency. Signup and view all the answers

Which complication is directly related to transurethral resection syndrome?

Hyponatremia Signup and view all the answers

Which medication is commonly used to address bladder spasms postoperatively?

Flavoxate (Urispas) Signup and view all the answers

What is the main function of radical prostatectomy?

To remove cancerous prostate tissue confined to the gland. Signup and view all the answers

What does the action of antiandrogen receptor antagonists in pharmacology for prostate cancer involve?

Inhibiting cancer cell growth by blocking androgens Signup and view all the answers

Which side effect is associated with androgen deprivation therapy (ADT)?

Decreased bone density Signup and view all the answers

Which medication is known to potentially cause erectile dysfunction?

Clonidine Signup and view all the answers

What is a common first line treatment for erectile dysfunction?

Sildenafil Signup and view all the answers

Which symptom is commonly associated with acute bacterial prostatitis?

Sudden onset of fever Signup and view all the answers

Which of the following is a risk factor for benign prostatic hyperplasia (BPH)?

Sedentary lifestyle Signup and view all the answers

What is the mechanism of action of alpha-adrenergic blockers used in BPH treatment?

Relax smooth muscle Signup and view all the answers

What is a common medication used to treat chronic prostatitis?

Trimethoprim-sulfamethoxazole Signup and view all the answers

Which type of prostatitis is most commonly diagnosed?

Chronic prostatitis/pelvic pain syndrome Signup and view all the answers

What is a common side effect of sildenafil?

Nasal congestion Signup and view all the answers

Which of the following should be avoided when taking sildenafil?

Organic nitrates Signup and view all the answers

What diagnostic test is primarily used for confirming prostate cancer?

Tissue biopsy removed by TURP Signup and view all the answers

Which symptom indicates obstruction due to prostate cancer?

Frequent urination Signup and view all the answers

Which group of medications is primarily used as first-line treatment for BPH?

Alpha-adrenergic blockers Signup and view all the answers

What type of prostatitis could be asymptomatic between episodes?

Chronic bacterial prostatitis Signup and view all the answers

What is the most common clinical manifestation of testicular cancer?

Painless enlargement of the testes Signup and view all the answers

Which of the following is a significant risk factor for developing testicular cancer?

Caucasian ethnicity Signup and view all the answers

What is the purpose of tumor markers in the management of testicular cancer?

Used for staging and monitoring treatment response Signup and view all the answers

What is a common complication of a vasectomy?

Swelling and bruising Signup and view all the answers

What should a man do to ensure he has reached full sterility after a vasectomy?

Get a sperm sample after 10-20 ejaculations Signup and view all the answers

Which of the following is NOT a recommended management after testicular cancer surgery?

Increased physical therapy post-surgery Signup and view all the answers

What is an important education point regarding vasectomy post-operative care?

Swelling management should be emphasized Signup and view all the answers

Which substance is commonly included in chemotherapy regimens for advanced testicular cancer?

Cisplatin Signup and view all the answers

What is a primary disadvantage of using the Prostate Specific Antigen (PSA) test for prostate cancer screening?

It can lead to unnecessary biopsies. Signup and view all the answers

Which of the following medications is commonly associated with causing erectile dysfunction?

Beta blockers Signup and view all the answers

Which factor should be considered when assessing the risk of urinary incontinence in older males?

Chronic illness or disability Signup and view all the answers

What characteristic symptom can indicate erectile dysfunction?

Inability to achieve a firm erection Signup and view all the answers

What is a common physical examination finding during a testicular exam?

Presence of a hydrocele Signup and view all the answers

What is the primary purpose of conducting a digital rectal exam in males over 50?

To evaluate the consistency of the prostate Signup and view all the answers

In which scenario might a man exhibit double or triple voiding symptoms?

Due to an enlarged prostate Signup and view all the answers

What does the acronym PLISSIT relate to in the context of sexual health assessment?

A model for sexual health intervention Signup and view all the answers

Which of the following factors does NOT commonly contribute to psychogenic erectile dysfunction?

Uncontrolled diabetes Signup and view all the answers

What is the recommended age for men to start regular PSA screening?

50 years Signup and view all the answers

What is a key characteristic of the Gleason Score in prostate cancer evaluation?

It includes two separate scores for architectural patterns. Signup and view all the answers

Which surgical procedure is considered the first line for disease confined to the prostate?

Radical prostatectomy Signup and view all the answers

What potential complication is commonly associated with radical prostatectomy?

Retrograde ejaculation Signup and view all the answers

What is a common side effect of androgen deprivation therapy (ADT)?

Gynecomastia and mastodynia Signup and view all the answers

What is the reason for avoiding contact with pregnant women and infants after brachytherapy?

Radiation exposure from implanted seeds Signup and view all the answers

What is one of the known side effects of the drug Docetaxel used in chemotherapy for prostate cancer?

Anemia Signup and view all the answers

What condition can result from excessive irrigation fluid absorption during TURP?

Transurethral Resection Syndrome Signup and view all the answers

Which of the following is true about continuous bladder irrigation (CBI) following prostate surgery?

It helps to prevent blood clot formation. Signup and view all the answers

Which of the following therapies involves the internal implantation of radioactive seeds?

Brachytherapy Signup and view all the answers

What treatment is primarily used for bladder spasms post prostate surgery?

Flavoxate (Urispas) Signup and view all the answers

What is the recommended initial treatment for erectile dysfunction?

Phosphodiesterase-5 inhibitors Signup and view all the answers

Which bacteria is most commonly associated with acute bacterial prostatitis?

E-Coli Signup and view all the answers

Which of the following conditions is a risk factor for developing benign prostatic hyperplasia (BPH)?

Hypertension Signup and view all the answers

What is a common clinical manifestation of chronic prostatitis/pelvic pain syndrome?

GU pain without bacteria Signup and view all the answers

Which medication should not be taken with sildenafil due to the risk of severe hypotension?

Organic nitrates Signup and view all the answers

What is the primary purpose of alpha-adrenergic blockers in the management of BPH?

To relax smooth muscle in the prostate Signup and view all the answers

What is a known side effect of finasteride when used for BPH treatment?

Gynecomastia Signup and view all the answers

Which method is often used for the diagnosis of prostate cancer?

Digital rectal exam (DRE) Signup and view all the answers

What lifestyle modification can help alleviate symptoms of prostatitis?

Avoid chocolate and spicy foods Signup and view all the answers

Which of the following types of prostatitis is the most commonly diagnosed?

Chronic prostatitis/pelvic pain syndrome Signup and view all the answers

What is a common initial sign of prostate cancer?

Urinary obstruction Signup and view all the answers

What is often included in treatment for acute bacterial prostatitis?

Administration of antibiotics Signup and view all the answers

Which form of surgical treatment involves the endoscopic removal of the inner part of the prostate?

Transurethral resection of the prostate (TURP) Signup and view all the answers

Which medical management option is commonly used for urinary retention in patients with BPH?

Tamsulosin Signup and view all the answers

Study Notes

Gerontologic Considerations

Prostate gland enlarges with age, affecting urine flow and sexual function.
Increased risk of gu cancer and urinary incontinence in older males.

Health History

Assess general health, chronic illnesses, and disabilities.
Medications impacting urinary and sexual functions include beta blockers, psychotropics, and statins.
Enlarged prostate leads to double or triple voiding to empty the bladder.
Use frameworks like PLISSIT and BETTER for discussing sexual health issues.

Physical Assessment

Digital rectal exam recommended starting at age 50, or 45 with family history, to check for prostate abnormalities.
Testicular examination includes palpation for nodules or inflammation; also assess penis for issues.
Various positions for examination include side-lying, standing, or lithotomy.

Diagnostic Evaluation

Prostate Specific Antigen (PSA) Test: Normal PSA level is less than 4.0 ng/mL; elevated PSA levels can indicate various conditions, not strictly cancer.
Prostate biopsies are infection-prone procedures that typically involve taking multiple samples.
Transrectal ultrasonography (TRUS) aids in assessing prostate abnormalities.

Erectile Dysfunction

Characterized by reduced erection frequency or inability to maintain erections.
Mechanism involves Nitric oxide inducing blood flow to the penis, leading to erection.
Factors contributing to ED include psychogenic issues, relationship problems, medication side effects, and various diseases.

Assessment and Medical Management for ED

Comprehensive assessment of sexual and medical history required.
Medical management may involve pharmacology, therapy, or surgical options.
PDE-5 inhibitors (e.g., sildenafil, tadalafil) are commonly used; they can cause side effects like nasal congestion and should not be combined with nitrates.

Prostatitis

Inflammation of the prostate gland, frequently causing urinary and sexual discomfort.
Most common urologic diagnosis in men under 50; caused by infectious agents like E. Coli.
Symptoms include fever, dysuria, and severe lower urinary tract symptoms.

Nursing Management for Prostatitis

Recommend self-care strategies like sitz baths and increased fluid intake.
Certain dietary restrictions to prevent exacerbation of prostatic secretions and symptoms.

Benign Prostatic Hyperplasia (BPH)

Characterized by urine flow obstruction and is most prevalent in older men.
Risk factors include lifestyle factors like obesity and smoking.
Symptoms include increased urinary frequency, hesitancy, and possible urinary retention.

Medical Management of BPH

Alpha adrenergic blockers and 5-alpha-reductase inhibitors are commonly prescribed.
Surgical interventions exist for severe cases, including TURP, which is a common procedure.

Prostate Cancer

Second most common cause of cancer death among men; risk factors include race, diet, and age.
Symptoms may involve urinary obstruction and painful ejaculation.
Diagnosis often confirmed via tissue biopsy or imaging studies.

Gleason Score

Used for grading prostate cancer based on architectural patterns of biopsy samples; higher scores indicate worse prognosis.

Medical Management for Prostate Cancer

Treatment depends on various factors, including Gleason score and patient's condition; options include surgery and hormone therapy.

Prostate Surgery

TURP involves removal of prostate tissue with a risk of complications such as retrograde ejaculation.
Post-operative care includes monitoring for signs of bleeding or infection.

Testicular Cancer

Most common in males aged 15-35; risk factors include undescended testicles and occupational hazards.
Symptoms typically involve a painless testicular mass or swelling.

Assessment and Medical Management for Testicular Cancer

No standard screening, but self-examinations should be performed monthly.
Tumor markers like AFP and HcG are significant for monitoring.
Treatment includes surgical removal of the affected testis and potential chemotherapy.

Vasectomy

Surgical procedure for male sterilization by cutting the vas deferens, without affecting sexual function.
Education about post-operative care is crucial, including the necessity of multiple ejaculations before achieving sterility.

Gerontologic Considerations

Prostate gland enlargement occurs with aging, alongside changes in scrotum and testes, leading to decreased sexual function.
Aging increases the risk of genitourinary cancers and urinary incontinence.

Health History

Collect comprehensive general health and chronic illness history.
Medications affecting urinary and sexual functions include beta blockers, psychotropic drugs (SSRIs, MAOIs, TCAs), and statins.
Enlarged prostate may cause double or triple voiding to completely empty the bladder.
Initiate discussions on urinary symptoms and sexual activity.
PLISSIT model: permission, limited information, specific suggestions, intensive therapy; BETTER strategy for discussing sexual health.

Physical Assessment

Digital Rectal Exam (DRE): Recommended starting at 50 years (45 if family history present); assesses prostate tenderness and nodules.
Testicular/scrotal examination: Check for nodules, masses, and abnormalities (e.g., hydrocele, hernia).
Various positions to conduct examinations include side-lying, standing, or lithotomy.

Diagnostic Evaluation

Prostate Specific Antigen (PSA) Test: Normal levels are < 4.0 ng/mL; elevated PSA can indicate BPH or other conditions. Sensitivity but not specific for cancer.
Prostate fluid or tissue analysis via biopsy may involve TRUS and is prone to infection.
Sexual function tests assess erection during REM sleep.

Erectile Dysfunction (ED)

Characterized by decreased frequency of erections and inability to maintain an erection.
Causes of ED:
- Psychogenic factors: anxiety, fatigue, depression, performance pressure, and relationship issues.
- Organic factors: medical conditions (CVD, diabetes, etc.) and medications (beta blockers, statins, clonidine).
Assessment includes sexual and medical history and may require therapy for psychogenic causes.
Treatments may involve pharmacology (e.g., sildenafil), penile implants, or vacuum constriction devices.

Prostatitis

Inflammation of the prostate, common in men < 50 years; most often caused by bacterial infections (e.g., E. coli).
Types: acute bacterial, chronic bacterial, chronic pelvic pain syndrome, asymptomatic inflammatory prostatitis.
Risk factors include recurrent UTIs, catheter use, and dehydration.
Symptoms include fever, dysuria (most common), and severe lower urinary tract symptoms.
Self-care includes sitz baths, maintaining hydration, and avoiding irritants.

Benign Prostatic Hyperplasia (BPH)

Most common urinary issue in older males caused by hormonal factors (DHT and estrogen).
Symptoms: increased urinary frequency, urge, nocturia, dribbling, urinary retention, and azotemia.
First-line treatment includes alpha-adrenergic blockers (e.g., terazosin, doxazosin) and 5-alpha-reductase inhibitors (e.g., finasteride).

Prostate Cancer

Second leading cause of cancer death in men; risk factors include age, race, and diet.
Symptoms often include urinary obstruction, hematuria, and painful ejaculation.
Diagnosed via DRE, elevated PSA, imaging studies, and definitive tissue biopsy.
Gleason Score determines cancer aggressiveness, combining scores of primary and secondary patterns.
Management may include watchful waiting, radical prostatectomy, or hormone therapy.

Prostate Surgery

Transurethral Resection of the Prostate (TURP): Involves removal of prostate tissue; can cause retrograde ejaculation.
Monitor for complications including hemorrhage and catheter obstruction.
Continuous bladder irrigation post-surgery prevents clot formation.

Testicular Cancer

Most common cancer in men aged 15-35; risk factors include undescended testicle and family history.
Key manifestation: painless testicular lump; associated with backache and weight loss.
Monthly testicular self-examinations are recommended.
Tumor markers (AFP, hCG) used for diagnosis and monitoring.
Treatment includes surgical removal and chemotherapy, with potential late effects like renal insufficiency.

Vasectomy

Procedure for male sterilization with no impact on sexual function.
Post-operative education includes management of swelling and the need for multiple ejaculations to achieve full sterility.
Complications may include bruising and infection.

General Nursing Management

Encourage fluid intake, monitor vital signs, and educate patients on self-examinations and medication effects.
Post-surgical care focuses on pain management and prevention of complications like incontinence and sexual dysfunction.

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Description

This quiz covers the gerontologic considerations related to the male reproductive process, including prostate gland enlargement and changes in sexual function. Additionally, it discusses health history factors and the impact of various medications on urinary and sexual functions. Prepare to test your knowledge on these critical aspects.