GenitalUrinary System

1
Genital-Urinary System

• Male Reproductive System

2
Behavioral Objectives

• By the end of this lecture the student will be
  able to
• Review the anatomy and physiology of the
  genito-urinary systems
• Describe the physical assessment of the GU
  systems
• Discuss the application of the nursing process as
  it relates to patients with disorders of the GU
  system
• Describe etiology, pathophysiology, clinical
  manifestations, nursing management and patient
  education for the following GU disorders
• Prostatitis,
• Orchitis
• Prostaic hypertrophy
• Prostatic neoplasms
• Discuss the nursing interventions in pre and
  post-operative care of patients undergoing the
  following GU system surgeries
• Prostatectomy

3
Introduction

• Several organs are both urinary tract and
  reproductive system
• Disease of male reproductive system are usually
  treated by an urologist.

4
Anatomy Physiology

• Brunner and Suddarths Medical Surgical Nursing
• pg 1486

5
Testes

• Descend into peritoneum in the last month of
  fetal life,
• Paired
• Ovoid
• Smooth
• Firm not soft
• Encased in the scrotum
• i temp

6
Spermatogenesis

• What is Spermatogenesis?
• Formation of Sperm
• Spermatozoa
• Immature sperm
• Collecting tubules
• Transmit the spermatozoa in the epididymis
• Testes have two functions
• Formation of spermatozoa
• Secretion of the male sex hormone - testosterone

7
Vas deferens (ductus deferens)

• Tube
• upward ? abd. cavity
• downward ? base of the bladder

8
Seminal vesicles

• It acts as a reservoir for testicular secretions
• The tract is continued called the ejaculatory
  duct
• Passes through the prostate gland and enters into
  the urethra

9
Accessory glands

• Prostate gland
• Location
• below the neck of the bladder
• Surrounds the urethra
• Function
• Secrets chemicals to help spermatozoa
• Cowpers gland / bulbourethral gland
  (bul-bo-urethral)
• Location
• Below the prostate
• Function
• Lubrication for sperm

10
Penis

• Dual function
• Copulation
• Urination
• Urethra
• Tube carries urine semen
• Opens at the tip of the glans
• The glans
• Covered penile skin foreskin
• Retracted to expose the glans.
• Circumcision
• Foreskin removal

11
Physical Assessment

• Brunner and Suddarths Medical Surgical nursing
  pg 1487-1489

12
Health History

• Evaluate urinary sexual function
• h urinary frequency
• i force of stream,
• double or Triple voiding
• Dysuria
• Hematuria
• Hematospermia
• blood in the ejaculate semen/sperm
• Medications
• Diuretics
• Psychotropic agents
• Anti-hypertensives
• Diagnosis
• DM
• HTN
• Smoking

13
Physical Assessment

• Digital Rectal Examination (DRE)
• 40 yrs
• Annually
• Prostate gland
• Size, shape and consistency

14
Physical Assessment

• Testicular exam
• Abnormalities masses
• Monthly

15
Physical Assessment

• Prostate Specific Antigen
• h PSA level is ?prostate Cancer?
• h PSA ? Prostate pathology screen
• BPH
• Prostatitis
• Foley catheter
• DRE does not cause Increase in PSA

16
Small group questions

• Describe the path a spermatozoa takes from
  formation to ejection
• Testes ? epididymis ? Vas deferens ? Seminal
  vesicles ? (Prostate gland cowpers gland) ?
  Urethra ? penis ? glans ?
• What are the male sex hormones and where are they
  formed?
• Testosterone - testes
• What type of doctor would a man see if he is
  having sexual dysfunction?
• Urologist
• While assessing the testes what would be normal
  findings?
• Paired, ovoid, smooth, firm

17

• 4. What are the male accessory glands and what
  are their purposes?
• Prostate ? chemical for spermatozoa passage
• Cowpers ? lubricating for ejaculation
• 5. Describe the purpose of a DRE, Testicular exam
  and PSA screen. How often should men have these
  screens done?
• DRE ? Annually after 40
• Testicular exam ? monthly
• PSA ? Annually after 50 (40 if high risk group)

18
Prostatitis

• Behavioral Objective
• Describe etiology, pathophysiology, clinical
  manifestations, nursing management and patient
  education for prostatitis
• Brunner and Suddarths Medical Surgical Nursing
  pg 1494

19
Prostatitis

• Pathophysiology
• Inflammation of the prostate gland cause by
  infectious agents
• E. coli is the most common
• Microorganisms are usually carried to the
  prostate from the urethra

20
Prostatitis

• Clinical manifestations
• Perineal discomfort
• Burning, urgency, frequency pain after
  ejaculations
• Prostate pain
• Dysuria
• May produce
• Fever and chills
• Rectal or low back pain

21
Prostatitis

• Assessment and diagnostic findings
• History
• Culture
• Histological examination of the tissue
• D.R.E.
• Swollen, tender firm

22

• Divided urinary specimen
• Clean glans of penis
• Void 10-15ml 1st container
• Urethral Urine
• Without interrupting the urinary stream, collect
  50-75 ml of urine -2nd container
• Bladder Urine
• Results
• UA is often WBC bacteria present
• Prostatic massage
• Prostatic fluid 3rd container