Med-Surg · chapter 20 · Genitourinary and Reproductive Systems
Male-Specific Disorders of the Reproductive Tract
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Therapeutic communication environment
It is important that nurses and other health care professionals promote an environment that is nonjudgmental and comfortable for the patient to allow them to fully express their concerns and obtain adequate treatment and support.
Erectile dysfunction impact
This condition affects nearly 30 million men in the United States and may cause distressing feelings such as guilt, rejection, shame, and frustration (CDC, 2022).
Testicular cancer age group
This cancer is typically diagnosed in men in their 20s or 30s, but there have been some cases diagnosed in children and older men.
Testicular torsion emergency
This is a medical emergency and, without immediate intervention, could result in irreversible damage to the testicles and infertility (Mayo Clinic, 2022b).
Initial assessment priorities
Initial steps in caring for a patient with a male reproductive system disorder is obtaining a thorough health history and performing a physical examination.
ED diagnostic approach
For example, for ED, a diagnosis is made based on the symptoms reported to the provider by the patient.
ED underlying causes workup
The provider may order blood tests after a diagnosis is made, but this is mostly to determine if there might be an underlying medical cause of ED, not to diagnose ED itself.
Torsion ultrasound urgency
When a patient presents with symptoms that indicate the possibility of testicular torsion (e.g., sudden lower abdominal pain), an emergent ultrasound of the scrotum is ordered.
Testicular cancer markers
In addition to imaging, blood tests can be performed to look at various tumor markers that may be indicative of cancer.
ED medication safety
Additionally, patients taking medications for ED should be instructed to never take nitrates for chest pain, because this could also result in severe hypotension.
Torsion nursing priority
One of the main nursing interventions in the care of patients with testicular torsion is immediate referral for imaging and potential surgery.
Orchiectomy postoperative care
Postoperative care of the patient after orchiectomy may involve caring for an indwelling catheter until the patient is ready to void on their own.
Fertility counseling option
In any case, it is important to counsel the patient about these potential outcomes and give them the option to undergo cryopreservation, or “sperm banking.”
Testicular self-exam teaching
Male patients between the ages of 14 and 45 years are at risk for testicular cancer. Nurses can help patients with primary prevention by teaching testicular self-examination.
Terms to know
- Erectile dysfunction
- Erectile dysfunction, also referred to as “impotence,” is a condition in which the man cannot maintain a full erection of the penis for sexual intercourse Mayo Clinic, 2022a).
- testicular torsion
- The condition testicular torsion occurs when the spermatic cord, the supplier of blood to the testicles, becomes twisted.
- cryopreservation
- In any case, it is important to counsel the patient about these potential outcomes and give them the option to undergo cryopreservation, or “sperm banking.”
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 14:10, a 16-year-old patient reports sudden, severe scrotal pain and nausea. The nurse observes scrotal swelling and suspects testicular torsion. Which entry best documents the immediate care plan?
- Arrange ultrasound and tumor-marker testing to investigate possible testicular cancer.
- Arrange scrotal ultrasound to characterize a possible testicular mass before contacting the provider.
- Contact the provider immediately for urgent imaging and possible surgical intervention.
- Reassess the patient's pain before determining whether provider notification is needed.
Answer: Contact the provider immediately for urgent imaging and possible surgical intervention.
Suspected testicular torsion requires immediate provider contact, imaging, and possible surgery to restore blood flow. Reassessment before notification delays urgent intervention, while tumor-marker testing and mass characterization address a cancer workup rather than the suspected emergency.
At 09:00, a nurse prepares the preoperative teaching plan for a 24-year-old patient scheduled for removal of one testicle because of cancer. The patient says, "I haven't decided whether I want children." Which entries belong in the teaching plan? Select all that apply.
- Discuss the potential effect of orchiectomy on future fertility.
- Explain the option of sperm banking before orchiectomy.
- Schedule the initial sperm-banking discussion after recovery from surgery.
- Explain that retaining one testicle makes fertility-preservation counseling unnecessary.
- Defer fertility counseling until the patient decides whether to have children.
Answer: Discuss the potential effect of orchiectomy on future fertility., Explain the option of sperm banking before orchiectomy.
The source recommends counseling about potential fertility effects and offering sperm banking before orchiectomy, even when future parenthood is not yet a priority. Deferring either discussion misses the preoperative opportunity to provide a sperm sample. Although the remaining testicle often compensates, it may not function adequately, so its presence does not eliminate the need for counseling.
At a 15:00 follow-up visit for erectile dysfunction, a patient reports following the prescribed medication and lifestyle plan but still being unable to maintain an erection. Which assessment-and-plan entry best reflects the reported treatment response?
- Treatment effective based on adherence; continue the current plan.
- Patient reports no improvement in sexual function; further investigation and possible specialist referral are warranted.
- Patient reports persistent symptoms; limit further evaluation to psychological screening.
- Treatment response cannot be evaluated until blood tests establish the diagnosis of erectile dysfunction.
Answer: Patient reports no improvement in sexual function; further investigation and possible specialist referral are warranted.
The source evaluates treatment effectiveness through the patient's reported sexual function, and lack of improvement warrants further investigation and possible specialist referral. Adherence alone does not establish effectiveness, and blood tests investigate underlying causes rather than establish the ED diagnosis. Psychological screening may contribute to assessment, but it should not replace broader investigation of ineffective treatment.
Where every quote comes from
Section 20.3 Male-Specific Disorders of the Reproductive Tract of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
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