20.1 Brief Review of Genitourinary and Reproductive Anatomy and Physiology

The major organs of the male genitourinary system are the penis and testicles. Other structures in the genitourinary system are the bulbourethral glands and the prostate gland.
Sperm production occurs in the testicles.
The major organs of the female genitourinary system are the uterus and ovaries. Other structures are the vagina, urinary bladder, and urethra.
Ovulation occurs when an egg is released from the ovary and generally occurs once a month.
The menstrual cycle lasts approximately 28 days and is controlled by the release of follicle-stimulating hormone and luteinizing hormone.

20.2 Sexually Transmitted Infections

STIs are transmitted through close sexual contact and are quite common worldwide. They can range from being completely asymptomatic to life-threatening, if not effectively treated. Other clinical manifestations include lesions, discharge, painful urination, or difficulty with conception.
The diagnostics of STIs include urine analysis, culture, and sensitivity, and by visualization. Some patients may have delayed diagnosis because they are asymptomatic.
Caring for patients with STIs is complex, and intervention and treatments will vary depending on the specific infection. Interventions center around counseling, education, and administering certain treatments.
Nursing goals for the care of patients with STIs include thorough assessment and detection, early intervention, and effective treatment.
Medical therapies can be pharmacological through antibiotics or antivirals, and surgical intervention may be required to remove lesions, if indicated.

Common disorders of the male reproductive system include testicular torsion, testicular cancer, and erectile dysfunction. These conditions surface from chronic comorbid disease, genetics, or acute injury.
Erectile dysfunction is a condition in which the male individual cannot maintain a full erection of the penis for sexual intercourse. It is generally diagnosed based on the patient’s subjective symptoms
Testicular cancer is rare and is typically diagnosed in young men in their 20s and 30s. Signs and symptoms include a painless hard lump or sudden swelling in the testicle.
Testicular torsion occurs when the spermatic cord, the supplier of blood to the testicles, becomes twisted. It is characterized by sudden severe pain in the testicles and scrotal swelling. It is a medical emergency.
It is imperative that nurses and other health care professionals be able to recognize common symptoms, initiate appropriate interventions, and provide follow-up and education to ensure the best patient outcomes.
Most male reproductive disorders are easily treated with medications or surgical procedures.
The nurse needs to create an open environment for the patient while also focusing on proper diagnosis, intervention, and initiation of effective treatment options.

The prostate gland is an important part of the male reproductive system because it assists with the hydration and elimination of sperm for reproduction.
The two main medical conditions that affect the prostate gland are benign prostatic hyperplasia (BPH) and prostate cancer. Both conditions can result in abnormal urinary elimination patterns and have a negative impact on mental and social health.
Prostate cancer is diagnosed through digital rectal exams and a prostate-specific antigen blood test.
BPH and prostate cancer are both quite common, especially in older men, but several treatment options exist, making them some of the most treatable conditions seen in the male population.
Nursing care of patients with prostate disorders centers around improving urinary elimination patterns and providing psychosocial and educational support to the patient.

Disorders of the female reproductive system include PID, endometriosis, and uterine fibroids.
Disorders of the female reproductive system can be difficult to diagnose because there are no specific diagnostic tests associated with any of the disorders. Diagnosis is typically symptom based.
Nurses must manage all aspects of patient care, which can be complex and include the patient’s physical, psychological, and educational needs. Nurses must also evaluate care and determine the effectiveness of treatments and interventions.
Treatment options range from pain control with medications to eradication of the disorder with surgical procedures.
These disorders can have a significant impact on female fertility and mental health, so it is important for nurses to provide these patients with supportive and empathetic care.

Breast cancer remains a problematic disease affecting women, with higher incidence of mortality in the Black community. Risk factors include genetics, nulliparity, obesity, use of hormone replacement therapy, and excessive alcohol and nicotine use.
The gold standard of diagnostics for breast cancer is the mammogram. Patients can perform self-breast exams to assess for presence of lumps.
Nursing care of the patient with a breast disorder includes thorough history, scheduling mammograms, providing education about self-breast exam, and supporting the patient requiring surgical intervention, such as a mastectomy.
Evaluation is tailored around monitoring the patient’s response to therapy and goals of eradicating cancer. Nurses must also extend psychosocial support to the patient with breast cancer.
Medical therapies include administration of chemotherapeutics, hormone therapy, and radiation. Surgical options may be a lumpectomy or a mastectomy.

The kidneys play a vital role in many body functions, including fluid and electrolyte balance and blood pressure control. Kidney disease arises from damage to the nephron unit, impaired blood flow to the kidney, or outward flow from the urethra. Symptoms of kidney disease include fluid overload, oliguria, electrolyte disturbance, fatigue, and weight gain.
Diagnosis of kidney disease encompasses noting the patient’s subjective complaints while also monitoring BUN and creatinine levels, urine analysis, and results of certain diagnostic tests that can uncover kidney disease.
Nurses caring for patients with kidney disease must assess for cues that further damage is occurring, through surveillance of laboratory tests and objective clinical findings. The responsibilities include monitoring hemodynamic stability, monitoring electrolytes, and specialty skills of dialysis when clinically appropriate.
Evaluation of nursing care of patients with kidney disease includes monitoring improvement or worsening of renal studies, and normalization of fluid and hemodynamic status.
Medical therapies vary in the treatment of kidney disease, from restoring perfusion to the renal unit through administration of fluids, treatment of hyperkalemia, to more invasive therapies such as dialysis.