N321 - Genitourinary System Male

Male genitalia - external

• penis - used for urination and reproduction

  • shaft and glans

• Fold of the foreskin is called the frenulum

scrotum and scrotum sac

• thin walled sac suspended below the pubic bone

• protective covering for testes and vas deferens

• maintain the cooler than body temperature necessary for sperm production

  • cremaster muscle sensitive to changes in temperature

internal genitalia - testes

• testes - produce spermatozoa and testosterone; suspended in the scrotum by the speramtic cord

internal genitalia - vas deferens

• vas deferens - passage for transporting sperm from the testes to the urethra for ejaculation

inguinal area

• located between the anterior superior iliac spine laterally and symphysis pubic medially

• frequent site of hernia development

  • this is because protusion of loop of bowle through weak areas of the msuculature

Anus and rectum

• anal canal - final segment of the digestive system

• rectum

prostate

• prostate surrounds the neck of the bladder and urethra

• secretes thin, milky substance that promotes sperm motility and neutralizes female acidic vaginal secretions

• can be palpated through the anterior wall of the rectum

• prostate gland enlargment (prostatic hyperplasia) increases in men over age 40

risk factors for prostate cancer

• certain gene changes

• exposure to agent orange

• working on a farm, in a tire plant with paint, with cadmium or firefighters exposed to toxic chemicals

• Diet - slightly higher risk for those who eat a diet high in red meat or high fat daily, fewer veggies

• lower melatonin levels (sleeping with even small light source; shift work)

demographic risk factors for prostate cancer

• rare in men under 40; risies after age 50

• race/ethnicity: highest in African American or Caribbean males of African origin; less often in Asian, Hispanic/Latino men than in white

• Geography: most common in North America, northwestern Europe, Australia, and on Caribbean islands

• family history: having a father or brother with prostate cancer

symptoms of prostate cancer

• trouble urinating

• decreased force in the stream of urine

• blood in the semen

• swelling in the legs

• bone pain

• erectile dysfunction

• may or may not be present, more likely present in advanced stages

education topics: prostate cancer

• don’t overeat (consume moderate servings and calories

• eat a diet low in fat and rich in fruits and veggies, high in fiber, and high in omega-3 fatty acids

• stay fit and maintain a healthy weight

• soy products and other legumes have phytoestrogens that may have a positive effect

• drink green tea daily

• drink no more than 2 alcoholic drinks a day

• sleep in a dark room; avoid bright light at night

Testicular Cancer

• high mortaility rate, esp if not detected early

• American Cancer Society recommends a testicular exam as part of routine check

• Males should be aware of a need for a monthly testicular self-examination

  • important for early diagnosis and treatment of testicular cancer

  • it is normal for one testis to be larger than the other

  • any evidence of a small, pea-like lump consult your physican - due to an infection or a tumor growth

  • start testciular exam at age 15-40

Health assessment

• collecting subjective data - use COLDSPA

  • history of current health problem

  • past and family histories

  • lifestyle and health practices

• collecting objective data

  • physical exam

    • preparing the client

    • equipment and supplies: stool, gown, disposable gloves, flashlight, and stethoscope

• validating and documenting findings

• make sure to tell the patient to empty his baldder so that he will be comfortable

physical assessment of penis

• inspection and palpation

  • base of the penis and pubic hair

  • shaft, foreskin, and glans

  • urethral discharge

physical assessment of scrotum

• inspection

  • base of penis and pubic hair

  • shaft, foreskin, and glans

  • scrotal skin

• palpation of scrotal contents

• auscultation

• transillumination - dim with lgihts and use a bright light directed towards a body part to see what’s undernearth the skin

abnormal scrotal mass

• if there is an abnormal mass found during inspection and palpation of the scrotum perform transilluminatin

  • shine light from the back of the scrotum through the mass - look for a red glow

  • note if the mass disappears if the patient lays down after inspection and palpation

    • if it remains auscultate it for bowl sounds

  • finally gently palpate the mass and push it towards the abdomen

STIs

• rashes, lesions, or lumps

• chancres (red, oval ulcerations) - syphilis, genital warts, and pimple-like lesions from herpes

  • detected in the glans

• yellow discharge - gonorrhea

foreskin abnormalities

• phimosis - tight forskin that cannot be retracted

• paraphimosis - foreskin that is once retracted cannot be returned to cover the glans

urethra abnormalities

• hypospadias - displacement of the urinary meatus to the ventral surface of the penis (toward the bottom)

• epispadias - displacement of the urinary meatus to the dorsal surface of the penis (toward the top)

• clear or white discharge - urethritis

  • any discharge can be cultured

scrotum abnormalities

• enlarged scrotal sac - fluid (hydrocele), blood (hematocele), bowel (hernia) or tumer (cancer)

vericocele

• enlargement of the veins within the scrotum

  • can cause low sperm production and decreased sperm quality, which can can cause infertility

  • indiciation - palpable, tortuous veins suggest cericocele

cyst

• beaded or thickened cord

• suggest hydrocele of the spermatic cord

thrombosed external hemorrhoid

• swollen

• itchy, painful, and bleeds when the client passes stool

prostatisis

• swollen, tender prostate

benigh prostatic hypertrophy

• enlarged, smooth, firm, slightly elastic prostate that may not have a median sulcus

prostate cancer

• hard, fixed, irregular nodules on the prostate

older client findings

• lumps, swelling, masses, sexual dysfunction

• pubic hair may be gray and sparse

• penis is samller and the testes hang lower in the scrotum

• scrotal sace droop more

  • fewer rugae

• testes may be smaller and feel softer to palpate in older men