Male Genitourinary

structure and function

Scrotum

•Rugae

•Cremaster muscle

•Testis

•Epididymis

•Vas deferens

•Spermatic cord

•Ejaculatory duct

penile discharge or lesions

• Discharge, leaking, dripping from penis?

• Color, thickness, amount, how often?

•Sores or growths on penis or scrotum?

•Had these symptoms before?

•• Sexual activity?

•• Past history of STIs?

•• Oral or anal sex?

•• Any concerns about HIV infection?

scrotal pain or swelling

OLDCART

inguinal pain or swelling

• May indicate inguinal hernia

•• Unilateral or bilateral

• Point to area of pain

• When does it hurt?

• Continuous or intermittent?

• Does it occur with lifting, standing,

bending, bearing down?

problems with urination

• Benign prostatic hyperplasia (BPH) or cancer

•• Men older than age 70 are at greatest risk

Any nocturia?

•• Difficulty starting or stopping urination?

•• Weak flow?

•• How often? Day? Night? Urgency?

•• Any pain or burning?

•• Any blood in urine?

•• Any discomfort or heaviness?

principles of interviewing adolescent male patients

•Ask questions that seem appropriate for boy’s age but be aware that norms vary widely.

•Ask direct, matter-of-fact questions. Avoid sounding judgmental.

•Start with a permission statement. “Often boys your age experience…”

•Try the ubiquity approach, “When did you…” rather than “Do you…”

•Sometimes all you do is “open the door” to later conversation

additional history for preadolescents and adolescents

•Around age 12 to 13 years…

•Who can you talk to…

•Boys around age 12 to 13 years have a normal experience…

•Teenage boys have other normal experiences and wonder if they are the only ones who ever had them…

aging adult

•Any difficulty urinating?...

•Do you need to get up at night…

•A man in his 70s, 80s, or 90s…

physical exam

•Preparation

•Position

•Apprehension regarding exam

•Equipment needed

•Gloves

penis inspect and palpate

•Skin

•Prepuce – retract to see glans if prepuce is in place

•Glans

•Urethral meatus

•Pubic hair

•Urethral discharge

•Shaft

•Base of penis

•Inguinal areas

scrotum inspect and palpate

•Skin

•Testis

•Epididymis

•Spermatic cord

•Any mass

•Note characteristics

•Transillumination

check for hernia inspect and palpate

•Person standing and straining down (Valsalva maneuver)

•Inguinal lymph nodes

•Assess for bulging and asymmetry – if present refer to MD for follow up but absence of bulge doesn’t guarantee absence of hernia

•Teach testicular self-examination

    T = Timing

    S = Shower

    E = Examination points

male genital lesion

•Herpes progenitalis

•Syphilitic chancre

•Condylomata acuminata (genital warts)

•Carcinoma

•Urethritis (urethral discharge and dysuria)

abnormalities of the penis

•Phimosis

•Paraphimosis

•Hypospadias

•Epispadias

•Peyronie’s disease

•Priapism

•Urethral stricture

abnormalities in the scrotum

•Absent testis; cryptorchidism

•Small testis

•Testicular torsion

•Epididymitis

•Spermatic cord varicocele

•Spermatocele

•Early testicular tumor

•Diffuse tumor

•Hydrocele

•Scrotal hernia

•Orchitis

•Scrotal edema

screening of STIs

•Nurses should master skills of eliciting sexual history

•Key information

•Sexual orientation

•Number of partners in past month

•History of past STIs

•Alcohol and drug use

•General risk reduction

•Correct use of male condoms

•Using a new condom with each sex act

•Applying the condom before any sexual contact occurs

•Adding only water-based lubricants

•Immediate withdrawal if the condom breaks during sexual activity

•Holding the condom during withdrawal to keep it from slipping off

•Screening for 15 to 65 years, all pregnant women

•Universal HIV testing from 13 to 64 years, prenatal testing of all pregnant women

•CDC recommends opt-out approach to HIV testing

•American College of Physicians recommend extending screening to 75 years

•Annual testing recommended for high-risk groups

•Presence of any STI warrants testing for coinfection with HIV

testicular cancer

•Encourage monthly self-examinations

•Seek physician evaluation for:

•Painless lump, swelling, or enlargement in either testicle

•Pain or discomfort in a testicle or scrotum

•Feeling of heaviness or sudden fluid collection in scrotum

•Dull ache in lower abdomen or groin

screening for prostate cancer

•2^nd leading cause of cancer death in American men

•Primary risk factors

•Age: increases risk after 65 years

•Ethnicity: higher in AA and African Caribbean males

•Family history: having a first-degree relative with prostate cancer doubles risk; inheritance of BRCA1 and BRCA2 gene increases risk of prostate cancer

•Men with symptoms of prostate disorders should be referred to urologist:

•Incomplete emptying of bladder, Urinary frequency or urgency

•Weak or intermittent stream or straining to initiate flow

•Hematuria, Nocturia

•Bony pain in pelvis

documentation

•Inspection

•Skin

•Circumcised?

•Lesions?

•Masses?

•Discharges?

•Swellings?

•Pain?