lecture 5: men's reproductive history and physical exam

corpus spongiosium

ventral column of erectile tissue containing the urethra (cavernosum urethra)

tunica albuginea of testis

fibrous envelope of the corpus cavernosum

-thinner, whiter in color, more elastic

sperm, testosterone--> secondary sex characteristics

what do the testes produce?

•Travel from testes & epididymis to vas deferens to seminal vesicles, out ejaculatory duct

path of spermatogenesis

prostate issues

urinary hesitancy in males suggests

•If you could spend rest of your life with your sexual function just as it is, how would that be?

•How is it compared to when you were ____?

•How does your partner feel about it?

•Do you have interest in sexual intercourse?

question to assess degree of sexual satisfaction

erectile dysfunction

-can be an early symptom of coronary artery disease

-precedes cardiac symptoms by 10 years

1.Inspect pubic hair characteristics & distribution

2.Retract foreskin if patient uncircumcised

3.Inspect the glans noting: color, smegma, external meatus of urethra, urethral discharge

inspection steps of male GU exa

•Palpate length of shaft, ventrally along the corpus spongiosum, & laterally both corpora cavernosa to detect nodules or plaques

how should you palpate the penis?

•Compress the glans anteroposteriorly between the thumb and forefinger

•Open & inspect the meatus and terminal urethra

how should you assess for penile discharge?

•Rugae produced by contractions of dartos muscle (only muscle besides platysma not to attach to a joint)

what produces the rugae of the scrotum?

•(a) testes

•(b) tunica vaginalis

•(c) epididymis (head, body, & tail)

•(d) spermatic cord

•(e) inguinal lymph nodes.

sequence to examine the scrotum

•Compare the spermatic cords by simultaneously grasping each at neck of scrotum. With thumb in front & forefinger behind scrotum, GENTLY compress cord

method to examine the spermatic cord

vas deferens

felt as a distinct hard cord, which can be separated from other cord structures

the spermatic cord & testes, so identify these structures & anatomic relations to the mass

inguinal hernias always descend in front of

Indirect inguinal hernia

what type of hernia?

•follows the pathway that the testicles made during prebirth development. It descends from the abdomen into the scrotum. This route is normally closed by birth but remains a potential space.

-more common with age, but can occur with any age

direct inguinal hernia

what type of hernia?

-occurs slightly to the inside of the site (medial), comes through weakened abdomen muscles

-rarely protrudes into the scrotum; almost ALWAYS in middle aged and elderly bc the abdominal walls weaken

femoral hernnia

what type of hernia?

-abdominal contents (usually intestine) can slip into the canal

- causes bulge below the inguinal crease in roughly the middle of the thigh

-HIGH RISK OF BECOMING irreducible and strangulated

small: by age 2

large: 2-4 years old

when do umbilical hernias usually close by?

•Disruption of the conjoined tendon

•Weakening of the transversalis fascia

•Tears in the internal oblique muscles

•Tear in oblique aponeurosis causing dilation of the superficial inguinal ring

etiologies of sports hernias

place light against posterior wall of scrotum, shining anteriorly through mass

how do you perform scrotal transillumination?

-most appear opaque

how do hernias appear on scrotal transillumination?

active hemorrhoids

relative contraindication to rectal exam

values below 4.0 are considered good

-above 4.0 is a risk for prostate cancer

normal PSA finding

pearly penile papules

Small skin colored bumps that often form in rows around the glans. Considered a normal anatomic variant, not contagious, and are asx

Considered harmless, they will decrease with age, but can last throughout ones lifetime

fordyce's spots

-sebacous glands found on shaft and scrotum of penis

-cosmetic concern only

inguinal adenopathy

swelling associated with shaving

•Usually congenital in children

•Due to trauma in adults

etiology of hydrocele

•When scrotum is investigated with focused beam of light, scrotum transilluminates, revealing a homogenous glow, without internal shadows

transillumination findings of hydrocele

scrotal ultrasonography

if suspect hydrocele after transillumination, whhat do you do next?

orichitis

-testes bilateral swollen, tender, and usually extremely painful

-associated with mumps

-mumps (unimmunized)

-primary or secondary epididymitis

-hydrocele

associated diseases of orchitis

Paraphimosis

condition in which a retracted prepuce cannot be pulled forward to cover the glans

gonorrhea

-purulent discharge 7-10 days after sex exposure usually indicates

herpes simplex

-small group of vesicles on erythematous base, frequently occuring on glans or prepuce

-when vesicles rupture, produces painful superficial ulcers that heal in 5 to 7 days

-ulcers may serve as portals of entry for bacteria

carcinoma of the penis

-appears as irritation or inflammation of the foreskin or glans, commonly the dorsal corona or the inner lip of foreskin

-a warty growth develops, ulcerates, and discharges watery pus

inguinal lymph nodes

penile carcinoma most often metastases to

primary lesion of syphilis

-hard chancre commonly occuring on glans or inner leaves of foreskin, occasionally on the shaft or scrotum

•The chancre begins as a silvery papule that gradually erodes to form a superficial ulcer with a serous discharge containing Treponema pallidum

progression of syphilitic chancre

condyloma latum

-cauliflower like plaque in genital area; manifestation of secondary syphilis

-these lesionns are soft, flat topped, moist or macerated reddish brown to grayish

-coalesce into larger plaques

•X-ray taken using a broken chicken bone on top of penis

how do you xray the penis for a fracture?

fractured penis

•Defined as rupture of the tunica albuguinea of corpus cavernosum when penis is in an erect state

-urologic emergency

peyronie disease

•Chronic disease of unknown cause, characterized by irregular fibrosis of the septum or sheath of the corpus cavernosum penis, extending into tunica albuginea

•Never affects corpus spongiosom

peyronie disease

considered a component of dupuytren diathesis along with palmar and solar fibrosis

epispadias

•Urethral opening along the dorsum of the penis on the glans, penile shaft, and penopubic angle

•Proximal forms are common and associated with incontinence

hypospadias

•Ectopic urethral opening which may be located ventrally on the glans, penile shaft, scrotum, or perineum

spermatocele

•Benign cystic accumulation of sperm

•Often found in the head of the epididymis

•Usually a smooth, firm, well-circumscribed mass of the scrotum

•Usually develop slowly and usually have no symptoms

•Common cause of infertility in men

presentation of varicocele

varicocele

•Incompetent or inadequate valves within the veins along the spermatic cord cause a varicocele.

•The abnormal valves obstruct normal blood flow causing a backup of blood, resulting in enlargement of the veins

Cryptochordism

•During fetal development, descent of one or both testis arrested in abdomen, inguinal canal, or at puboscrotal junction

•Testes is palpable in the inguinal canal or at the puboscrotal junction, but frequently is atrophied

•Testicular maldescent may decrease fertility and is frequently associated with a congenital inguinal hernia on the same side as a result of persistence of part of the saccus vaginalis

testicular cancer

maldescended testis (cryptochordism) carry an increased risk of this cancer