Health Assessment -- Male Genitourinary System (FINAL EXAM)

male genitalia: scrotum

- scrotum holds two testes (left lower)

- scrotum keeps testes at the right temperature; if it is too cold, scrotum pulls testicles closer to body; if it's too warm, testicles hang away from body (keep 95 F temperature)

male genitalia: epididymis

sperm mature here and store

prostate

enlargement: sometimes normal part of men's aging process; caused by changes in hormone balance and in cell growth; but if left untreated, it can lead to bladder, urinary tract or kidney problems

male genitalia: inguinal area

- when inspecting the inguinal area for bulging, the nurse would ask the patient to cough or to bear down as if having a bowel movement; bulges that appear the the external inguinal ring or at the femoral canal when the patient bends down may signal a HERNIA

palpating for a hernia (right side)

when palpating for the presence of a hernia on the right side, the male patient to asked to shift his weight onto the left (unexamined) leg

inguinal hernia s/s

- BULGE in the groin area on either side of pubic bone, which becomes more obvious when client is upright, especially cough or strain

- burning or aching sensation at the bulge

- PAIN or discomfort in groin, especially when bending over, coughing or lifting

inspecting inguinal area for bulging

nurse would ask the client to turn his head and cough or to bear down as if having a bowel movement

male genitalia -- subjective history (scrotum)

- testicles fail to descend (cryptorchidism), bulging, swelling, lumps, masses, self-exam testes

- scrotum enlarges with aging

male genitalia exam

to palpate for urethral discharge, the nurse would gently squeeze the glans between the thumb and index finger in order to visualize the discharge in the urethra

epispadias

displacement of urinary meatus in the dorsal surface of the penis

hypospadias

displacement of urinary meatus in the ventral surface of the penis

enlarged scrotal sac

enlarged scrotal sac results from FLUID COLLECTION (hydrocele); varicocele enlargement of the veins

swelling or masses of scrotum

contain serous fluid; such as hydrocele or spermatocele (epididymis), light up with a red glow with transillumination

hematocele/tumors

if there is blood on the scrotum, there is no transillumination

scrotum and inguinal areas palpation

inspect and palpate inguinal and femoral areas for any bulges (bear down)

male genitalia: testicular self exam (TSE)

- men who has undescended testicles at birth, or who are infertile, are at greater risk of testicular cancer

- monthly: after a warm bath or shower after scrotum is more relaxed

- aim to perform TSE about once every four weeks

epididymitis

pain is relieved by elevation of testes/scrotum

phimosis

foreskin is non retractable over the glans penis tip forming a pointy type with a tiny orifice; can be cured with circumcision

parapimosis

- inability to replace the foreskin

- a foreskin that is left in a retracted position leads to venous congestion and edema of the foreskin

- band of tissue impairs blood and lymph flow

- penile pain & swelling

- untreated: gangrene of the glans penis

orchitis

inflammation of the testes, associated frequently with MUMPS

orchitis s/s

- pain, swelling, heaviness and fever

- scrotum appears enlarged and reddened

- swollen, tender testis is palpated

- the examiner may have difficulty differentiating between testis and epididymis

peyronie disease

- development of non-cancerous fibrous scar tissue, hard, non-tender SQ plaques on dorsal or lateral surface of the penis

- causes painful bleeding with erection and erectile dysfunction

- inability to have sexual intercourse

- > 45 years

- caused by trauma

- more common in diabetes & gout patients

priapism

- prolonged erection of the penis

- is not caused by sexual stimulation; continues for 2-4 hours

- painful

- penile tissue becomes necrotic without treatment

- more common in those with sickle cell anemia

prostate

an enlarged smooth, firm, slightly elastic prostate that may not have a median sulcus suggests benign prostatic hypertrophy (BPH)

prostatitis

caused by a bacterial infection (e. coli)

screening tests for male genitalia

- digital rectal exam (DRE)

- prostate-specific antigen (PSA)

digital rectal exam (DRE)

part of usual exam; after age 40

prostate-specific antigen (PSA)

- men age 50 or more should talk to a healthcare provider about the pros and cons of PSA testing so that they can make an informed decision regarding testing

- PSA level may be ELEVATED in BPH or with infection or inflammation of the prostate

older adult considerations

- most men's testicles are about the same size, though it's common for one to be slightly bigger than the other; it is also common for one testicle to hang lower than the other one even in old age

- in older adult male, the penis becomes SMALLER, and pubic hair gray and sparse

- testes DO NOT decrease in size with aging; may decrease in size with long-term illness

- bulging on the inguinal area would be considered an ABNORMAL finding associated with a hernia

- penis size may DECREASE with aging

anus abnormalities

hemorrhoids, fissure, pilonidal cyst (with tuft or hair)

pilonidal cysts

- almost always located near the tailbone at the top of the cleft of the buttocks

- abnormal skin growth located at the tailbone that contains hair and skin

- if it becomes infected, the resulting abscess is often extremely painful

anal fissure

causes include CONSTIPATION (passage of hard, large stools), inflammatory bowel disease (IBS), too much pressure, tight anal sphincter muscles, and poor blood supply to anus and poor healing

hemorrhoids

painless papule caused by varicose veins

conditions of anus and rectum

anal warts, perianal/perirectal abscess, anorectal fissure, anal fistula, hemorrhoids, & anal cancer

anus and rectum examination

the most frequently used position for inspection and palpation of the anus, rectum, and prostate is the left lateral position

anal warts

- painful or painless warts

- patient may be unaware of such growths

- growths in or around the anus and genital area

perianal/perirectal abscess

- infection of the anal tissue or glands

- painful and tender

- fever

- pain on defecation

anorectal fissure

- tear in the anal mucosa

- pain or itching

- bleeding

- history of hard stools

anal fistula

- inflammatory tract that runs from the anus or rectum and opens onto the surface of the perianal skin

- chills or fever

- malaise

- drainage

hemorrhoids

- swollen veins in the lower portion of the rectum or anus

- discomfort

- itching

- discharge

dysuria

painful urination

urgency

have to go right away

hesitancy

difficulty getting the urine stream going

nocturia

needing to void 2-3 times a night

nocturnal enuresis

"bedwetting"

crytochidism

failure of one or both testicles to descend into scrotum

spermatocele

- benign accumulation of sperm occurring on the epididymitis

- sperm filled cystic mass located on the epididymis

hydrocele

enlarged scrotal sac may result from fluid and easily transilluminates

varicocele

enlargement of the veins within the scrotum, which may cause low sperm production and decreased sperm quality, which can cause infertility

melena

black, tarry stool from bleeding higher up in the GI tract

occult blood

hidden blood in the stool; positive guaiac test

dyschezia

chronic constipation with defect reflex for defecation

encopresis

fecal incontinence or soiling (involuntary)

flatulence

flatus (gas) expelled

steatorrhea

excess fat in the stool

stress incontinence

the involuntary loss of urine during coughing, sneezing, laughing, or other physical activities that increase abdominal pressure

urge incontinence

- occurs after the patient experienced a strong need to void; involuntary loss of urine associated with an abrupt or strong desire to void

- frequently caused by a neurologic disorder such as CVA or MS (impairs the ability of bladder or urinary sphincter to contract and relax)

overflow incontinence

- involuntary loss of urine associated with over distention of the bladder

- causes: prostatic hypertrophy is a common cause in men & diabetic neuropathy is a common cause in both sexes

functional incontinence

inability to get to the bathroom in time or to understand the cues to void due to problems with mobility or cognition

STI/STDs

prevalent:

- gonorrhea

- chlamydia

- syphilis

- genital herpes 1 & 2

- genital warts (HPV)

gonorrhea

- mucopurulent foul smelling discharge (or drip) from the penis (white, yellow, beige, or greenish)

- may have epididymitis, proctitis, pharyngitis

- epididymitis, which can present present as unilateral testicular pain without discharge or dysuria

chlamydia

most common bacterial STD

syphilis

syphilitic chancres begin as a small, solitary, silverly papule within 2 to 4 weeks of infection which then erodes to a red, round, or oval, superficial ulcer with a yellowish serous discharge and it is PAINLESS

secondary syphilis

- within a few weeks of the original chancre healing, rash often starts on the trunk of the body, but eventually covers entire body, palm and feet with systemic symptoms; several weeks to months

- warlike sores in the mouth or genital area, hair loss, muscle aches, fever, sore throat, tiredness (fatigue), weight loss, swollen lymph nodes

latent stage of syphilis

- if not treated, the disease moves from the secondary to the latent (hidden) stage; lasts for years

- called the hidden stage because there are no symptoms

- without treatment, disease might lead to major health problems: neuro (headaches, dementia), heart, liver, bone and joint damages

- treated with penicillin

genital herpes 1 & 2

- painful, shallow, blister-like vesicle lesions, ulcer and surrounded by erythema

- ulcer can be on penis and scrotum

human papilloma virus

genital warts are the first symptoms

genital warts

- may be firm, but they are never shiny

- soft, pointed, moist, fleshy, painless papules that may be single or multiple in a cauliflower-like patch

genital carcinoma

men with a history of cryptorchidism are at the greatest risk for the development of testicular cancer