Nur 319 Ch 25: Male Genitourinary System Abnormals

Urethritis

(Urethral discharge and dysuria). Infection of urethra causes painful, burning urination, or pruritus. Meatus edges are reddened, everted, and swollen with purulent discharge. Urine is cloudy with discharge and mucus shreds.

Renal Calculi

Renal stones (crystals of calcium oxalate or uric acid) form in kidney tubules then migrate and become urgent when they pass into ureter, become lodged, and obstruct urine flow – causes hydronephrosis; Can cause abrupt severe flank (side) pain with radiation to groin or abdomen, nausea, vomiting, restlessness, and hematuria.

Acute Urinary Retention and UTI

Inability to pass urine with bladder distention and lower abdominal pain. Common in older men due to bladder outlet obstruction. This can cause UTI, causing stasis and turbulent flow. UTI incidence increases among men ages ≥60 years and presents with dysuria, frequency, urgency, nocturia, suprapubic pain, occasionally gross hematuria, possibly fever. Treat with antibiotics and address underlying problem.

Urethral Stricture

Pinpoint, constricted opening at meatus or inside along urethra. Occurs congenitally or secondary to urethral injury.

Tinea Cruris

A fungal infection in the crural fold, not extending to scrotum. “jock itch” after sweating or wearing layers of occlusive clothing. It forms a red-brown half-moon shape with well-defined borders. Antifungal for treatment. 

HSV-2 Infection (genital herpes)

Clusters of small vesicles with surrounding erythema, which are often painful and erupt on the glans, foreskin, or anus. These rupture to form superficial ulcers. May have mild tingling before outbreak or shooting pain in buttock or leg. An STI, the initial infection lasts 7 to 10 days and is treated with oral antivirals. The virus remains dormant indefinitely; recurrent infections last 3 to 10 days with milder symptoms.

Genital Warts

Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower-like patch. Color may be gray, pale yellow, or pink in white males and black or translucent gray-black in black males; may grow into large grape like clusters; caused by HPV; Gardasil vaccine for prevention

Syphilitic Chancre

Small, solitary, silvery papule that erodes to a red, round or oval, superficial ulcer with yellowish serous discharge. Nontender indurated base that can be lifted like a button. Lymph nodes are enlarged early. STI treated with penicillin G. If untreated it leads to cardiac and neurologic problems and blindness.

Carcinoma

Red, raised, warty growth or as an ulcer with watery discharge. As it grows it can necrose and slough. Usually, painless. Follows chronic inflammation and enlarged lymph nodes are common. Almost always on glans or inner lip of foreskin

Hypospadias

Congenital; urethral meatus opens on the ventral side of the glans or shaft. Shiny tissue extends from the meatus to the tip and the foreskin is not fully developed, leaving the ventral side of the glans uncovered.

Priapism

Prolonged painful erection w/o sexual stimuli and unrelieved by sex or masturbation. ER

Phimosis

Nonretractable foreskin, forms a pointy tip, foreskin is advanced and very tight. Can be congenital or from adhesions secondary to infection

Paraphimosis

Foreskin is retracted and fixed. When retracted tight or inflamed foreskin cannot be returned to original position. Impedes circulation and causes glans to swell.  Medical Emergency.

Epispadias

Meatus opens on upper side of shaft. Rare but disabling.

Peyronie Disease

Hard, nontender, subcutaneous plaques on dorsal or lateral surface palpated by stretching the penis; Usually occurs in men 45 years and older. Caused by trauma.

Absent Testis

Undescended testis. Atrophic scrotum on affected side. Affects fertility and decreased sperm production. Increases risk of testicular cancer.

Small Testes

hypogonadism

Testicular Torsion

Sudden twisting of spermatic cord. Occurs in late childhood, early adolescence. Blood supply is cut off, resulting in ischemia and engorgement. Emergent. testis can become gangrenous in a few hours; Red, swollen scrotum, one testis (usually left)

Epididmyitis

Acute infection; prostatitis; Severe pain of sudden onset in scrotum, relieved by elevation

Varicocele

dilated, tortuous internal spermatic varicose veins caused by incompetent valves, which permit reflux of blood; Screen at early adolescence; obtain scrotal ultrasound; early treatment important to prevent potential infertility when an adult; feels distinctive, like a “bag of worms”; Testes on side of varicocele may be smaller due to impaired circulation

Spermatocele

Retention cyst in epididymis; filled with thin, milky fluid that contains sperm

Early Testicular Torsion

Solitary, firm, nontender nodule or harder-than-normal section of testicle; testicular swelling occurs in most; may have history of undescended testicle or familial testicular cancer

Diffuse Tumor

Nontender swelling of testis, firm palpation does not cause usual sickening discomfort as with normal testes. DOES NOT TRANSILLUMATE

Hydrocele

Nontender swelling of testis, painless swelling, person may complain of bulk, TRANSILLUMINATES PINK OR RED, able to get fingers above mass

Scrotal Hernia

Swelling, may have pain with straining, does not transilluminate, soft mushy mass, fingers cannot get above mass

Orchitis

Acute inflammation of the testis. Does not transilluminate, sudden onset of acute or moderate pain, enlarged, edematous tender and tense swelling of testis. Hard to distinguish testis from epididymis.

Scrotal Edema

tenderness, enlarged scrotal, taut with pitting. Unable to feel scrotal contents.

Indirect Inguinal Hernia

Sac herniates through internal inguinal ring.  can remain in canal or pass into scrotum.  most common of all hernias; can be congenital or acquired.

Direct Inguinal Hernia

Directly behind and through inguinal ring, above inguinal ligament.  Less common, often in men older than 40; brought on by heavy lifting, atrophy, obesity, chronic cough, or ascites.

Femoral Hernia

Through femoral ring and canal, below inguinal ligament, appears more often on right side.  Least common of hernias, more common in female; acquired due to abdominal pressure, muscle weakness, or frequent stooping.