male health

patient history

• surgeries

  • cryptochidism (undescended testicle)

• injuries

  • testicular torsion

• urinary

  • kidney disease, kidney stones, utis

• genital

  • testicular, prostate or penile cancer, STIs

• diabetes, hypertension, neurological impairment, resp and cardiac conditions

dadspies

• diet

• alcohol - colon cancer

• drugs

• smoking

• physical exam - prostate

• immunizations - gardasil (hpv)

• exercise (colon / prostate cancer)

• stress / sex

questions about urine

• urinating more

  • polyuria

  • oliguria

• nocturia

• urgency

• pain or burning when peeing

• colour

incontinence

• true incontinence

• urge incontinence

• stress incontinence

• functional incontinence

• overflow incontinence

scrotum testicular questions

• any lump / swelling / mass on testes

• any change in size of scrotum

• noted any bulge or swelling

changes with aging

• penis smaller decreased blood flow

• prostate enlarges

• valsalva manoeuvre - relaation of perineal musculature and decreased shincpter control

• less sperm prod

• less testosterone

• less intense sexual response

cultural considerations

• circumcisions

• reduces infectrion by hiv, hpv, decreases risk of STIs

circumcised

• smegma - thing, white cheesy substance present

• retract the prepuce (foreskin)

circumcised penis

• glans and corona are visible, lighter in colour than shaft and free of smegma

prostate obstruction

• trouble starting urine stream

• strain to start force of stream

• dribbling

• after, still feeling like urinating

• UTIs

hypospadias

urethral meatus opens on the underside of glans or shaft or at the penoscrotal junction

epispadias

meatus opens on the upper side of glans or shaft

testicle

• egg shapes and movable

• rubbery with smooth surface

• compare two sides

• epididymis - tube on top and behind testible (soft)

prostate

• 2.5cm by 4cm wide, should not preotrude more than 1cm into the rectum

• heart shape with central groove

• elastic and rubbery

phimosis

• nonretractable foreskin

paraphimosis

• foreskin is trapped behind head of penis

genital herpes - hsv 2

• cluster of small vesicles

• erupt on glans or foreskin

• rupture to form superficial ulcers

• virus remains dormant

syphilitic chancre

• 2-4 weeks after infection

• small solitary silvery papule

• treated w penicilin g

• untreated leads to cardiac problems, neurological problems and blindness

genital warts

• soft pointed moist fleshy painless papules

• caused by hpv

• correlated early onset of sexual activity, infrequent use of contraception, multiple sexual partners

carcinoma

• red, raised warty growth as an ulcer with watery discharge

• usually painless

• on glans, inner lip of foreskin and after chronic inflammation

• enlarged lymph nodes

testicular torsion

• severe pain of sudden onset in testicle

• sudden twisting in spermatic cord

• no fever

• red testicle, swollen scrotum, one scrotum might be higher

• cremaster reflex is present

veriocelee

• dialated varicose veins in spermatic cord as a result of incompetent valves in veins

• infertility, low sperm count, decreased sperm motility

• asymptomatic

hydrocele

• improper lymph drainage

• layers collect in tunica vaginalis

• transillumination test

epididymitis

• positve phren sign: pain relieved when lifting up the testicle

• sever sudden pain

• fever

• rapid swelling and enlargement of scrotum

• treatment: antibiotics

• chlamydia and gonorrea cause this

benign prostatic hypertrophy

• urinary freq, weak stream, nocturia

• symmetrical, non-tender enlargement occurs in middle age

• surface feels smoth, mdeian sulcus gone

prostatitis

• fever, chills, malaise, urgancy, dysuria

• acute inflammation, tender, asymmetrical, swollen gland

• boggy (squishy)

• libido problems, erectile disfunction

• treatment: antibiotics

fissure

• longitudinal tear in superficial nucosa at anal margin

• causes: severe diarrhea, trauma. firm hard constipated stools

• itching, bleeding, pain

hemorrhoids

• varicose vein

• thrombosed - clotted blood becomes painful, swollen mass that itches and bleeds w/ defecation

• cause: portal venous pressure, straining at stool, constipaition, pregnancy, obesity

hernia

• inspect inguinal region for bulge as patient stands and as the patient strains down

• protrusion of bowel through the wall of the cavity in which it normally resides

• most common

indirect inguinal hernia

• sac herniates through internal inguinal ring and can remain in canal or pass into scrotum

• increased intrabdominal pressure - bearing down, tensing ab muscles

• congenital or acquired

direct inguinal hernia

• acquired by heavy lifting, muscle atrophy, asciteis

• usually painless, round swelling close to pubis in area of internal inguinal ring

femoral artery

• through remoral ring and canal below inginal ligament

• pain may be secer as hernia may be strangulated

• least common

testicular cancer

• most common ages 15-35

• most diagnosed between 20-35

• at risk if u have an undescended testicle (cryptochidism), family history or personal history

screening

• timing, shower, examination

• testicular cancer can be detected and treated early

• lumps show up on sides but can be deteceted in front

colon cancer symptoms

• appear once tumour causes bleeding or blocks bowel

• diahrrhea or constipation

• general discomfort

• strong urge to defecate

• feeling of bowel not being completely emptied

• nausea or vomiting

• weight loss

• fatigue

lower risks of colon cancer

• limit red and processed meat consumption

• eat high fibre diet

• stay active

• limit alcohol

updated colon cancer screening guidelines

• 45-75 years, FIT test every 2 years

• increased risk: only 1 first degree relative with colorectal cancer before age 60 or two or more first degree relative diagnosed with colon cancer at any age

• colon cancer checks : should check 10 years before ur yougnest relative got diagnosed with colon cancer

prostate carcinoma

• frequency, nocturia, prematuria, continuous pain in lower back, pelvis and thighs

• malignant neoplasm that starts as a single hard nodule on posterior surface of prostate

• multiple hard nodules can appear and cover entire prostate

prostate cancer risk

• family history

• black ethnicity

• obesity or overweight

• tall adult height

• inherited gene mutations

prostate screening

• DRE digital rectal exam

• PSA prostate - specific antigen , tumour marker = elevated prostate antigens in blood

• transrectal ulltrasound (TRUS) / biopsy