Male Genitourinary System Assessment and Pathophysiology
Subjective Data Assessment Questions
To gather a comprehensive history regarding the male genitourinary system, specific questions regarding urinary habits and physical changes must be addressed:
Urinary Frequency, Urgency, and Nocturia: Inquire about changes in the number of times the patient voids, the sudden need to urinate, or the necessity to wake up during the night to urinate.
Dysuria: Determine if the patient experiences pain or burning during urination.
Hesitancy and Straining: Ask if the patient has difficulty starting the urine stream or needs to push to empty the bladder.
Urine Color: Assess for any abnormal colors or the presence of blood.
Past Genitourinary History: Document any previous issues, surgeries, or conditions related to the renal or reproductive systems.
Penis: Assess for symptoms such as pain, the presence of lesions, or any unusual discharge.
Scrotum: Inquire about self-care behaviors, the presence of any lumps, or general scrotal discomfort.
Sexual Activity and Contraceptive Use: Document current sexual health practices and methods used for pregnancy prevention.
Sexually Transmitted Infection (STI) Contact: Ask about known exposure to partners with STIs.
Objective Physical Examination: Penis
Skin Integrity: The skin normally appears wrinkled and hairless. No lesions should be present. The dorsal vein may be visible on the surface.
Glans Assessment: The glans should appear smooth and free of lesions.
Foreskin Retraction:
In uncircumcised males, the foreskin should be retracted by the patient or the examiner to inspect the glans.
The foreskin should move easily without resistance.
It is normal for some cheesy smegma to have collected underneath the foreskin.
After the inspection is complete, the foreskin must be slid back to its original position.
Objective Physical Examination: Scrotum and Contents
Scrotal Inspection:
The size of the scrotum varies based on the ambient room temperature.
Asymmetry is considered a normal finding, where the left scrotal half is typically positioned lower than the right half.
Testes Palpation:
Normal testes feel oval, firm, rubbery, and smooth.
They should be equal in size bilaterally and freely movable within the scrotal sac.
They are naturally tender to moderate pressure.
Epididymis: This structure should feel discrete and is normally softer than the testis itself. It should feel smooth and be nontender upon palpation.
Spermatic Cord: The examiner should feel a smooth, nontender cord.
Abnormal Scrotal Masses: Historically, no other contents should be present in the scrotum. If a mass is detected, the following must be noted:
Is there any tenderness associated with the mass?
Does the mass reduce or disappear when the person lies down?
Can bowel sounds be heard over the mass via auscultation?
Testicular Self-Examination (TSE)
Health Teaching: Every male from the age of to through adulthood should be taught how to perform a self-examination.
Rationale: While the overall incidence of testicular cancer is rare, it is the most common cancer occurring in young men between the ages of and .
TSE Protocol:
T – Timing: Perform the examination once a month.
S – Shower: Conduct the exam in a warm shower, as warm water relaxes the scrotal sac, making palpation easier.
E – Examine: Carefully check for any changes and report them immediately to a healthcare provider.
Developmental Competence: Infants and Children
Penis and Scrotum Size: The penis is usually small in infants and young boys until the onset of puberty. In obese boys, the penis may appear even smaller because it is partially hidden by skin folds at the base.
Foreskin in Infants: For uncircumcised infants, the foreskin is normally tight during the first months of life. It should not be retracted during this time because of the high risk of tearing the membrane that attaches the foreskin to the shaft.
Scrotal Appearance:
The scrotum appears pink in white infants and dark brown in dark-skinned infants.
Rugae (skin folds) should be well-formed in a full-term infant.
While size varies with temperature, the infant’s scrotum often looks large in proportion to the penis.
Reflexes: The cremasteric reflex is typically strong in infants.
Developmental Competence: Adolescents and Puberty
Puberty Onset: Signs of puberty are appearing earlier in boys. The average age for African American boys is years, while for Caucasian and Hispanic boys, the average age is years.
Sequence of Development:
The first physical sign of puberty is the enlargement of the testes.
This is followed by the appearance of pubic hair.
Subsequent to hair growth, the size of the penis increases.
Documentation: These stages are formally documented using Tanner’s sexual maturity ratings.
Developmental Competence: Adults and Aging
Sperm Production: Around age , sperm production begins to decrease, though it can continue into the and .
Testosterone levels: Production of testosterone begins to decline after age , but the decline is so gradual that physical changes are often not evident until much later in life.
Observed Changes in Older Males:
Pubic hair becomes thinner and may turn gray.
The size of the penis may decrease.
Testes may decrease in size and feel less firm upon palpation.
The scrotal sac becomes pendulous and exhibits fewer rugae.
Continuous sitting can lead to excoriation of the scrotal skin.
Prostate Gland Abnormalities
Benign Prostatic Hypertrophy (BPH):
Subjective Symptoms: Include urinary frequency, urgency, hesitancy, straining, a weak or intermittent stream, a sensation of incomplete bladder emptying, and nocturia.
Objective Signs: A symmetric, nontender enlargement of the gland. It commonly begins occurring in the middle years. The surface of the prostate feels smooth, rubbery, or firm—similar to the consistency of the tip of a nose. The median sulcus is typically obliterated.
Prostatitis:
Subjective Symptoms: Fever, chills, malaise, frequency, urgency, dysuria, and urethral discharge. Patients may report a dull, aching pain in the perineal and rectal areas.
Objective Signs: The gland is exquisitely tender, swollen, and slightly asymmetric, indicating acute inflammation.
Prostate Cancer (PC):
Subjective Symptoms: Early-stage PC is asymptomatic. Extensive cancer symptoms include frequency, nocturia, hematuria, a weak stream, hesitancy, and pain or burning. Continuous pain may be felt in the lower back, pelvis, or thighs.
Objective Signs: A later-stage neoplasm may be palpated as a single hard nodule on the posterior surface, causing asymmetry. As it progresses, multiple hard nodules may appear, or the entire gland may feel stone-hard and fixed. The median sulcus is obliterated.
Detection: Early detection (before symptoms) is crucial, typically utilizing PSA (Prostate-Specific Antigen) levels—though not always accurate—and transrectal ultrasonography.
Penile Abnormalities and Conditions
Priapism: A prolonged, painful erection that occurs without sexual stimulation and is not relieved by intercourse or masturbation. If the condition lasts hours or longer, it can lead to penile ischemia, tissue fibrosis, and permanent erectile dysfunction. Causes include side effects of erectile dysfunction medication, street drugs, sickle-cell trait/disease, leukemia (where high WBC counts cause engorgement), malignancy, trauma, or spinal cord injuries.
Paraphimosis: A medical emergency where the foreskin is retracted and becomes fixed behind the glans. A tight or inflamed foreskin cannot be returned to its original position, creating a constricting band that prevents venous and lymphatic return and eventually compromises arterial circulation, causing the glans to swell.
Phimosis: A condition involving a nonretractable foreskin that forms a pointy tip with a very small orifice. It is so tight that it cannot be retracted over the glans. It can be congenital or acquired due to adhesions from infection. Poor hygiene and the retention of smegma/dirt increase the risk for inflammation, calculus formation, and obstructive uropathy.
Hypospadias: A congenital abnormality where the urethral opening is located on the ventral (under) side of the penis rather than at the tip.
Epispadias: A rare abnormality where the urethral opening is located on the dorsal (upper) side of the penis.
Other Abnormal Genitourinary Findings
Cryptorchidism: Refers to undescended testes (testes that have never descended into the scrotal sac). This condition is common in premature infants and leads to decreased spermatogenesis and infertility. It also significantly increases the risk for testicular cancer.
Genital Herpes (HSV-2 Infection):
Characteristics: Clusters of small, painful vesicles with surrounding erythema. These eventually rupture to form superficial ulcers.
Symptoms: Patients may experience mild tingling before an outbreak or shooting pain in the buttocks or legs.
Duration: Outbreaks typically last to days. The virus remains dormant indefinitely but is treated with oral antivirals during active stages.
Genital Warts:
Characteristics: Soft, pointed, moist, fleshy, and painless papules. They can appear as single entities or in multiple clusters resembling a cauliflower-like patch.
Cause: These are caused by the Human Papillomavirus (HPV) and represent one of the most common STIs.
Questions & Discussion
Question: The nurse is reviewing the importance of testicular self-examination (TSE) with a -year-old male. Which statement by the patient confirms the patient’s understanding of TSE?
’I will check my testicles for lumps in the shower.’
’I will bear down and check my groin area while seated.’
’I will check my testicles while lying on my right side.’
’I will have my testicles examined by my health care provider every year.’
Answer: The correct understanding is confirmed by the statement, ’I will check my testicles for lumps in the shower.’", "title": "Male Genitourinary System Assessment and Pathophysiology"}