Genitourinary Systems & Bowel Care & STIs

Question 1

Steps to assessing the male genitalia?

Answer 1

• inspect the penis
  
  • no lesions
  • no discharge from the urinary meatus
  • may have smegma beneath the prepuce
  • urinary meatus is positioned centrally
  • no infestations in the pubic hair
• palpate the penis
  
  • with index and thumb, compress the glans, should have no discharge
  • palpate down the shaft of the penis
  • no discharge
  • semifirm, nontender, smooth
  • no masses
• inspect the scrotum
  
  • hold the penis out of the way, or ask pt to hold it
  • scrotum normally asymmetrical
  • no lesions; occasional sebaceous cysts
• palpate the scrotum
  
  • scrotal contents should slide easily
  • testes feels smooth and rubbery; equal bilaterally; slightly tender upon moderate pressure
  • epididymis feels discrete, softer than the testis, smooth, and nontender
• palpate the spermatic cord
  
  • should feel smooth and nontender; not swollen and tortuous.
• inspect for hernia
  
  • inspect for hernia as pt stands and strains down
• palpate for hernia
  
  • ask pt to bear weight on unexamined leg
  • invaginate the scrotal skin and go to the external inguinal ring
  • ask pt to bear down
    
    • should not feel a bulge in the inguinal canal as pt bears down
• palpate inguinal lymph nodes
  
  • palpate the horizontal chain along the groin inferior to the inguinal ligament and the vertical chain along the upper inner thigh
  • nodes should feel small, soft, discrete, moveable, nontender

Question 2

Points to cover during TSE education?

Answer 2

• explain why TSE is performed
  
  • to detect early onset of testicular cancer and other abnormalities in the scrotal contents
• explain who should perform TSE
  
  • boys age 13 and over; testicular cancer is most common among men 15-29 years of age
• explain frequency of testicular examination
  
  • perform this once a month after a warm shower when your hands are warm and your testicles are fully descended and relaxed; easier to palpate
• describing method of palpating testicles
  
  • palpate half of scrotum first; roll the testicles around with gentle pressure;
    
    • testicles should feel smooth, soft, rubbery, mildly tender to moderate pressure; move on to other half
  • compare size of both testicles; one should not be larger than the other
  • palpate the epididymis which is found above and behind the testicles; should feel softer than the testes, smooth, and nontender
• describing abnormal findings to look for
  
  • pt should not feel any painless lumps, tenderness, swelling
• instruct to report abnormal findings promptly

Question 3

Points to cover during prostate cancer education?

Answer 3

• higher risk among men of African descent
• highly genetic
• diet high in fat may increase risk of prostate cancer; exercise and eat a healthy diet
• ## beginning at 50 years of age, men should have an annual prostate-specific antigen test (PSA) blood test and digital rectal examination (DRE)