Male Genitourinary System

Question 1

Penis structure

Answer 1

corpora cavernosa
coprora spongiosum
glans
corona
urethra
foreskin
scrotum
rugae
cremaster/dartos
testis
epididymis
vas deferns
spermatic cord
ejaculatory duct
inguinal area
inguinal ligament
inguinal canal
femoral canal

Question 2

Developmental considerations for infants

Answer 2

descent of testes

Question 3

Adolescents developmental considerations

Answer 3

signs of puberty
Tanner’s sexual maturity rating

Question 4

Adults and older adults developmental considerations

Answer 4

sperm production begins to decrease at 40 years
testostosterone declines after 55 years
slower and less intense sexual response
sexual expression in later life (physical chnges do not interfere with libido

Question 5

Specific developmental considerations for infants

Answer 5

observe first voiding if possible
if uncircumcised the foreskin will be tight first 3 months
Importance of documentation of findings on palpation of testes
hydrocele finding in boys under 2 years of age
careful inspection of inguinal area for bulge

Question 6

Adolescent specific considerations

Answer 6

Note normal development of genitals by using sexual maturity rating charts

Question 7

Older adult specific developmental considerations

Answer 7

Decreased penis size
thinner, greying pubic hair

Question 8

Cultural and social considerations

Answer 8

religious and cultural values related to circumcision
No medical indication for neonatal circumcision (not covered by health insurance, reduces infection by HIV, Herpes simplex virus 2 and HPV (decreases STI)
Keep in mind parental knowledge of care of uncricumsized penis

Question 9

Cultural and social considerations

Answer 9

Circumcision of male infants-religious and cultural values
No medical indication for neonatal circumcision and its not covered by provincial health insurance
Keep in mind parental knowledge of care of uncircumcised penis
HPV vax approved for boys and men

Question 10

Subjective data:health history

Answer 10

Frequency, urgency and nocturia
dysuria
hesitancy and straining
penis, pain, lesion and discharge
urine colour
past geniturinary history
scrotum-self care behaviours
sexual activity and contraceptive use
STI contact

Question 11

Additional health questions for infants

Answer 11

urination
toilet training
abnormalities
molestation

Question 12

Additional questions for older adults

Answer 12

prostate enlargment
incontinence nocturia
sexual function

Question 13

Additional questions for preadolescents and adolescents

Answer 13

puberty
nocturnal emission
erotic feelings
sexual activity
self-exam
molestation

Question 14

What are the principles of interviewing adolescent male patients

Answer 14

ask age appropriate questions-norms do vary
ask matter of fact question
avoid sounding judgemental
start with a permission statement like “often boys your age…”
try ubiquity approach (when did you vs do you)
“open the door” to later convo

Question 15

Additional questions for adolescents

Answer 15

around age 12-13 years
who can you talk to
boys are 12-13 have a normal experience
teenage boys have a normal experience and wonder if anyone else had them
often boys your age have questions about sexual activity
has a nurse or doc ever taught you
has anone ever touched your genitals

Question 16

Objective data

Answer 16

inspect and palpate-skin, glans, urethral meatus, pubic hair, urethral discharge, shaft
scrotum-skin and testes

Question 17

Objective data is urine output

Answer 17

Normal is 1500mL a day
moderate distension and urge to urinate with 200-250 mL
assess with indwelling catheter-moniter for signs and symptoms of cather aquired UTI, risk factors are prolonged catheterization, female gender, diabetes, malnutrition, old age and impaired immunity, and proper anchorage

Question 18

Self care-testicular self-exam

Answer 18

teach it early as it results in cure of almost 100%
signs-lump, pain, heaviness, or dull ache
Risk factors-15-49 years
delayed descent of testis, family history, abnormal development of testicles
T=timing, S=shower, E=examination

Question 19

Abnormal findings

Answer 19

colour and discolouration-med side effects, liver disease, some foods, blood in urine, dehydration, excess fluids, hepatitis, urinary tract infection, kidney stones
problems-urethritis, urethral discharge and dysuria
renal calculi
acute urinary retention