Male GU Flashcards
male genital examination
- Penis and urethral meatus
- Scrotum
- -Testes
- -Duct system and spermatic cord
- Inguinal area
- -Lymphatics
- -Hernias
penis anatomy
- Shaft
- -Corpus cavernosa (2 erectile bodies)
- -Corpus spongiosum-surrounds urethra
- Glans: extension of corpus spongiosum
- -Corona
- Prepuce (foreskin)
- Urethra
Scrotum anatomy
- Two compartments
- Each contains:
- -Testis
- -Epididymis
- -Spermatic cord & vas deferens
- Skin has hair and apocrine, sweat and sebaceous glands
Spermatic cord
bundle of fibers and tissues that form a cord-like structure that runs through the abdominal region down to the testicles in males. This cord is present in a pair, with one cord connecting with one testicle. It performs multiple functions in males, including the primary function of facilitating the passage for semen. Problems with the functioning of this cord can result in pain in the pelvis and impotence. In anatomical terms, the cord is usually referred to as the vas deferens. However, the vas deferens is just a part of its anatomy, and this cord also performs the additional role of supplying blood to the testicles. The cord is enveloped by fibrous tissue to prevent it from the risk of injury and trauma, but it is still delicate enough to be vulnerable to the torsion of testicles
problems with spermatic cord
Apart from testicular torsion, the spermatic cord is also prone to the risks of herniation. A hernia can impinge upon the cord, resulting in its malfunctioning. Surgical treatment may be necessary to correct this condition.
testes anatomy
- Ovoid
- Somewhat rubbery
- Average 3.5 - 5.5cm in length
- Left lower than right
epididymis anatomy
- Coiled duct (20+ feet long!)
- -Runs from top to bottom of testis
- -Continuous with vas deferens
- Lies posterolaterally along the testes
- Soft, rubbery structure
Vas Deferens
-long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the body, in preparation for ejaculation.
Spermatic cord anatomy
- Testicular blood supply – arterial and venous
- Spermatic ductal system (vas deferens)
- External and internal inguinal rings
- Lymphatics
- Nerves
- Cremasteric muscle
Lymphatic drainage
- Inguinal nodes
- -penis
- -scrotal surface
- Periaortic abdominal nodes
- -Testes, prostate
Inguinal lymph nodes
- Supramedial superficial inguinal
- Superolateral superficial inguinal
- Inferior superficial inguinal
- Deep inguinal lymph nodes
inguinal ligament
Inguinal ligament runs from ASIS to pubic symphysis
Femoral vessels pass underneath
Lymph nodes and inguinal canal are superficial to it
tanner stages (sexual developtment)
Important to document in pediatric or adolescent patients
signs of male aging
- Pubic hair: Graying or decrease
- Penis may decrease in size
- Testicles may drop lower in scrotum
inspection of the penis
Shaft & prepuce:
- Ulcers
- Scars
- Nodules/Lesions
- Inflammation
syphilis
Initial symptom is a painless ulcerative chancre with an indurated center and pale edges.
This lesion will resolve spontaneously without treatment and become latent syphilis.
HPV: Condyloma Acuminata
- Common cause of genital warts
- Usually caused by HPV types 6 & 11
- HPV vaccination now recommended for boys & girls
- -Protects against HPV 6,11,16,18
herpes simplex virus
Initial cluster of small vesicles followed by shallow, painful ulcers on a red base
Lesions self resolve then recur
phimosis
- tight prepuce; cannot be retracted over glans
- Foreskin cannot be retracted behind the glans penis
- In pediatric patients younger than 4 years, it is normal for the foreskin to be unretractable
paraphimosis
- tight prepuce; cannot be returned once retracted
- Foreskin is retracted and left behind the glans penis
- This constricts the glans, causing vascular engorgement and edema
- Often iatrogenic
balantitis
- an inflammation of the glans of the penis
- Inflammation of the glans penis
- Commonly caused by Candida albicans
- More common in diabetics
palpation of penis
- Using thumb and 2nd and 3rd digit
- Palpating for:
- -Tenderness
- -Induration
- -Nodules
peyronie’s disease
Painful erections from scar tissue and fibrous plaques under the skin
Surgical correction required
inspection and palpation of the urethra
- Open urethral meatus by compressing glans between index finger and thumb
- Inspect for:
- -Location
- -Erythema
- -Discharge
hypospadias
urethral opening occurs on bottom of the penis
epispadias
urethral opening occurs on top of the penis
inspection of the scrotum
- Skin & hair
- Contours
- Posterior scrotum
palpation of the scrotum
- Testes
- Epididymis
- Spermatic cord
palpation of the testes
- Size
- Shape
- Consistency
- Nodules: hard? painless?
- Tenderness
- If something unusual is found, check the contralateral side
orchitis
- An inflammation of the testis
- Usually unilateral
- Swelling, tenderness at testis
- Inflammation/redness of scrotum may be present
- Transillumination will not occur
cryptochidism
- arrest of one or both testes in the normal path of descent
- Spontaneous descent may occur in 50% in first year of life
- Testes are smaller than normal
- Document bilateral testes in all patients less than one year old
testicular cancer
- Common symptoms of testicular cancer include:
- A swelling and/or lump in one or both of the testes
- Pain in the testes or scrotum may or may not be present
- A feeling of heaviness in the scrotum
- A dull feeling of pain in the region of the lower abdominal area, groin, or lower back
- recommended to screen all men ages 15-35 years for testicular cancer and teach monthly self exam
palpation of epidiymis and spermatic cord
Tenderness
Nodules
Swelling
epididymitis
common inflammatory/infectious condition that can be acute, subacute, or chronic. On occasion, significant areas of painless induration or nodularity can be palpated in the epididymis in men who have no prior history of scrotal pain. No further evaluation or treatment is necessary, and scrotal ultrasonography is generally unremarkable.
testicular torsion
- Twist within the scrotal sac
- Blood supply to the testis is cut off resulting in edema and ischemia
- Sudden onset of severe scrotal pain, abdominal pain, nausea, vomiting, edema, erythema, and extreme tenderness
- Medical emergency
hydrocele
- A fluid filled scrotal mass that is usually painless though the patient may note a feeling of heaviness
- A collection of fluid within the tunica vaginalis (a blind pouch)
- Mass transilluminates
- Anterior to testicle
- cause of most is unknown
- Hydroceles in newborns may mean there is an opening between the abdomen and the scrotum. Normally such openings close before birth or shortly after.
- Hydroceles that appear later in life may be caused by an injury or surgery to the scrotum or groin area. Or they can be caused by inflammation or infection of the epididymis or testicles. In rare cases, hydroceles may occur with cancer of the testicle or the left kidney. This type of hydrocele can occur at any age but is most common in men older than 40.
varicocele
- A varicocele is an abnormal dilation of veins that drain each testis
- Varicose veins of the scrotum (“bag of worms”)
- Usually asymptomatic, left side
- Most easily palpated with the patient in an upright position
- Result from dilation of Pampiniform Plexus
- made up of veins that contain inadequate valves
inguinal hernias
-Inguinal canal
–Tunnel for the vas deferens through abdominal muscles
–Superficial and parallel to the inguinal ligament
–Internal and external inguinal rings
caused by loops of bowel forcing through weak areas of the inguinal canal
femoral hernia
- below inguinal ligament
- medial to femoral vein
- Most rare type
- More common in women
- Occurs through the femoral canal
- A mass or bulge present below the inguinal ligament
direct inguinal hernia
push directly through the abdominal fascia
indirect inguinal hernia
descend down the inguinal canal
palpation of hernias
- patient standing, provider sitting
- right hand for patient’s right side
- gather loose scrotal skin with index finger
- follow spermatic cord upward/lateral
- find external ring
- patient to cough/strain down
feeling of an indirect inguinal hernia
As patient coughs, bulge will be felt at fingertip
feeling of direct inguinal hernia
- May be felt on the pad of the finger
- Placing the other hand over the external inguinal ring, one may feel a direct inguinal hernia
digital rectal exam (DRE)
- Check anus
- -Hemorrhoids, fissures
- -Infections
- Check prostate
- -Benign prostatic hypertrophy
- -Cancer
- Check rectum
- -Tumors
- -GI bleeding
position of DRE
Upright vs. fetal / knees in chest
Direct the patient into position
Inspection of anus
- External anus for fissures, hemorrhoids
- Bleeding or infection
- Warts, rashes or lesions
DRE palpation
- Well lubricated, gloved hand
- Slow, ask patient to relax
- Communication
- Slowly insert index finger
- -Assess anal sphincter tone
- Assess the prostate
- -Size/consistency
- Extend finger as far as possible into rectum
- -Examine entire circumference
- -Masses/stool/anything else
- Withdraw finger
- -guaiac card
- Anal reflex (anal “wink”)
Prostate assessment
- Size of a chestnut
- -Approximately 4 cm diameter
- Contour: smooth, symmetric
- Consistency: normal is rubbery and nontender
- -Rubbery and enlarged: BPH
- -Soft and tender: infection (prostatitis)
- -Hard nontender mass: tumor
fecal occult blood test
smear stool from rectal exam (gloved hand) onto card to assess for occult GI bleeding Guaiac test Hemoccult test Fecal occult blood test (FOBT) Fecal immunochemical test (FIT)
