Male GU

Question 1

What are the 4 areas should you inspect on the penis, and describe how you would inspect each area

Answer 1

1. The skin - Inspect the skin on the ventral and dorsal surfaces and the base
   of the penis for excoriations or inflammation, lifting the penis when
   necessary.
2. The prepuce (foreskin) - If present, retract the prepuce or ask the patient to
   retract it. This step is essential for the detection of chancres and carcinomas.
   Smegma, a cheesy, whitish material, may accumulate normally under
   the foreskin.
3. The glans - Look for any ulcers, scars, nodules, or signs of inflammation.
4. The urethral meatus - Inspect the location of the urethral meatus.

Question 2

What is phimosis?

Answer 2

It is a tight prepuce (foreskin) that cannot be retracted over the glans

Question 3

What is Paraphimosis?

Answer 3

It is a tight prepuce that, once retracted, cannot be returned. Edema ensues.

Question 4

What is the proper technique for assessing the urethral meatus in a male?

Answer 4

• Compress the glans gently between your index finger above and your thumb below (Fig. 13-3). This will open the urethral meatus and allow you to inspect it for discharge.
  
  • Normally, there is none.
• If pt. reports discharge that you are unable to see, ask him to
• strip, or milk, the shaft of the penis from its base to the glans.
• Profuse yellow discharge signals gonococcal urethritis; scanty white or
  clear discharge signals nongonococcal urethritis. Definitive diagnosis requires Gram stain and culture.

Question 5

What is the correct technique used when palpating the penis?

Answer 5

• Palpate the shaft of the penis between your thumb and first two fingers, noting any induration. (This may be omitted in a young asymptomatic male patient.) Palpate any abnormality of the penis, noting any induration or tenderness.
• Induration along the ventral surface of the penis suggests a urethral stricture or possibly a carcinoma.

Question 6

What are the 3 areas should you inspect on the scrotum, and describe how you would inspect each area

Answer 6

1. The skin - Lift up the scrotum so that you can inspect its posterior surface.
   Note any lesions or scars. Inspect the pubic hair distribution.
   
   • There may be dome-shaped white or yellow papules or nodules formed by occluded follicles filled with keratin debris of desquamated follicular epithelium. Such epidermoid cysts are common, frequently multiple, and benign
2. The scrotal contours - Inspect for swelling, lumps, veins, bulging masses, or
   asymmetry of the left and right hemiscrotum.
3. The inguinal areas - Note any erythema, excoriation, or visible adenopathy.

Question 7

What is the correct technique used to palpate the scrotum?

Answer 7

• If using a one-handed technique, palpate each testis and epididymis between your thumb and first two fingers (Fig. 13-5).
• If using two hands, cradle the testis at both poles in the thumb and fingertips of both hands. Palpate the scrotal contents as you gently slide them back and forth from the fingertips of one hand to the other, without changing the position of your hands as they cup the scrotum

Question 8

How should a normal scrotum feel on palpation?

Answer 8

• The testes should be firm but not hard, descended, symmetric, nontender and without masses
• It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other
• For each testis, assess size, shape, consistency, and tenderness; feel for any nodules. Pressure on the testis normally produces a deep visceral pain.

Question 9

How would you palpate the epididymis and what does a normal epididymis feel like?

Answer 9

• Palpate the epididymis on the posterior surface of each testicle without applying excess pressure, which can cause discomfort.
• The epididymis feels nodular and cord-like and should not be confused with an abnormal lump. Normally, it should not be tender.

Question 10

What is the correct technique used when palpating the prostate gland?

Answer 10

1. Insert your finger into the rectum as far as possible
2. Rotate your hand further counterclockwise so that your finger can examine the posterior surface of the prostate gland (Fig. 15-9).
   
   • Examining his prostate gland may prompt an urge to urinate.
3. Sweep your finger carefully over the prostate gland, identifying its lateral lobes and the groove of the median sulcus between them.
4. Note the size, shape, mobility, and consistency of the prostate, and identify any nodules or tenderness

Question 11

What does a normal prostate feel like?

Answer 11

The normal prostate is rubbery and nontender, with no evidence of fixity to the surrounding tissues.

Question 12

Describe the incidence rates of testicular cancer

Answer 12

The incidence of testicular cancer is low, about 5 per 100,000 men, but it is the most common solid cancer of young men between ages 15 and 34 years

Question 13

What are the 6 risk factors for testicular cancer?

Answer 13

1. Cryptorchidism, which confers a high risk for testicular carcinoma in the undescended testicle
2. History of carcinoma in the contralateral testicle
3. Mumps orchitis
4. Inguinal hernia
5. Hydrocele in childhood
6. Positive family history

Question 14

How would you instruct a patient to do a testicular self-exam?

Answer 14

1. Perform the examination after a warm shower and is best done while standing
2. Standing in front of a mirror, check for any swelling on the skin of the scrotum.
3. With the penis out of the way, gently feel your scrotal sac to locate a testicle. Examine each testicle separately.
4. Use one hand to stabilize the testicle. Using the fingers and thumb of your other hand, firmly but gently feel or
   roll the testicle between your fingers. Feel the entire surface. Find the epididymis. This is a soft, tube-like structure at the back of the testicle that collects and carries sperm, and is not an abnormal lump. Check the other testicle and epididymis the same way.
5. If you find a hard lump, an absent or enlarged testicle, a painful swollen scrotum, or any other differences that do not seem normal, do not wait. See your healthcare provider right away.

Question 15

Describe the stage 1 tanner stage in a male

Answer 15

• Pubic hair - Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen
• Penis - Preadolescent—same size and proportions as in childhood
• Testes and scrotum - Preadolescent—same size
  and proportions as in childhood

Question 16

Describe the stage 2 tanner stage in a male

Answer 16

• Pubic hair - Sparse growth of long, slightly pigmented, downy
  hair, straight or only slightly curled, chiefly at the base of the penis
• Penis - Slight or no enlargement
• Testes and scrotum - Testes larger; scrotum larger, somewhat reddened, and altered in texture

Question 17

Describe the stage 3 tanner stage in a male

Answer 17

• Pubic hair - Darker, coarser, curlier hair spreading sparsely over the pubic symphysis
• Penis - Larger, especially in length
• Testes and scrotum - Further enlarged​

Question 18

Describe the stage 4 tanner stage in a male

Answer 18

• Pubic hair - Coarse and curly hair, as in the adult; area covered
  greater than in stage 3, but not as great as in the
  adult and not yet including the thighs
• Penis - Further enlarged in length and breadth, with development of the glans
• Testes and scrotum - Further enlarged; scrotal
  skin darkened

Question 19

Describe the stage 5 tanner stage in a male

Answer 19

• Pubic hair - Hair adult in quantity and quality , spreads to the
  medial surfaces of the thighs but not up over the abdomen
• Penis - Adult in size and shape
• Testes and scrotum - Adult in size and shape

Question 20

How do you inspect for hernias?

Answer 20

• Sitting comfortably in front of the patient, with the patient standing and an assistant present, if indicated, inspect the inguinal regions and genitalia for bulging areas and asymmetry.
• A bulge in this area suggests a hernia.

Question 21

What is the proper technique used for palpating inguinal hernias?

Answer 21

1. Place the tip of your dominant index finger at the anterior inferior margin of the scrotum, staying superficial to the testicle, then move your finger and hand upward toward the external inguinal ring, invaginating the scrotal skin beneath the peripubic fat pad next to the base of the penis.
2. Follow the spermatic cord upward to the inguinal ligament. Find the triangular slit-like opening of the external inguinal ring just above and lateral to the pubic tubercle. Palpate the external inguinal ring and its floor. Ask the patient to cough. Palpate for a distinct bulge or mass that moves against your stationary finger during the cough.
3. The external ring may be large enough for you to gently palpate obliquely along the inguinal canal toward the internal inguinal ring. Again ask the patient to cough. Check for a bulge that slides down the inguinal canal and taps against the fingertip.
4. Use the same techniques with the same dominant finger to examine both sides.

Question 22

What are the characteristics of indirect hernias?

Answer 22

• Most common, all ages, both sexes. Often in children; may occur in adults.
• Located above the inguinal ligament, near its midpoint (the internal inguinal ring).
• Often comes down into the scrotum when examining the scrotum

Question 23

What are the characteristics of direct hernias?

Answer 23

• Less common. Usually in men older than 40 yrs; rare in women.
• Above inguinal ligament, close to the pubic tubercle (near the external inguinal ring).
• Rarely is felt in the scrotum; The hernia bulges anteriorly and pushes the side of the finger forward.

Question 24

What is testicular torsion? And describe the findings associated with this condition

Answer 24

• Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is often retracted upward in the scrotum.
• The cremasteric reflex is nearly always absent on the affected side in boys or men with testicular torsion.
• If the presentation is delayed, the scrotum becomes red and edematous.
• There is no associated urinary infection.
• Torsion is most common in neonates and adolescents, but can occur at any age.
• It is a surgical emergency because of obstructed circulation

Question 25

What is acute epididymitis? What causes it and what findings are associated with it?

Answer 25

• An acutely inflamed epididymis is indurated, swollen, and notably tender, making it difficult to distinguish from the testis.
• The scrotum may be reddened and the vas deferens inflamed.
• Causes include infection from Neisseria gonorrheae, Chlamydia trachomatis (younger adults), Escherichia coli, and Pseudomonas (older adults); trauma; and autoimmune disease.
• Barring urinary symptoms, urinalysis is often negative.

Question 26

What is a hydrocele and what are its characteristics?

Answer 26

• A nontender, fluid-filled mass within the tunica vaginalis.
• It lights up with a red glow when flashing a bright light behind the scrotum, transilluminates, and the examining fingers can palpate above the mass within the scrotum.

Question 27

What is hypospadias?

Answer 27

A congenital displacement of the urethral meatus to the inferior surface of the penis. The meatus may be subcoronal, midshaft, or at the junction of the penis and scrotum (penoscrotal).

Question 28

What is balanitis?

Answer 28

It is inflammation of the glans penis caused by poor hygiene, skin irritants, thrush, or bacteria

Question 29

What are the characteristics of testicular cancer?

Answer 29

• Usually appears as a painless nodule. Any nodule within the testis warrants investigation for malignancy
• As a testicular neoplasm grows and spreads, it may seem to replace the entire organ. The testicle characteristically feels heavier than normal

Question 30

What are the characteristics of acute prostatitis?

Answer 30

• Presents with fever, UTI symptoms such as frequency, urgency, dysuria, incomplete voiding, and low back pain.
• The prostate will feel tender, swollen, boggy, and warm.
• Caused by gram-negative aerobes such as Escherichia coli, Enterococcus, and Proteus.
• In men younger than age 35 yrs, consider sexual transmission of Neisseria gonorrhea and Chlamydia trachomatis

Question 31

What is BPH and what symptoms are associated with it?

Answer 31

• BPH is a nonmalignant enlargement of the prostate gland that increases with age, present in more than 50% of men by age 50 yrs.
• Symptoms arise both from smooth muscle contraction in the prostate and bladder neck and from compression of the urethra.
• They may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both, and are seen in more than one third of men by age 65 yrs.
• The affected gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen

Question 32

What are some characteristics of prostate cancer?

Answer 32

• Prostate cancer is suggested by an area of hardness in the gland.
• A distinct hard nodule that alters the contour of the gland may or may not be palpable.
• As the cancer enlarges, it feels irregular and may extend beyond the confines of the gland. The median sulcus may be obscured.
• Hard areas in the prostate are not always malignant. They may also result from prostatic stones, chronic inflammation, and other conditions.