Where do the testies/scrotal lymnph nodes drain?
- Lymphatics of penis and scrotal surface drain into inguinal lymph nodes
- Lymphatics of testes drain into abdomen
- Abdominal lymph nodes are not accessible to clinical examination
Developemental competency for adolecentmale genitourinary syst.
- Puberty begins between ages of 9½ and 13½
- First sign is enlargement of testes
- Next, pubic hair appears, then penis size increases
- Stages of development are documented in Tanner’s sexual maturity ratings
- Complete change in development from preadolescent to adult takes around 3 years, although normal range is 2 to 5 years
Finding in the scrotal area are...
- Sebascious cysts: normal finding.
- Left side testy is often larger.
- Go easy on testicular exams. Should be smooth, egg shaped, no lumps. Again, lumps are cancer until proven otherwise and will be painless.
- Teens -30’s are most common time for testicular cancer.
- Epididymidis: Inflamed epididymis, typically caused by lack of support.
Structure and fuction of the inguinal area
Don't forget to palpate inguinal lymph node while you're there!
- Males and females both can get inguinal hernias.
- To inspect, have pt standing and run index finger (gently) up the inguinal canal. Pt will bear down (Valsalva maneuver). If hernia, you will feel section of bowel press against your finger tip.
Developemental competency in Adult and aging men genitourinary system.
- Male does not experience a definite end to fertility as female does
- Around age 40 years, production of sperm begins to decrease, although it continues into 80s and 90s
- After age 55 to 60 years, testosterone production declines
- Testosterone production declines after age 55 to 60 years
- Decline proceeds gradually
- Aging changes also are due to decreased muscle tone, subcutaneous fat, and cellular metabolism
- Pubic hair decreases and penis size decreases
- Due to decreased tone of dartos muscle, scrotal contents hang lower, rugae decrease, and scrotum becomes pendulous
- Testes decrease in size and are less firm to palpation
- Increased connective tissue is present in tubules, so these become thickened and produce less sperm
Cultural competence male sexual expression in later life
- Chronologic age by itself should not mean a halt in sexual activity; physical changes need not interfere with libido and sexual pleasure
- Older male is capable of sexual function as long as he is in reasonably good health and has an interested, willing partner
- Danger is in male misinterpreting normal age changes as a sexual failure; once this idea occurs, it may demoralize man and place undue emphasis on performance rather than on pleasure
In later life, sexual expression may be diminished in men due to...
- Loss of spouse
- Preoccupation with work
- Marital or family conflict
- Side effects of medications
- Heavy use of alcohol
- Lack of privacy, living with adult children or in a nursing home
- Economic or emotional stress
- Poor nutrition or fatigue
What are some advantages of being circumcised.
- Circumcision lowers risk of certain STIs, specifically syphilis, chancroid, and somewhat reduced risk of genital herpes
- Circumcised men have a significantly lowered risk of acquiring genital HPV infection, and their partners have a lower risk of cervical cancer
- Finally, epidemiological studies now suggest a potential reduction in acquisition of HIV in circumcised men
- Dysuria: does it hurt? Blood? frequency? Fever? Back pain? Color? If UTI ask more questions like new partner? Reusing condoms?
- Syphilus: nonpainful lesion.
- Self Care: Monthly
- Painless lumps: Again, cancer UPO.
- Educate on STI contact and risk reduction. Never fully protected.
Principles of interviewing adolexcent male patients
- Ask questions that seem appropriate for boy’s age but be aware that norms vary widely.
- Ask direct, matter-of-fact questions. Avoid sounding judgmental.
- Start with a permission statement. “Often boys your age experience…”
- Try the ubiquity approach, “When did you…” rather than “Do you…”
- Sometimes all you do is “open the door” to later conversation
Additional Hx for preadolexcents and adolescents
- Around age 12 to 13 years…
- Who can you talk to…
- Boys around age 12 to 13 years have a normal experience…
- Teenage boys have other normal experiences and wonder if they are the only ones who ever had them…
- Often boys your age have questions about sexual activity.…
- Has a nurse or doctor ever taught you…
- Has anyone ever touched your genitals…
Objective data during PE male reproductive organ
- Penis – Inspect and Palpate
- phimosis--unable to retract foreskin
- paraphimosis--retracted foreskin which is unable to return over head of penis.
- Urethral meatus:
- Epispadias--meatus is on dorsal side
- Hypospadias--meatus is on ventral side. Needs surgery to correct or poor dude will be peeing in his own face.
- Pubic hair
- Urethral discharge
- Shaft of penis (should not hurt)
Sometimes men will have an errection. What then?
Apprehension regarding exam, feeling uncomfortable, developmental level of patient, adolescents. Just reassure that it's normal and move on.
- Occasionally need:
- Glass slide for urethral specimen
- Materials for cytology, flashlight (can transiluminate)
More objective findings of the male reproductive organ during PE
- Scrotum – Inspect and Palpate
- Spermatic cord
- Any mass: note location, size, tenderness, mobility, texture
- Note characteristics
how do you Teach testicular self exam?
- T = Timing (pick a date and stick to it each month)
- S = Shower (easy, convenient time to do it)
- E = Examination points (See lovely diagram above. Don't forget posterior)
Understanding your prostate
- Discussion of prostate health and examination of prostate gland is a unique aspect of male health assessment
- Prostate cancer typically detected by testing blood for prostate-specific antigen (PSA) and/or on digital rectal examination (DRE). Needs to be done during the correct age/developemental stage (until after age 50) and needs to be pair with a digital rectal exam (start at age 40). Blood must be drawn before exam. If done afterward blood levels will be artificially elevated.
- Saw Palmetto supplement can help increase protate health.
Male genital lesions
- Genital herpes, HSV-2 Infection
- Syphilitic Chancre
- Genital warts, HPV (16-18 would not be visible to naked eye. Will not generally display symptoms with 16-18 until cancer. GET IMMUNIZATION!)
Urinary problems with men
- Urethritis (Urethral discharge and Dysuria)
- Renal calculi (kidney stones): Terrible flank (low back) pain. Do not do CVA tenderness. Dehydration is #1 contributing factor.
- Acute urinary retention due to renal calculi, enlarged prostate.
- Urethral stricture: scarring, stone, in urethra causing blockage.
- Absent testis
- Small testis
- Testicular torsion: twisting. Hurst a lot. Often requires surgery.
- Varicocele: vericose veins of spermatic cord.
- Spermatocele: retension cyst in epidimis found higher up in the scrotum.
- Early testicular tumor
- Diffuse tumor
- Hydrocele: Cystic mass in scrotum. Transilluminates.
- Scrotal hernia: Due to indirect inguinal hernia that has extended down into scrotum.
- Orchitis: Enlarged, swollen testies.
- Scrotal edema
What is Priopism?
SE of ED drugs. Englarged glands. Will need to puncture to release some blood.
Abnormal Testicular findings.
Identify hydrocele, orchitis, scrotal edema and scrotal hernia
Types of hernias...
Femoral: because of femoral artery, when repaired can only sew one side.