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What are some of the external anatomical traits of the penis?
- darker than other skin/hairless
- visible dorsal vein
- urethra at tip of glans
- Glans
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What two structures make up the external part of the penis
shaft and glans
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What is the glans penis?
the head/ dorsal tip of the penis
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What is circumcision? complications? common populations
- removal of the foreskin
- risk of infection and ischemia necrosis of the penis
- most common in the US among caucasians and Jewish descent
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Risk for being uncircumcised?
Increased risk for some STI's, penile cancer, and cervical cancer among partners
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What is smegma? Who gets it?
- white cheesy material on glans penis formed from sebaceous material (from glans) and desquamation of epithelial cells (the foreskin)
- Those that are uncircumcised
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What 3 structures make the internal anatomy of the penis?
- corpus cavernosa
- corpus spongiosum
- bulbourethral gland (cowpers gland)
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Where is the corpus cavernosa located?
dorsum (top) and sides of penis
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where is the corpus spongiosum located and what does it contain?
ventral (underneath) portion of penis- contains the urethra
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What does the bulbourethral gland do?
produces pre-ejacualte fluid, lubricates the urethra for sperm to pass through and neutralizes acidic urine
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What are some of the physical characteristics of the scrotum?
- it is darker than other skin
- scant amount of hair
- rugae (folds) with deeply pigmetned skin and large sebaceous follicles
- septum that divides the scrotal sac
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what is the scrotum?
sac of skin and muscle, between the penis and the anus that contains and protects the testis
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What is the purpose of the testes? what are their average size?
- producer sperm and testosterone
- 4x3x2 cm (left is usually lower than the right)
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What is the epididymis? and where is it located?
- tightly coiled tube that collects and provides transit for sperm
- located on posterior side of testes
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Starting from the testes, name the different structures sperm travels through to ultimately reach the urethra
vas-deferens, spermatic cord, seminal vesicles, ejaculatory duct, urethra
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What is the purpose of the seminal vesicles?
secretes a fluid that nourishes sperm
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What is the Cremaster muscle?
muscle that raise and lowers the testes - (helps regulate temperature)
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Describe the prostate
- 2.5x4cm
- surrounds the urethra at the bladder neck
- secretes ejaculatory fluid to help sperm motility
- 2 lobes, separated by a median sulcus
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Where are the testes located prenatally?
located in the abdomen and descend down the inguinal canal to the scrotum
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During puberty, what developments occur to male genitalia?
- Enlargement of the testes
- Pubic hair growth
- enlargement of the penis
- prostate doubles in size
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What developments occur to the male genitalia in adulthood?
- Prostate enlarges throughout life (may impede urine flow, symptoms after 50)
- testosterone production gradually declines after 60
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What is Benign Prostatic Hypertrophy?
BPH- enlargement of the prostate; may impede urine flow; symptoms usually around age 50
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What does decreased testosterone production cause?
- Lower sperm count (fertility may decline)
- erectile dysfunction (decreased firmness of erections)
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What are potential causes for increased urinary frequency?
- bladder irritation (UTI)
- urethritis (STI/chlamydia)
- tumor
- BPH
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What are possible causes of increased urinary urgency?
UTI and BPH
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What are symptoms of BPH?
- increased frequency
- increased urgency
- hesitancy
- decreased force of stream
- post void dribbling
- post void fullness
- nocturia
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what is nocturia? causes?
awakening at night to urinate due to incomplet bladder emptying and mobilization of fluid and increased renal blood flow in recumbant position (seen in renal failure)
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what is dysuria? causes?
pain or burning during urination du to UTI or STI
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what is pyuria?
Pus in the urine- sign of infection
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What may cause purulent urethral discharge?
gonorrhea
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What may cause clear urethral discharge?
chlamydia
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What is polyuria? what population does it affect?
- abnormal large production and passage of urine
- Seen in DM pts (glucose causes osmotic diuresis)
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What is enuresis?
bed wetting- nighttime incontinence after age 5-6 yo; may be psychological or structural problem with urinary tract
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what is incontinence?
involuntary leakage of urine
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What is overflow incontinence?
- bladder is constantly dribbling, or can not stop bladder from dribbling after urination.
- Due to incomplet bladder emptying, prostatism
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What is stress incontinence?
- Associated with rapid movement of the diaphragm-
- urination with coughing, sneezing, or laughing ( more common in women)- insufficient strength of the pelvic floor muscles
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What is urgency incontinence?
- Involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.
- seen with infection, prostatism or neurological disorder
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What is hematuria
Blood in the urine
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What are 2 kinds of hematuria?
- macrohematuria- visible blood in urine (red)
- microhematuria- blood seen with microscope
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what is a chancre?
painless sore from syphilis
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What is phimosis?
foreskin cant be retracted associated with poor hygiene
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what is balanitis?
inflammation of glans (bacterial or fungal) in uncircumcised pts
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What is paraphimosis?
the foreskin is permanently retracted
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What is priapism?
- prolonged painful erection (dangerous if > 4hrs)
- Occurs with leukemia, hemoglopinapathies (sickle cell traits) and ED meds (Viagra, cialis, levitra)
- may cause sterility
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What is peyronies disease?
- The corpus cavernosis develops scar tissue (etiology unknown) and the penis curves when erect
- usually occurs afte age 45
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What is hypospadias?
urethral meatus (opening) is underneath/ ventral side of penis (most common)
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what is epispadias?
the urethral meatus (opening) is on the dorsal/top part of the penis
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What is a potential cause for scrotal lumps?
sebaceous cysts ( common)
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What is scrotal edema a sign for?
CHF or renal failure
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What is hydrocele? causes?
- serous fluid around the testicle
- often due to trauma (resolves spontaneously)
- detected by transillumination (fluid glows red as light reflects off of it)
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What is cryptorchridism?
- undescended testicle
- leads to decreased spermatogenesis and fertility
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What is orchitis?
acute inflammation of testis (seen with mumps)
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What is epididymitis?
acute infection of epididymis
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What is a spermatocele?
- a retention cyst- a collection of sperm in the epididymis
- most common after a vasectomy
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what is testicular torsion?
- The sudden twisting of spermatic cord ( more common on the left)
- rare after age 20
- may occur spontaneously during sleep or after trauma
- considered a surgical emergency due to compromised blood supply
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what is a varicocele?
- dialted veins of the spermatic cord
- more common on the left side
- may be visible when pt stands
- may cause infertility due to increased venous pressure and testicular temp
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What are symptoms of a varicocele?
- dull ache along spermatic cord
- scrotal pain or heaviness
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Which lymph nodes does the penis drain into? are they palpable
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Which lymph nodes do the testes drain into?
- ABD nodes- not palpable
- and left supraclavicular nodes
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How do you detect a inguinal hernia?
- Examine with pt standing
- put finger up through scrotum and into inguinal canal
- ask pt to cough
- should feel soft tissue of intestines if hernia is present
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what is an indirect hernia?
- most common in children and young males
- herniation into inguinal canal (palpated in inguinal canal)
- most common
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What is a direct hernia?
- Herniation through the external inguinal ring (bulge seen over inguinal canal)
- more common in men after 40
- 2nd most common hernia
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what is a femoral hernia?
- herniation through the femoral ring (bulge seen in groin)
- higher incidence in women
- least common
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What is an incarcerated hernia
- strangulated hernia
- non reducible; cant push back in
- may lead to compromised blood supply (surgical emergency)
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