Inflammatory Disorders of the Male Penne Mott Gonococcal

Inflammatory Disorders of the Male Penne Mott

Gonococcal /Non Gonococcal (NGU) Urethritis • Causes – Gonorrhea – Chlamydia (NGU)

Gonococcal /Non Gonococcal (NGU) Urethritis • • • Thick yellowish green purulent discharge Appears 3 – 14 days after sexual exposure NGU – scant to moderate amount Pain in urethra Redness / irritation

Gonococcal /Non Gonococcal (NGU) Urethritis • Treatment – Rocephin or Zithromax – Gonorrhea – Doxy or tetracycline – Chlamydia – Condom use – Treatment of sex partners

Epididymitis • Convoluted tubules top of each testicle • Inflammation / infection epididymis • High incidence young males

Epididymitis - Causes • Infection – E-coli from lower urinary tract or prostate • Trauma • STD’s – Chlamydia / gonorrhea

Epididymitis - Assessment • “Duck Waddle” walk • Acute painful scrotal swelling (unilateral) • Prehn’s sign – lifting the scrotum onto symphysis relieves pain • NV • Fever / chills • Dysuria, frequency, urgency

Epididymitis - Treatment • • Bedrest Scrotal elevation Ice Sitz Analgesics / antipyretics Antibiotics Treatment of STD

Epididymitis - Complications • Epididymal Abscess – may extend testicles • Chronic epididymitis – Tx epididymectomy • Sterility

Orchitis • Rare, acute testicular inflammation • Associated with mumps, pneumonia, TB, syphilis, parasites, trauma • Can be SE – Epididymitis – Mono – Flu – catheterization

Orchitis- Assessment • Red, edematous extremely tender testicles • Fever

Orchitis - Treatment • • • BR Scrotal Support Local heat Analgesics Antibiotics ***Preventable with immunization

Testicular Torsion • Torsion of spermatic cord = twisting of the testis that cuts off blood supply to testis • Adolescent males

Testicular Torsion – S/S • • • Acute scrotal pain Nausea Vomiting No urinary complaints U/A – no WBC’s or bacteria MEDICAL EMERGENCY!!!!

Testicular Torsion - Treatment • Surgery – Surgical exploration of the scrotum & bilateral testicular fixation • Necrosis – orchiectomy

Hydrocele • Collection of fluid between visceral & parietal membranes of the tunica vaginalis (membranes that surrounds the testis)

Hydrocele - Causes • Trauma • Infection (Epididymitis or orthitis) • Cancer of testis • Most commonly occurs – Infants – Males > 40

Hydrocele – S/S • Painless swelling scrotum • Positive transillumination

Hydrocele - Treatment • None unless swelling large & uncomfortable • Fluid aspiration – may be repeated 1 -3 mos • Hydocelectomy –excision of membrane

Varicocele • Distention of testicular veins • Infertility

Varicocele – S/S • Wormlike mass “Bag of Worms” above the testis when patient stands • Dragging sensations • Dull aching • Pain relieved by masturbation or sex (relieves venous congestion)

Varicocele - Treatment • Scrotal support • Varicocelectomy • Sclerosing agent injections

Priapism • Prolonged state of erection not associated with sexual desire • Painful • Rare • Urologic emergency

Priapism - Treatment • Ketamine HCL (Ketalar) – Rapid acting nonbarbiturate anesthetic – IM / IV – SE: unpleasant psychic sx. (dreams, hallucinations) vomiting, hypersalivation, skin rashes

Hypospadias • Congential malposition of the meatus on the ventral side of the penis • Associated with infertility

Cryptorchidism • Failure of the testes to descend

Cryptorchidism – S/S • No palpable testes

Cryptorchidism - Treatment • Orchiopexy before age 2 -3 • After age 3 increased risk infertility • *Increased risk of Testicular CA

Cryptorchidism – Pre op • Psychologic Problems RT genital surgery in children – Fear / punishment – Body mutilation – Castration

Cryptorchidism – Pre op • The earlier a repair can be made, the more likely the possibility that the child will develop a normal body image • Ideal time 6 -15 months

Cryptorchidism – Post op • • Care of the surgical site Tub baths often discouraged 1 st week Catheter care Restriction of activites –pushing, lifting, playing with staddle toys, sandboxes, rough activites

Testicular Exam • Testicular cancers can occur as early as adolescence • Monthly • Shower – warms the scrotum • Use both hands to palpate scrotal contents • Roll each testicle between thumb and 1 st three fingers

Testicular Exam • ID structures – S –permatic cord – V –as deference – E –pididymis – T -estes

Testicular Exam • Testis should feel round soft – hard boiled egg without shell • Epididymis – not as smooth • One testicle may be larger • Spermatic cord -firm smooth • Check – lumps, irregularities, pain, dragging sensations

Testicular Exam • Consult health care provider when abnormalities are discovered