Male Genitourinary System Chapter 24 Elsevier items and

Male Genitourinary System Chapter 24 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 12 -

Chapter 24: Male Genitourinary System Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 2

Chapter 24: Male Genitourinary System Structure and Function Penis Corpora cavernosa Corpora spongiosum Glans Corona Urethra Foreskin Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 3

Chapter 24: Male Genitourinary System Scrotum Rugae Cremaster muscle Testis Epididymis Vas deferens Spermatic cord Ejaculatory duct Copyright Connie Cooper Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 4

Chapter 24: Male Genitourinary System Structure and Function (cont. ) Inguinal area Inguinal ligament Inguinal canal Ø Internal ring Ø External ring Femoral canal Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 5

Chapter 24: Male Genitourinary System Subjective Data— Health History Questions Frequency, urgency, and nocturia Dysuria Hesitancy and straining Urine color Genitourinary history Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 6

Chapter 24: Male Genitourinary System Subjective Data— Health History Questions (cont. ) Penis—pain, lesion, and/or discharge Scrotum—self-care behaviors; lump Sexual activity and contraceptive use Sexually transmitted disease contact Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 7

Chapter 24: Male Genitourinary System Principles of interviewing adolescent 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 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 8

Chapter 24: Male Genitourinary System Additional History for Preadolescents 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… Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 9

Chapter 24: Male Genitourinary System Additional History (cont. ) Often boys your age have questions about sexual activity. … Has a nurse or doctor ever taught you… Has anyone ever touched your genitals… Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 10

Chapter 24: Male Genitourinary System Additional History for the Aging Adult • Any difficulty urinating? . . . • Do you need to get up at night… • A man in his 70 s, 80 s, or 90 s… Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 11

Chapter 24: Male Genitourinary System Objective Data—The Physical Exam Preparation Ø Position Ø Apprehension regarding exam Equipment needed Ø Gloves Ø Occasionally need • Glass slide for urethral specimen • Materials for cytology • Flashlight Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 12

Chapter 24: Male Genitourinary System Objective Data—The Physical Exam (cont. ) Penis—Inspect and palpate Skin Glans Urethral meatus Pubic hair Urethral discharge Shaft Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 13

Chapter 24: Male Genitourinary System Objective Data—The Physical Exam (cont. ) Scrotum—Inspect and palpate Skin Testis Epididymis Spermatic cord Any mass Ø Note characteristics Ø Transillumination Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 14

Chapter 24: Male Genitourinary System Objective Data—The Physical Exam (cont. ) Check for hernia—Inspect and palpate Person standing and straining down Ø Palpation technique Ø Inguinal lymph nodes Teach testicular selfexamination T = Timing S = Shower E = Examination points Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 15

Chapter 24: Male Genitourinary System Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 16

Chapter 24: Male Genitourinary System Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 17

Chapter 24: Male Genitourinary System Abnormal Findings Male Genital Lesions Herpes progenitalis Syphilitic chancre Condylomata acuminata (genital warts) Carcinoma Urethritis (urethral discharge and dysuria) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 18

Chapter 24: Male Genitourinary System Abnormal Findings (cont. ) Abnormalities of the Penis Phimosis Paraphimosis Hypospadias Epispadias Peyronie’s disease Priapism Urethral stricture Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 19

Chapter 24: Male Genitourinary System Abnormal Findings (cont. ) Abnormalities in the Scrotum Absent testis; cryptorchidism Small testis Testicular torsion Epididymitis Spermatic cord varicocele Spermatocele Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 20

Chapter 24: Male Genitourinary System Abnormal Findings (cont. ) Abnormalities in the Scrotum Early testicular tumor Diffuse tumor Hydrocele Scrotal hernia Orchitis Scrotal edema Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 21

Chapter 24: Male Genitourinary System Abnormal Findings (cont. ) Inguinal and Femoral Hernias Indirect inguinal Direct inguinal Femoral Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 22

Chapter 24: Male Genitourinary System Which of the following introductions would be the best way to start your question when interviewing an adolescent? A. Often young men your age… B. I worry that you might… C. Do you… D. You don’t…do you? Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 23

Chapter 24: Male Genitourinary System Which of the following topics will be least embarrassing to a male patient? A. Elimination (urination) B. Sexual function C. Reproduction D. Sexually transmitted infection exposure Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. 24