Male reproductive system 2015 - 2016 L/ Hanaa Hammad

Learning outcome At the end of this Lesson the study participants will be able to: Name the anatomic landmarks of the male genitalia. Describe the characteristics of the most common male reproductive chief complaints. Perform inspection, palpation, and auscultation on an adult male. Explain the pathophysiological rationale for abnormal findings.

Learning outcome cont’d Document male reproductive assessment findings. Describe the pathological changes that occur in the male reproductive system with the aging process.

Anatomy and Physiology

Anatomy and Physiology cont’d Penis Testes Scrotum Bulbourethral glands Seminal vesicles Epididymis Ejaculatory ducts Urethra Glands penis Spermatic cord Ductus deferens

Anatomy and Physiology cont’d Testes: Are two-egg shaped structure. Function of Testes: Testosterone hormone secretion. Spermatogenesis = sperm production Epididymis: A comma shaped tube, lies along & sides of each testis. Function: It is a storage & maturation site of sperm which takes from 1 to 3 weeks.

Anatomy and Physiology cont’d Seminal vesicles: Are two pouches along the posterior surface of the urinary bladder, directly in front of the rectum? Function: Secret about 60% of fluid volume of semen. Prostate Gland: Doughnut-shape, encircle urethra, lies just below the bladder. Function: It secretes about 35% of fluid volume of semen.

Anatomy and Physiology cont’d Bulbo urethral gland: A pea sized gland inferior to the prostate and Secretes about 5% of fluid volume of semen. Penis: Three cylindrical masses of erectile tissue. Function: Micturition. Introduce semen into vagina.

Health History Personal history Present & past history. Common Chief Complaints(Urethral discharge Palpable mass ,Erectile dysfunction ,Penile lesion, Scrotal pain

Characteristics of Chief Complaint Quality , Quantity , Associated manifestations , Aggravating and alleviating factors , Setting , Timing Assessment

Examination Equipment Needed for Male Gloves. Glass slide for urethral specimen Materials for cytology Flashlight

Positioning for Male Examination Position male standing with undershorts down, with appropriate draping. Examiner should be sitting. (Male may be supine for first part of exam, standing for hernia check. 3. Take time for patient to discuss genitourinary history.

Inspection & palpation of male reproductive system Assessment Normal Finding Inspect Penis & Glands Penis skin wrinkled, hairless, no lesions the glands, smooth no lesions. Retract uncircumcised foreskin to original position.

Inspection & palpation of male reproductive system Deviations from Normal: Pubic lice or nits- Hypospadias- ventral location of meatus. Epispadias- dorsal location of meatus ulcer, grouped vesicles Himosis - unable to retract foreskin Stricture- narrowed opening Edges that are red, edematous, purulent discharge Nodule, tenderness

Inspection and palpation of male scrotum Assessment Normal Finding Inspect scrotum as male holds penis. Palpate gently each. Half between thumb and first two fingers Asymmetrical (left scrotal half lower than right) Scrotal size varies with room temp. Contents should easily slide. Testes palpable, oval, firm, rubbery, smooth, equal bilateral and freely movable. Epididymis feels discrete, softer than testis, smooth, nontender

Inspection & palpation of male scrotum Assessment Normal Finding Inspect each spermatic cord between thumb and forefinger along its length from Epididymis to external inguinal ring Should feel smooth, nontender cord. Deviations from Normal: Scrotal swelling (edema). Lesions Absent testes , Nodules swollen, tender epididymis Hernia, hydrocele, tumor.

Inspection for hernia Assessment Inspect inguinal region for bulge as patient stands and strains Palpate right side of inguinal canal by asking patient. to shift wt. onto left leg. Place right index finger low in the right scrotal half. Palpate up length of spermatic cord Deviations from Normal: Feels like triangular slit like opening, may go easier if you ask patient . to bear down. Bulge at external inguinal ring or femoral canal

Palpate for hernia

Palpate for hernia Assessment Normal Finding Palpate inguinal lymph nodes by palpating horizontal chain along groin inferior to ligament and vertical chain along inner thigh feels small, soft, discrete, and movable. Deviations from Normal: Palpable herniatino mass bumps your fingertip or pushes against the side of your finger.

Gerontological Variations Thinner pubic hair Decreased testosterone levels Penile and testicular atrophy Slightly decreased spermatogenesis Increased time to obtain erection Increased risk for impotence

Special Techniques Androscopy :Used to identify skin lesions Urethral culture: Used to identify causative organism of penile discharge Transillumination of the scrotum : Used to determine the etiology of a scrotal mass

Thank you