1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Assessment of the Male Genitourinary System Health Assessment Across the Lifespan NRS 102

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

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

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

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

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

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 24: Male Genitourinary System Slide 24-7 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

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

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

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 24: Male Genitourinary System Slide 24-10 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…

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

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

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

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

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

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

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

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

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

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

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

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

23. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 24: Male Genitourinary System Slide 24-23 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?

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