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Advanced Health Assessment. July 27, 1999. ASSESSMENT OF MALE GENITALIA. Jay Gilbaugh, M. D. 851 N. Hillside, Wichita 316-685-1371. Anatomic Review. Penis Scrotum Inguinal Canal Testes. Anatomic Review. Epididymis Spermatic Cord Prostate Seminal Vesicles. Genitourinary History.
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Advanced Health Assessment • July 27, 1999
ASSESSMENT OF MALE GENITALIA Jay Gilbaugh, M. D. 851 N. Hillside, Wichita 316-685-1371
Anatomic Review • Penis • Scrotum • Inguinal Canal • Testes
Anatomic Review • Epididymis • Spermatic Cord • Prostate • Seminal Vesicles
Genitourinary History • Previous surgeries, conditions • Previous UTI or STD • Testicular pain or mass • Penile lesion or discharge • Voiding history
Voiding History • Quality or urine stream • Nocturia - quantitate • Urinary frequency • Hesitancy, urgency, double voiding, post-void dribbling or feeling of incomplete emptying
Voiding History • Dysuria • Hematuria • Incontinence • Stress • Urge
Sexual History • Quality of libido • Quality of erections • Problems with ejaculation
Physical Exam • General • Penis • Common abnormalities • Scrotum • Scrotal contents • Groin • Prostate
General Exam • Inspection, palpation, transillumination • Patient standing (easiest) • Professional, straight-forward • Minimize patient anxiety
Exam of Penis • Inspect shaft for gross lesions • Palpate shaft for plaques • Retract foreskin (except infants) • Examine glans for gross lesions
Exam of Penis • Examine meatus for size & location • Evert meatus to inspect fossa navicularis • Examine for urethral discharge • Reduce foreskin after exam!
Common Abnormalities: Shaft • Peyronie’s disease • Skin lesions • herpes • condylomata accuminatum (venereal warts) • molluscum contagiosum • Priapism - persistent, prolonged erection
Common Abnormalities: Prepuce • Phimosis • Paraphimosis
Common Abnormalities: Glans • Balanitis/balanoposthitis • Pearly papules • Chancre/ulcer
Common Abnormalities: Meatus • Stenosis • Position • Epispadias • Hypospadias
Exam of Scrotum • Inspect for gross lesions • Palpate for thickness • Palpate inguinal canals
Common Abnormalities: Scrotum • Sebaceous cysts of scrotum • Scrotal edema • Scrotal erythema • Yeast infection • Fournier’s ganrene (necrotizing fasciitis) • Inguinal hernias
Exam: Scrotal Contents • Palpate testis for consistency & masses • Palpate epididymis for consistency, tenderness, masses • Palpate vas deferens for presence • Palpate spermatic cord for varicosities (valsalva) • Check cremasteric reflex
Common Abnormalities: Testes • Hydrocele - transilluminate • Testicular cancer • Testicular torsion
Common Abnormalities: Epididymis • Epididymitis • Spermatocele (epididymal cyst)
Common Abnormalities: Spermatic Cord • Varicocele
Exam of Groin • Palpate for inguinal adenopathy
Exam of Prostate • Use plenty of water-soluble lubricant • Have patient bear down, as with having BM • Palpate both sides to compare: • Size • Consistency • Tenderness
Common Abnormalities • Prostatic hypertrophy • Prostatitis syndromes • Prostate Cancer