jarvis 6th ed -chapter 24

8/13/2019 Jarvis 6th ed -Chapter 24

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Chapter 24 Male Genitourinary System

Adults And Aging Adult

The male does not experience a definite end to fertility as the female does. Around age 40 years, the production ofsperm begins to decrease, although it continues into the 80s and 90s. After age 55 to 60 years, testosterone producti

declines ery gradually so that the resulting physical changes are not eident until later in life.

!n the aging male, the amount of pubic hair decreases and the remaining hair turns gray. "enis si#e decreases todecreased tone of the dartos muscle, the scrotal contents hang lo$er, the rugae decrease, and the scrotum loo%s

pendulous. The testes decrease in si#e and are less firm to palpation. !ncreased connectie tissue is present in the

tubules, so these become thic%ened and produce less sperm.

!n general, declining testosterone production leaes the older male $ith a slo$er and less intense sexual response, aan erection ta%es longer to deelop and is less full or firm. &'aculation is shorter and less forceful, and the olume o

seminal fluid is less than $hen the man $as younger. The refractory state ($hen the male is physiologically unable

e'aculate) lasts longer, from *+ to +4 hours as compared $ith t$o minutes in the younger male.!n the absence of disease, a $ithdra$al from sexual actiity may be due to loss of spouse depression preoccupatio

$ith $or% marital or family conflict side effects of medications such as antihypertensies, psychotropics,

antidepressants, antispasmodics, sedaties, tran-uili#ers or narcotics, and estrogens heay use of alcohol lac% ofpriacy (liing $ith older children or in a nursing home) economic or emotional stress poor nutrition or fatigue.

Culture And Genetics

Circumcision /uring pregnancy or the immediate neonatal period, parents $ill as% you about $hether tocircumcise the male infant. There are religious and cultural indications for circumcision. ircumcision reduces 1!2

ac-uisition in men by 53 to 60, as sho$n in three randomi#ed trials and numerous obserational studies in sub

aharan Africa, and it reduces 1!2 transmission to uninfected $oman sexual partners. 7urther, circumcisionsignificantly reduce the incidence of herpes simplex irus type !! (12 +) and the prealence of human papillom

irus (1"2). ertain types of 1"2 cause cerical cancer. The mechanism may be that the presence of the fores%in

increases susceptibility to small abrasions, allo$ing more contact time bet$een pathogens and the mucosa of thepartner. The ris% for other T!s (trichomonas aginalis, bacterial agenosis) is reduced in $omen $ith circumcised

partners as $ell.

!n the nited tates, the public health implications of these findings are being debated. outine neonatal circumcisrates hae dropped from a high of 80 after :orld :ar !! to about 65 of ne$borns in *999, in part because the

American Academy of pediatrics does not endorse the procedure. ;ecause of this,


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0arly sym$toms of enlarging $rostate may be tolerated or ignored. #ater sym$toms are more dramatic' hematur

urinary tract infection.

Assessing Male Genitalia

our demeanor should be confident and relaxed, unhurried yet businessli%e. /o not discuss genitourinary history osexual practices $hile you are performing the examination. This may be perceied as 'udgmental. se a firm,

deliberate touch, not a soft, stro%ing one. !f an erection does occur, do not stop the examination or leae the room.

This only focuses more attention on the erection and increases embarrassment. eassure the male that this is only anormal physiologic response to touch, 'ust as $hen the pupil constricts in response to bright light. "roceed $ith the

rest of the examination.

Inspect And Palpate The Penis

The s%in normally loo%s $rin%led, hairless, and $ithout lesions. The dorsal ein may be apparent.

The glans loo%s smooth and $ithout lesions. As% the uncircumcised male to retract the fores%in, or you retract it. !t

should moe easily. ome cheesy smegma may hae collected under the fores%in. After inspection, slide the fores%bac% to the original position. The urethral meatus is positioned 'ust about centrally. At the base of the penis, pubic

hair distribution is consistent $ith age. 1air is $ithout pest inhabitants

Phimosis 1 narrowed o$ening of $re$uce so cannot retract the foreskin.

)y$os$adias 1 venture location of meatus.

0$is$adias 1 dorsal location of meatus.

Inspect And Palpate The Scrotum

"alpate gently each scrotal half bet$een your thumb and the first t$o fingers. The scrotal contents should slide easi

2estes normally feel oval, firm and robbery, smooth and equal bilaterally and are freely movable and slightly

tender to moderate $ressure.

Inspect And Palpate or !ernia

"alpate the inguinal canal. 7or the right side, as% the male to shift his $eight onto the left (unexamined) leg. "laceyour right index finger lo$ on the right scrotal half. "alpate up the length of the spermatic cord, inaginating the

scrotal s%in as you go, to the external inguinal ring Pal$able herniating mass bum$s your fingerti$ or $ushes

against the side of your finger.

Palpate Inguinal "ymph #odes

!t is normal to palpate an isolated node on occasion it then feels small (less than * cm), soft, discrete, and moable

enlarged, hard, matted, fixed nodes.

Sel$ Care Testicular Sel$%&'amination (TS&)

&ncourage self care by teaching eery male (from *3 to *4 years old through adulthood) ho$ to examine his o$ntesticles. The oerall incidence of testicular cancer is rare, accounting for about 8000 ne$ cases annually. !t is rare

before age *5 years, pea%s during ages +0 to 39 years, and then declines.

&arly detection is enhanced the mail familiar $ith his normal consistency. "oints to include during health teachingare= TB timing, once a month

SB sho$er, $arm $ater relaxes scrotal sac&B examine, chec% for changes, report changes immediately

Phrase *our Teaching Something "i+e This=

A good time to examine the testicles is during the shower or bath, when your hands are warm and soapy and the

scrotum is warm. Cold hands stimulate a muscle (cremasteric) reflex, retracting the scrotal contents. The proceduris simple. Hold the scrotum in the palm of your hand and gently feel each testicle using your thumb and first two

fingers. If it hurts, you are using too much pressure. The testicle is egg shaped and moable. It feels a robbery with

smooth surface, li!e a peeled hard"boiled egg. The epididymis is on top and behind the testicle# it feels a bit softer.Abnormal lumps are ery rare and usually not worrisome. $ut, if you eer notice a firm, painless lump, a hard area

or an oerall enlarged testicle, call your physician for a further chec!.


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Assess ,rinary unction

A urinalysis sho$s a color of pale yello$ to amber due to the presence of urochrome pigments.&ormal urine is cland slightly acidic with a $) range of !.5 to 3." 1 cloudiness suggests $resence of white blood cells, bacteria, cast

,nderstanding Prostate Changes

The discussion of prostate health and the examination of the prostate gland are uni-ue aspects of male healthassessment. The prostate gland goes through t$o main periods of gro$th. The first occurs early in puberty, and the

second begins after age +5. Although the prostate continues to gro$ during most of a manCs life, the enlargement

rarely causes symptoms before age 40. 1o$eer, more than half of men in the 60s and as many as 90 of men in tD0s $ill hae some symptoms. The gradual enlargement is considered to be a normal part of aging and is often

referred to as benign prostatic hyperplasia (;"1). ;y itself, ;"1 does not raise an indiidualCs ris% for prostatecancer ho$eer, the symptoms of ;"1 and prostate cancer can be ery similar, including hesitant, interrupted, or$ea% urinary stream urinary urgency lea%ing or dribbling and increased fre-uency of urination, especially at nigh

T$o groups that are increased ris% for prostate cancer are AfricanAmerican men and men $hose firstdegree

relaties hae had prostate cancer. !n AfricanAmerican men, prostate cancer tends to start younger and gro$ faster

than in men of other racial ethnic groups. onretractable fores%in forming a pointy tip $ith a tiny orifice. 7ores%in is adanced and so tight it is impossible t

retract oer glans.


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&pispadias ontender s$elling of testes

Di$$use Tumor % Discussion

/iffuse tumor maintains shape of testis.

.rchitis % Clinical indings

= Acute or moderate pain of sudden onset, s$ollen testes, feeling

of $eight, feer

F= !nspection &nlarged, edematous, red does not transilluminate

"alpation $ollen, congested, tense, and tender hard todistinguish testes from epididymis

A= Tender s$elling of testis

.rchitis % Discussion

Acute inflammation of testis.

jarvis 6th ed -chapter 24

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