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Male GU Powerpoint
Terms in this set (182)
2 corpora cavernosa
1 corpus spongiosum
components of penis
what structure of the penis does the urethra run through?
corpora cavernosa are made up of these
when do smooth muscles of the corpora cavernosa contract?
distal corpus spongiosum expands to form this
parts of penis
part of penis composed of erectile tissue
dorsal vein of the penis
runs along penile shaft with artery and nerve on either side
internal pudendal artery --> dorsal and deep arteries
blood supply to penis
nerves responsible for erection
free fold of skin at distal end of penis
removed during circumcision
prepuce (foreskin) may be retracted to expose this structure
secretion between prepuce and glans
root of penis
lies deep to scrotum in perineum where corpora cavernosa diverge
veins of the penis drain into this
smooth muscle relaxation --> vasodilatation
decreased venous return
how does PANS innervation lead to erection?
AV channels closed
(decreased venous outflow)
during erection, the ___ are closed and the ___ are opened
pouch containing testes, suspended externally from the perineum
structure dividing scrotum
involuntary smooth muscle
voluntary striated muscle
the wall of the scrotum contains these two things
internal urinary meatus of bladder
external meatus of penis
urethra extends between these two structures
three portions of the urethra
common ejaculatory duct
what structures enter the urethra at the prostatic (posterior) portion?
left (lower than right)
which testicle is commonly lower than the other
3.5 x 3 cm
common dimensions of prostate
what structure traverses through the prostate?
what structure(s) is/are on either side of the prostate
prostate carcinoma frequently affects this lobe
midline groove b/w lateral lobes may be obliterated
how may the prostate present in the case of cancer
middle and lateral lobes
prostate lobes typically involved in BPH
changes in urine flow
groin mass or swelling
most common symptoms associated with male GU
sudden distention of ureter, renal pelvis, or blader
what could cause flank pain?
colicky pain from upper ureter may cause referred pain to where?
lower ureteral dilatation may refer pain to where?
pain from this is severe, patient is often restless
aching pain in CV angle
sudden distention of the renal capsule could result in this
aching pain in CV angle should raise suspicion of what two pathologies?
urge to urinate
symptoms associated with bladder distention
what structures could be involved in facilitation of groin pain?
common clinicopathologic correlations with groin pain?
testicular pain can result from any disease of what two structures?
spermatic cord torsion
common clinicopathologic correlations with testicular pain
presentation of testicular pain should also raise suspicion of referred pain from where?
types of dysuria
passage of air in the urine
end of urination
when is pneumaturia usually emitted?
introduction of air by instrumentation
fistula to the bowel
UTI by gas-forming bacteria
what does pneumaturia indicate?
presence of fecal material in urine
two things that result in fecaluria
ulceration from bowel to urinary tract
fecaluria from intestinovesicular fistula or urethrorectal fistula occurs as a consequence of this
diseases associated with fecaluria
pus in urine
inflammation of the urinary tract
pyuria is the body's response to this
most common cause of inflammation and subsequent pyuria
passing urine more often than normal
urinary frequency at night
most common symptom of the genitourologic system
decreased bladder size
bladder wall irritation
increasing urine volume
causes of urinary frequency
most common cause of reduced usable bladder capacity in men
sensation of incomplete emptying
symptoms of prostatic hyperplasia
complete inability to urinate necessitating catheterization, can result from long-standing prostatic hypertrophy
conditions that can result from long-standing prostatic hypertrophy
voiding large amounts of urine
polyuria is usually accompanied by this
common causes of polydipsia
inability to retain urine voluntarily
pressure within the bladder is constantly elevated; slight increase in intra-abdominal pressure raises the intravesicular pressure sufficiently to overcome bladder neck resistance, and urine escapes; leakage may be steady or intermittent
leakage that occurs only when the patient strains; residual urine is insignificant, any increase in intra-abdominal pressure causes leakage
loss of muscular support in urethrovesicular region
stress incontinence is due to this
stress incontinence is more commonly seen in...
normal volume of urine production
polyuria frequently results in urine volume of this amount
psychologic diabetes insipidus
most important diseases to differentiate with polyuria
high osmotic load
symptoms associated with DM
hypothalamus or pituitary gland
diabetes insipidus is caused by a ___ deficiency related to a lesion in the ___ or ___
urine cannot become concentrated despite rise in plasma osmolality
psychogenic diabetes insipidus
polyuria related to compulsive drinking of water
red urine is often indicative of this but should not be automatically assumed
excessive ingestion of beets
other causes of red urine (besides blood)
when it is determined that the urine is red as a result of the presence of blood, the hematuria is called this...
strenuous activities may traumatize blood cells as they travel through the small vessels in the feet, which may cause intravascular hemolysis and hemoglobinuria
blood only at the beginning of urination or initial hematuria usually has a source where?
bladder neck or posterior urethra
blood only at the end of urination or terminal hematuria indicates a disorder wehre?
above prostate gland or massive hemorrhage at any level
blood evenly distributed throughout urination is total hematuria and implies disease where?
external urethral meatus
blood staining of undergarments without blood in the urine indicates pathologic processes where?
renal cell carcinoma
weight loss and hematuria are seen in this disease
red urine that occurs 10-14 days after an upper respiratory infection may indicate this
penile discharge (ask if bloody or purulent)
continuous or intermittent flow of fluid from the urethra
bloody penile discharges associated with these
thick and yellowish-green
description of purulent penile discharge
associations with purulent penile discharges
what should you suspect when patient presents with penile lesions?
most common male GU rash
patient develops bright red, well-defined, scaling plaques. affects entire scrotum, inguinal folds, and penis. Penis may be sole area of involvement
psoriatic patches on other body parts
what usually facilitates the diagnosis of psoriasis upon presentation of a penile rash?
may develop from soaps or disinfectants. Irritants used for facial actinic keratoses may inadvertently be transferred to the genitalia. itching is a major symptom
fixed drug reactions
manifest as sudden onset of multiple, well-defined, macular, eczematous, bullous patches; appear in same area of body each time responsible drug is given
distal penis and glans
when the genitalia are involved in fixed drug eruptions, where do they typically occur?
inflammatory disorder characterized by violaceous, flat, shiny papules that are faintly erythematous to violet in color
what part of the male genitalia is frequently involved in lichen planus?
resolves with residual hyperpigmentation
how does penile lichen planus typically present and how does it resolve?
painful scrotal enlargement may result from these conditions
association with scrotal enlargement that often cause decreased fertility
most common cause of swelling in the groin
after patient has been lying down
when are hernias reduced in size?
adenopathy from infection of external genitalia
what, besides hernias, may also cause inguinal swelling?
inguinal node enlargement
what can present if carcinoma of the testis involves the scrotal skin?
the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance
penile erection is a ___ phenomenon
occlusion of the cavernosal arteries
problems secondary to smoking
what vascular diseases can cause ED?
histamine type 2 receptor blockers
what drugs are associated with ED?
risk factors in ED
the inability to conceive or to cause pregnancy
infertility is a common problem found in what percentage of all marriages?
males account for this percentage of all infertility
a couple is said to be infertile when after this period of time of normal intercourse without contraceptives, pregnancy does not occur
inability to retract foreskin
inflammation caused by buildup of smegma from an inability to retract foreskin (phimosis) and thus inability to clean glands
primary syphilis: chancre
usually single lesion, non-tender w/indurated edge
multiple lesions, extremely tender with tender adenopathy
venereal warts, characteristic of HPV infection, resemble cauliflower, highly contagious
inflammation of glans penis often caused by Candida
uncircumcised men (warm and moist)
what population is balanitis mostly found in
infection involving glans and foreskin
pinpoint, dark red, slightly raised telangiectatic lesions on scrotum common if >50 yo
rare disease, diffuse angiokeratomas in a "bathing suit" distribution
pearly penile papules
chancre of primary syphilis
opening of urethra anywhere along the urethral groove on underside of penis, if present at birth check for other GU tract anomalies
opening along dorsum
nontender induration/fibrosis under the skin of the shaft, penile deviation during erection
foreskin becomes caught behind corona after retraction
enlargement of the spermatic cord resulting from dilatation of the pampiniform plexus
what side is varicocele usually on?
bag of worms
what does varicocele feel like?
patient standing or straining (gravity dependent)
in what position can you get the best visualization of varicocele?
necessary if a scrotal mass is detected
transillumination effect for vascular structures, tumors, blood, hernias, and normal testicles
transmission of red glow
transillumination effect for serous fluid-containing cavity: like hydrocele or spermatocele
abnormal collection of clear fluid in the tunica vaginalis, seen as a massive scrotal enlargement
pea-sized, nontender mass that contains spermatozoa and is usually attached to the upper pole of the epididymis
percentage of hernias located in inguinal area
indirect inguinal hernia
if there is a large scrotal mass that appears opaque on transillumination what may be present?
usually first indication of a urinary tract tumor
surgical emergency, twisting of the testis leading to venous obstruction, edema, and eventual arterial obstruction
in what age group is testicular torsion most commonly seen?
acute, unilateral testicular pain often accompanied by nausea/vomiting
what are the symptoms of testicular torsion?
testis enlarge and extremely sensitive, may be retracted
how does testis present on PE when there is testicular torsion?
most common cause of acute scrotal swelling
recent onset of testicular pain associated w/fever, dysuria, and scrotal swelling
what does the patient complain of when presenting with epididymitis?
epididymis tender and indurated, testis may be enlarged and tender (epididymo-orchitis)
what does the PE reveal in epididymitis?
third most common cause of testicular swelling
when do 10-15% of patients with testicular tumors seek medical attention?
non-acute, nonneoplastic lesions
most common types of intrascrotal pathologic conditions
hydrocele is a collection of serous fluid within the layers of what?
is hydrocele associated with pain?
spermatocele is cystic collections of fluid where?
what complaints to patients with spermatocele have?
varicocele is a common intrascrotal mass from abnormal dilatation of the vein of what?
history of infertility or sensation of heaviness in testicle or pain in scrotum
what symptoms in HPI my be associated with varicocele?
varicocele rarely develops after this age
what does right sided varicocele suggest?
tumor of left kidney
what might acute left sided varicocele indicate?
history of this is highly associated with testicular malignancies
common, usually self-limited, cutaneous eruption affecting the skin and mucous membranes
most important diagnostic sign of molluscum contagiosum
painful, can occur anywhere in body, highly contagious
important characteristics of molluscum contagiosum
12-21 d after infection
how soon does primary lesion (chancre) of syphilis occur?
spontaneously within a month
how does primary syphilis (chancre) resolve/heal?
evolve to secondary stage after 2 months
if untreated, primary syphilis can cause this
widespread, nonpruritic maculopapular rash
condyloma lata - "pasted" on appearance
after 2 years, cardiovascular syphilis or neurosyphilis appear
very common STD, cause of venereal warts, condyloma acuminata
3 types of hernias
left lateral prone (Sims)
position recommended to use for rectal exam on patients who are weak and confined to bed
right upper leg flexed
left lower leg semiextended
during rectal exam how should the patient's legs be positioned?
hemorrhoids or fissures
what is the examiner looking for when they ask the patient to strain during rectal exam?
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