Ch 43

After seeking care due to recent history of testicular enlargement scrotal pain, a 22-year-old college student has been diagnosed with testicular cancer. Which of the clients following statements indicates the need for further teaching?

" I can't shake this feeling like I've received a death sentence"; survival rates are high

Two nursing students are debating the merits and demerits of infant circumcision. Which of the following statements is most accurate?

"Circumcised men tend to have a lower incidence of penile cancer."

A medical student is assessing a 22-year-old male who has come to the emergency department because of pain and swelling in his scrotum over the past 36 hours. The attending physician has told the student that she suspects epididymitis. Which of the medical student's following questions is most likely to be useful in the differential diagnosis of epididymitis?

"Have you had unprotected sex in the past?"

A patient with excruciating back pain that has been getting worse over the past few months comes to the Emergency Department. His chief complaint is excruciating back pain that has been getting worse over the past few months. He has also noticed decreased sensation in his lower extremities, some urinary incontinence, and feels like he never really empties his bladder all the way after voiding. Following diagnostic testing, the patient is diagnosed with advanced prostate cancer with spinal cord compression. The nurse should anticipate administering which medications to this patient? Select all that apply.

-Ketoconazole, a fungicide, to lower serum testosterone levels. -Bisphosphonates, such as pamidronate, to inhibit bone loss

A 69-year-old client presents with urinary urgency and nocturia. After testing he has been diagnosed with benign prosthetic hyperplasia. When describing the etiology and prognosis of BPH, what should the nurse explain to the client?

Surgery can often be avoided if pharmacologic interventions are successful

A 66-year-old man has presented to a nurse practitioner to get a refill for his antiplatelet medication. The client has a history of ischemic heart disease and suffered a myocardial infarction 5 years ago and has unstable angina; he uses a transdermal nitroglycerin patch to control his angina. The client has a 40 pack-year smoking history and uses nebulized bronchodilators at home for the treatment of transient shortness of breath. He has long-standing hypertension that is treated with a potassium-sparing diuretic and a β-adrenergic-blocking medication. During the nurse's assessment, the man states that he has been unable to maintain his erection in recent months. Which of the following aspects of the man's health problems and treatments would the nurse identify as contributing to his erectile difficulty (ED)? Select all that apply. His

-antihypertensive medications. -hypertension -smoking -age

Which chronic health issues increase a man's risk for developing erectile dysfunction? Select all that apply

Diabetes, hyperlipidemia, hypertension

Select the factor that would increase a male's risk for the development of testicular cancer

History of cryptorchidism

Which diagnosis is most likely to require surgical correction?

Hypospadias

prepuce

foreskin

sx of hydrocele

a "heaviness" in the scrotum or pain in the lower back

nonseminoma tumors

o Include embryonal carcinoma, teratoma, choriocarcinoma, and yolk cell carcinoma derivatives

In hypospadias, the treatment of choice is surgery to repair the defect. What influences the timing of the surgical repair? Select all that apply

Penile size, psychological effects of the child, anesthetic risk

Which of the following teaching points by an oncologist is most appropriate for a 33-year-old male who will begin treatment shortly for his testicular cancer?

"You should know that there might be adverse effects on your sexual function after treatment is finished."

While working with a client with a fairly recent spinal cord injury, the partner asks about the couples ability to maintain a sexual relationship. Which response by the nurse is most accurate?

"If the parasympathetic impulses can pass from the sacral segments of spinal cord through pelvic nerves, an erection should be possible"

A 20-year-old male has been diagnosed with testicular cancer and is seeking information about his diagnosis from a number of Web sites. Which of the following statements that he has read is most plausible?

"Men with cryptorchidism--the term for an undescended testicle--are known to have a higher risk of developing testicular cancer."

A care aide at a long-term care facility has left a note for the care director stating that an 82-year-old resident has a grossly distended scrotum and a likely inguinal hernia. On examination, the resident has been diagnosed instead with hydrocele. What will the care team most likely tell the resident and his family about his diagnosis?

"While distressing to look at, this condition usually doesn't have any significant consequences and won't need treatment."

Main diagnostic criterion of chronic bacterial prostatitis

positive bacterial cultures of prostatic fluid

Acute bacterial prostatitis

- An acute infection of the prostate gland that results in pelvic pain and urinary tract symptoms such as dysuria, frequency, and retention and may lead to systemic symptoms such as fevers, chills, nausea, emesis, and malaise - Most cases are caused by ascending urethral infection or intraprostatic reflux and are facilitated by numerous risk factors including BPH, GU infections, hx of STDs, and being immunocompromised (having HIV) - Direct or lymphatic spread from the rectum or hematogenous spread via bacterial sepsis may also cause acute bacterial prostatitis - Most frequently caused by E. Coli - Other sx include: hesitancy, incomplete voiding, straining, weak stream; suprapubic, rectal or perineal pain; painful ejaculation, hematospermia, and painful defecation

teratoma

- Composed of somatic cell types from two or more germ-like layers - Usually benign in children but can contain minute foci of cancer cells in adults

treatment of BPH

- Emphasis on less invasive methods including pharmacologic agents - When more signs of obstruction develop- surgery is indicated to avoid serious kidney damage - Tx options: lifestyle changes, medications, and surgery · Lifestyle changes: reducing liquid intake, especially before sleep; avoiding or reducing intake of caffeine or alcohol; avoiding or monitoring the use of medications such as decongestants, antihistamines, antidepressants, and diuretics; training the bladder to gold more urine for longer periods; exercising pelvic floor muscles; preventing or treating constipation

Peyronie Disease

- Involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis - Characterized initially by an inflammatory process that results in dense fibrous plaque formation - The plaque is usually on the dorsal midline of the shaft, causing upward bowing of the shaft during erection - Some may develop scarring on both the dorsal and ventral aspects of the shaft causing the penis to be straight but shortened or have a lateral bend - The fibrous tissue prevents lengthening of the involved area during erection, making intercourse difficult and painful

goals of treatment in balanoposthitis

reduce sexual dysfunction, minimize urinary dysfunction, to exclude penile cancer, treat premalignant disease, and to diagnose and treat STDs

Neurogenic causes of ED

- Parkinson disease, multiple sclerosis, heavy metal positioning, stroke, cerebral trauma, and spinal cord and nerve injuries

preventable risk factors for ED

-obesity, physical inactivity, high cholesterol levels, high blood pressure, and smoking - These risk factors can result in ED before the heart is ever affected

An adult male reports painful urination, rectal pain, fever and chills, general malaise and myalgia. Vital signs are temperature of 101.7, blood pressure of 105/74, pulse 98 bpm, respirations 22 breaths per minute. What condition should the healthcare provider suspect?

Acute bacterial prostatitis

An adolescent male comes to the urgent care clinic. Upon assessment, the following is noted history of circumcision, erythema of the glans, and prepuce with a malodorous discharge. Based on the symptoms, the probable diagnosis would be

Acute superficial balanoposthitis

Which statements regarding prostate cancer are true? Select all that apply

Age is a risk factor of this cancer, African-American males are at highest risk for developing the disease, prognosis has improved because of PSA diagnostic screenings

The nurse is caring for a client recently diagnosed with testicular cancer. The nurse evaluates the medical record for which of these diagnostic test, typically altered in this type of malignancy?

Alpha fetoprotein test

A patient is admitted into the emergency department with a sustained erection lasting 4 hours. Which initial treatments does the nurse anticipate administering? Select all that apply

Analgesics, sedation, hydrating measures

Following a long history of intermittent back pain and urinary urgency, a 50-year-old client has been diagnosed with chronic bacterial prostatitis. Which of the following factors is most likely to influence his health care provider's choice of treatment?

Antibacterial drugs penetrate poorly into the chronically inflamed prostate.

Embryonal Carcinomas

Are the least differentiated of the tumors

The nurse is counseling a client with mild BPH on lifestyle changes that can reduce the urinary symptoms associated with the condition. What lifestyle intervention should the nurse include in the teaching? Select all that apply

Avoid over-the-counter antihistamines, avoid caffeinated beverages, do not take fluids after 8 PM

BPH and prostatic adenocarcinoma present differently. The nurse is aware of which difference?

BPH is commonly located in the periurethral zone of the prostate, while prostate cancer's are commonly located in the peripheral zones of the prostate

A client on the urology floor who has BPH asked the nurse how the pharmacologic agent finasteride will help decrease the size of his prostate. Which principle explains the mechanism of action?

Blocking effects of androgens on the prostate

treatment of hypospadias

surgical repair between 6-18 months of age

An overweight 50-year-old client presents with reports of ED. What aspect of the clients health should the nurse prioritize is the most important to assess?

Cardiovascular

Epididymitis can be sexually transmitted, or it can be caused by a variety of other reasons, including abnormalities in the genitourinary tract. What are the most common causes of epididymitis in young men without underlining genitourinary disease?

Chlamydia and gonorrhea

Which of the following is the most common cause of recurrent urinary tract infections in males?

Chronic bacterial prostatitis

What risk factors associated with erectile dysfunction are considered preventable?

Cigarette smoking

A newborn male has been diagnosed with hypospadias following his postpartum assessment by a pediatrician. Which of the following diagnostics and treatment options is the physician most likely to rule out first?

Circumcision

Hypospadias and Epispadias

Congenital disorders of the penis resulting from embryologic defects in the development of the urethral groove and penile urethra

The community health nurse is providing men's health education on prostate cancer. Which risk factors for prostate cancer should the nurse include in the discussion? Select all that apply

Consuming high-fat dairy items, high fat diet from processed meat

The nurse is teaching a male client about testicular cancer. Which risk factor does the nurse discuss as a major one for testicular cancer?

Cryptorchidism

A client asked the nurse what can cause or contribute to the development of benign prostatic hypertrophy (BPH). The best response would be

Dihydrotestosterone (DHT) proliferates the growth of prostatic stromal cells, leading to a reduction in the death of the epithelial cells

Of the following list of medications, which would likely be prescribed to a patient with benign prostatic hyperplasia (BPH) as a way to decrease the prostate size by blocking the effects of androgens on the prostate?

Finasteride (Proscar), a 5a-reductase inhibitor

Select the factor that would increase a males risk for the development of testicular cancer

History of cryptorchidism

The mother of a five-year-old boy brings him into the clinic because there's a firm feeling and swelling around one of his testes. What would the suspected diagnosis be?

Hydrocele

Which chronic health issues increase a man's risk of developing erectile dysfunction? Select all that apply

Hyperlipidemia, hypertension, diabetes

The nurse in the urology clinic is reviewing the chart of a client with erectile dysfunction. Which factor in the clients history does the nurse recognizes a hormone based condition that may contribute to erectile dysfunction?

Hypogonadism

A Patient calls the clinic and informs the nurse that he has sustained an erection for three hours and that it is extremely painful. The patient has a history of sickle cell disease and this has not happened to him in the past. Which of the following should the nurse instruct the patient about?

If the patient does not seek medical attention, impotence may occur

A 51-year-old man is receiving his annual physical exam, and his care provider is explaining the rationale for performing a digital rectal exam (DRE). Which of the following statements best captures the rationale for the procedure?

If the prostate is hardened on examination, a biopsy is indicated for further investigation.

A 54-year-old diabetic patient has come to the urology clinic complaining of erectile dysfunction. His history includes obesity, coronary artery disease that required CABG 3 years ago, hypertension, and gout. The nurse practitioner is reviewing his record in order to prescribe medication. The practitioner is considering prescribing sildenafil (Viagra). Which of the following home medications is contraindicated if taken concurrently with sildenafil?

Imdur (isosorbide mononitrate), a vasodilator

An adult male has been diagnosed with mumps orchitis. The nurse should educate the client regarding which complication associated with mumps orchitis ?

Impaired spermatogenesis

Immediate complications of transurethral prostatectomy (TURP)

Inability to urinate, postoperative hemorrhage or clot retention and urinary tract infection

What late complication of a transurethral prostatectomy will the nurse address with the patient as part of discharge teaching?

Incontinence, sexual dysfunction, and bladder neck constriction

The community health nurse is conducting a men's health class. Which of these does the nurse relate as the major role of the prostate?

It increases sperm motility

Which statements are true regarding priapism? Select all that apply

It is not always related to sexual stimulation, it can result in ischemia of erectile tissue of the penis, it can be triggered by sickle cell disease

When assessing the client with chronic inflammatory bacterial prostatitis, the nurse recognizes which of these findings are typically present? Select all that apply

Low back pain, bacteruria, frequency of urination, painful urination

yolk sac tumors

Mimic the embryonic yolk sac histologically

The nurse is reviewing the laboratory results of a client who has noninflammatory prostatitis. The nurse would expect the results to include

Normal leukocyte count; men with non-inflammatory prostatitis have symptoms resembling those of non-bacterial prostatitis, but have negative urine culture results and no evidence of prostatic inflammation

A 27-year-old male developed mumps and was ill for several days. The client suddenly developed a fever and painful enlargement of the testes approximately four days after recovering. The nurse should suspect that the client has developed

Orchitis

A 40-year-old African American patient is at increased risk of developing prostate cancer, since his father was diagnosed with the disease at age 60 and his brother at age 56. What diagnostic measures should be undertaken?

PSA and DRE starting before the age of 50

The provider is assessing a client with a history of ED who is requesting a prescription for treatment. When assessing for additional information related to the cause of ED dysfunction, which information should the provider solicit from the client?

Presence of arterial occlusive disease

The nurse in a neurology unit is teaching about medications to treat erectile dysfunction. The mechanism of action of most of these medications is that the medication

Promotes increasing blood flow to the corposa cavernosa

A 52-year-old male diagnosed with erectile dysfunction asks the nurse what will be implemented as first option for treatment. The best response would be

Psychosexual counseling and PDE-5 inhibitor medications

choriocarcinoma

Rare and highly malignant form of testicular cancer that is identical to tumors that arise in placental tissue

A client with advanced prostate cancer has been prescribed biphosphonates and asked the nurse the purpose of the medication. What indications for biphosphonate should the nurse include? Select all that apply

Reducing pain, lowering serum calcium levels, preventing fractures

balanitis

Refers to inflammation either chronic or acute of the glans penis and posthitis inflammation of the prepuce

A 34-year-old male has been diagnosed with testicular cancer after he visited his family physician with a complaint of an enlarged, painful testicle. Biopsy has indicated that his tumor is malignant, and his oncologist believes that the tumor arose in the seminiferous epithelium and is producing a uniform population of cells. What is the client's most likely specific diagnosis?

Seminoma

steps of an erection

Sexual arousal -> increased nitric oxide release -> relaxation of arterial smooth muscle and arterial dilation and trabecular smooth muscle relaxation with expansion of sinusoidal spaces of the corposa cavernosa -> increased intracavernosal pressure -> increased penile rigidity

Which factor in the evaluation and treatment of BPH is considered to be the single most important one?

Subjective symptoms reported by the client

The nurse has just completed the admission assessment of a client diagnosed with invasive penile cancer. The most likely plan of treatment will be

Surgical removal of the affected area

A 14-year-old boy has been brought to the emergency department by his mother in excruciating pain that is radiating from his scrotum to his inguinal area. The boy's heart rate is 122 beats/minute, and he has vomited twice before arrival at the hospital. Examination reveals that his scrotum is reddened and slightly swollen, and the testes are firm to touch and tender, with extensive cremaster muscle contraction noted. What is the boy's most likely diagnosis?

Testicular torsion

When explaining to a patient why his prostate is enlarging, the nurse will mention that which of the following hormones may contribute to the prostatic hyperplasia? Select all that apply.

Testosterone Dihydrotestosterone Estrogens

A 71-year-old man diagnosed with a stage T2 prostate tumor 2 years ago has elected watchful waiting, based upon an underlying heart condition that renders surgery potentially fatal. Recently, his PSA has jumped considerably, as have his levels of serum acid phosphatase. Which course of action would be least appropriate at this stage?

Treatment with GnRH agonists alone

Who is more prone to balanitis xerotica?

Uncircumcised males

A client asks "what caused my acute prostatitis?" Which response by the nurse explains the most common cause of acute prostatitis?

Urethral infection with E. coli

As men age, BPH becomes common. Which symptom is usually not associated with obstructive symptoms of BPH?

Urge incontinence (this is an irritated symptom of BPH not an obstructive symptom)

epispadias

a congenital abnormality in males in which the urethra is on the upper surface of the penis

tx options of BPH for men with heart or lung disease and are precluded from major surgery

a stent may be used to widen and maintain the patency of the urethra

A nurse practitioner has a 30-year-old male patient presenting with fever and chills, urinary frequency and urgency, and pain with urination. A urine sample displays cloudy and foul-smelling urine. During digital rectal exam of the prostate, the nurse notes a thick white discharge. A likely diagnosis would be

acute bacterial prostatitis requiring antimicrobial therapy.

risk factors of BPH

age >40, family history of BPH, medical conditions such as obesity, CV disease, and DMII; lack of physical exercise, and ED

drugs reported to cause ED

antidepressants, antipsychotics, antiandrogens, glaucoma eye drops, chemotherapy drugs, and antihypertensive meds

While teaching a health class to junior and senior male high school students, the school nurse educates them regarding the first sign of testicular cancer, which would include

enlargement of the testicle.

risk factors for hypospadias

family history, maternal factors (older maternal age, multiple pregnancies, high body mass index, health conditions such as hypertension or preeclampsia)

how is BPH characterized?

formation of large, discrete lesions in the periurethral region of the prostate rather than the peripheral zones which are commonly affected by prostate CA

causes of balanoposthitis

infection, trauma, or irritation

posthitis

inflammation of the prepuce

when do people with phimosis seek medical care?

when s/sx of infection develop, including pain and swelling of the foreskin or purulent discharge from the penile meatus

Inflammatory Prostatitis

· A large group of males with prostatitis have no bacteria in the urinary system yet have pain along the penis, testicles, and scrotum; painful ejaculation, low back pain; rectal pain along the inner thighs; urinary sx; decreased libido, and ED · Often have inflammation of the prostate with an elevated leukocyte count and abnormal inflammatory cells in their prostatic secretions

noninflammatory prostatitis

· Often have sx resembling those of nonbacterial prostatitis but have negative urine culture results and no evidence of prostatic inflammation (normal leukocyte count) · Cause is unknown · In some cases, there is an apparent functional obstruction of the bladder neck near the external urethral sphincter; during voiding, this results in higher than normal pressures in the prostatic urethra that cause intraprostatic urine reflux and chemical irritation of the prostate by the urine · There may be an apparent myalgia associated with prolonged tension of the pelvic floor muscles

Which of the following disorders of the male genitourinary system creates the most urgent need for prompt and aggressive surgical treatment?

intravaginal testicular torsion

A client is concerned about having mumps orchitis and asks the nurse about the symptoms. Which is the nurses best response?

Painful enlargement of the testes with fever 3 days after infection

When assessing a client with chronic inflammatory bacterial prostatitis, the nurse recognizes which findings are typically present? Select all that apply

Painful urination, frequency of urination, low back pain, bacteriuria

A nurse is providing teaching to the parents of a child who has undergone correction surgery for cryptorchidism. The most important information for the nurse to provide is

Parent should be taught that their child needs frequent follow up visits

A 41-year-old male has presented to his family physician stating that for the last 2 years his erection "is as crooked as a dog's hind leg and hurts too." He has subsequently been diagnosed with Peyronie disease. Which of the following statements by his physician is most appropriate?

"This might need surgery, but it could possibly disappear over time without needing treatment

Balanoposthitis

- Often both the glans penis and prepuce are affected, which results in the condition balanoposthitis - May be characterized by erythema of the glans and prepuce, itching, soreness, blisters, ulcers, and painful urination, foul-smelling discharge may also be present - Males with poor hygiene, immunosuppression, or diabetes are more prone to balanoposthitis - Usually encountered in males with phimosis or a large, redundant prepuce that interferes with cleanliness and predisposes to bacterial growth in the accumulated secretions and smegma

Psychogenic causes of ED

- Performance anxiety, a strained relationship with a sexual partner, depression, and overt psychotic disorders - Can be further exacerbated by the side effects of many of the therapies used to treat these disorders, which can themselves cause ED

Chronic bacterial prostatitis

- Subtle and difficult to treat - Most commonly caused by E. Col or other gram-negative enterobacteriaceae and typically affects males 36-50 years of age - After an episode of acute bacterial prostatitis, approximately 5% may progress to chronic bacterial prostatitis - Patients may present with relapsing UTIs which may be episodic or persistent - The UTIs are typically not associated with systemic signs of infection - Other irritative or obstructive urologic sx may be present - Complaints vary but may include: dysuria, urgency and frequency, hesitancy or retention, hematuria, malodorous urine and urethral discharge - Fevers and chills are uncommon and are more prevalent in acute bacterial prostatitis

Phimosis

- Tightening of the prepuce or penile foreskin that prevents its retraction over the glans - Foreskin begins to develop during the 8th week of gestation as a fold of skin at the distal edge of the penis that eventually grows forward over the base of the glans- by the 16th week of gestation, the prepuce and the glans are adherent

organic causes of ED

- include neurogenic, hormonal, vascular, drug-induced, and penile-related etiologies - Most common cause is vascular and involves the penile arteries, veins, or both - Arterial issues are usually caused by arteriosclerosis or hardening of the arteries although sometimes they are due to trauma to the arteries - Another proposed cause: partial or complete wasting or atrophy of smooth muscle in the penis or the growth of excessive smooth muscle tissue - Also common in people with DM—this process involves premature and unusually severe hardening of the arteries - A history of extensive pelvic surgery, especially radical prostatectomy, is a common cause due to both direct and indirect nerve damage - Endocrine disorders such as hypogonadism, hyperprolactinemia, and thyroid disease play a significant role in ED - For people with HTN, ED is impaired not so much by the increased BP as by the associated arterial lesions caused by the high pressure that narrows the vessel lumen - Cigarette smoking can induce vasoconstriction and penile venous leaking - Alcohol in small amounts may increase libido and improve erection, however in large amounts it can cause central sedation, decreased libido, and transient ED - Aging is also known to increase the risk of ED and age-related declines in testosterone may play a role (andropause)

Hypospadias

- urethral opening or meatus may be at any location along the underside of the shaft of the penis, the scrotum, or the perineum - most commonly classified as proximal or distal with proximal cases being considered more severe and being associated with more negative psychological effects - result of abnormal fusion of urethral tissue at the time of organ development

Paraphimosis

-foreskin is so tight and constricted that it cannot cover the glans - can constrict the blood supply to the glans and lead to ischemia and necrosis - Many cases result from the foreskin being retracted for an extended people as in the case of catheterized uncircumcised males - Can present as a swollen, tender penis with multiple skin folds just under the glans

Palliative care for patients diagnosed with terminal prostate cancer include focal irradiation of symptomatic bone disease and which of the following?

Pain control

spermatocele

o A painless, sperm-containing cyst that forms at the end of the epididymis o Located above and posterior to the testes, is attached to the epididymis and is separate from the testes o May be solitary or multiple and are usually less than 1 cm in diameter o Freely moveable and should transilluminate o Rarely cause problems, but a large one may be come painful and require removal

Epididymitis

o Acute or chronic inflammation of the epididymis, the elongated cordlike structure that lies along the posterior border of the testis, whose function is the storage, transport, and maturation of sperm o There may be gradual onset of posterior testicular pain, usually unilateral and occasionally the pain radiates to the lower abdomen; other sx include discharge, dysuria, frequency, urgency, erythema of the scrotal skin, and fever o Acute epididymitis: pain, swelling, and inflammation of the epididymis that lasts <6 weeks o Chronic epididymitis: characterized by >6 week period of symptoms o Prehn Sign: physical elevation of the testicle or scrotum when a person is standing decreases the pain of epididymitis but does not decrease pain associated with testicular torsion o Caused by multiple infectious, noninfectious, and even postinfectious microbial sources

hematocele

o An accumulation of blood in the space between the parietal and visceral tunica vaginalis, which causes the scrotal skin to become dark red or purpose o Often associated with hydrocele o May develop as a result of an abdominal surgical procedure, scrotal trauma, a bleeding disorder, or a testicular tumor

Testicular Cancer

o Cause is unknown but risk factors include cryptorchidism, genetic factors, and disorders of testicular development

Varicocele

o Characterized by varicosities of the pampiniform plexus, a network of veins supplying the testes o The left side is more commonly affected because the vein inserts into the left renal vein whereas the right spermatic vein usually enters the inferior vena cava o Incompetent valves are more common in the left internal spermatic veins, causing a reflux of blood back into the veins of the pampiniform plexus o The force of gravity from the upright position also contributes to venous dilation o If condition persists- thee may be damage to the elastic fivers and hypertrophy of the vein walls as occurs in formation of varicose veins in the legs o Is typically idiopathic o Rarely found before puberty o Sx: abnormal feeling of heaviness in left scrotum, although many are asymptomatic o Usually is readily diagnosed on physical exam when the person is in the standing and recumbent positions—typically, the varicocele disappears in the lying position because of venous decompression into the renal vein o Scrotal palpation of a varicocele is like feeling a "bag of worms" o The Valsalva maneuver may be used to accentuate small varicosities

hydrocele

o Collection of fluid in the scrotum without an obvious inguinal hernia o The tunica vaginalis has an outer parietal layer and a deeper visceral layer that adheres to the dense fibrous covering of the testes, the tunica albuginea—a space exists between these two layers that typically contains a few milliliters of clear fluid o A hydrocele forms when excess fluid collects between the layers of the tunica vaginalis o The typical hydrocele is seen shortly after birth as a unilateral or bilateral swelling in the scrotum, and it may vary in size o The scrotum appears swollen with fluid and may be bluish in color o The scrotum may be very tense and is usually not tender o Transillumination of the scrotum (shining a light through the scrotum to visualize its internal structures) or US can help determine whether the mass is color or cystic and whether the testicle is normal - A dense hydrocele that does not illuminate should be differentiated from a testicular tumor

BPH

o Condition in males in which the prostate gland is enlarged but not cancerous o Prostate goes through two growth periods in a man's life- the fist is early in puberty when the prostate doubles in size and the second behind at age 25 and continues during the remainder of the mans life o During the second growth phase, the gland impinges on the urethra, obstructing urine flow o The bladder wall thickens and eventually the bladder may weaken and lose the ability to empty completely leaving some urine in the bladder o The narrowing urethra and subsequent urinary retention are associated with the many s/sx: trouble starting urination, an interrupted urine stream, and nocturia

Erectile Dysfunction

o Defined as the persistent inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse o Was once believed to be solely a psychological condition and grouped with mental health but today we know that there is a physical etiology

erection

o Erection is a neurovascular process involving the autonomic nervous system, neurotransmitters and endothelial relaxing factors, the vascular smooth muscle of the arteries and veins supplying the penile tissue and the trabecular smooth muscle of the sinusoids of the corposa cavernosa o Under the control of parasympathetic nervous system, and ejaculation and detumescence (penile relaxation) are under sympathetic nervous system control o Somatic innervation, which occurs through the pudendal nerve, is responsible for penile sensation and contraction and relaxation of the extracorporeal striated muscles

Seminoma

o Increased incidence of testicular germ cell tumors have been described in HIV infected men o Most frequent in the fourth decade of life o Are thought to arise from the seminiferous epithelium of the testes and are the type of germ cell tumor most likely to produce a uniform population of cells

risk factors of penile cancer

o Increasing age, poor hygiene, smoking, HPV types 16 and 18 infections, UV exposure, and immunosuppression; there is an association between penile cancer and poor genital hygiene and phimosis

signs of penile cancer

o Invasive carcinoma begins as a small lump or ulcer o If phimosis is present, there may be painful swelling, purulent drainage, or difficulty urinating o Palpable lymph nodes may be present in the inguinal region

Priapism

o Involuntary, persistent (>4 hours) penile erection that continues hours beyond, or is unrelated to, sexual stimulation o Typically, only the corpora cavernosa are affected o True urologic emergency because prolonged erection can result in ischemia and fibrosis of the erectile tissue with significant risk of impotence o Can occur at any age o Sickle cell disease or neoplasms are the most common cause in males between 5-10 years' old o Can occur secondary to a disease or drug effect; other secondary causes include hematologic conditions such as leukemia, sickle cell disease, and thrombocytopenia; neurologic conditions such as stroke, spinal cord injury, and other central nervous system lesions; and renal failure o Males with sickle cell disease are frequently affected

Prostatitis

o Refers to a variety of inflammatory disorders of the prostate gland, some bacterial and some not o It may occur spontaneously as a result of catheterization or instrumentation or secondary to other diseases

testicular torsion

o Refers to the twisting of the spermatic cord that suspends the testis and subsequent loss of the blood supply to the ipsilateral testicle o Considered a urologic emergency- early dx and tx are critical o The rate of testicular viability decreases rapidly after 6 hours from onset of symptoms

initial tx of priaprism

o analgesics, sedation and hydration; urinary retention may necessitate catheterization; local measures include ice packs and cold saline enemas, aspiration and irrigation of the corpus cavernosium with plain or heparinized saline or instillation of alpha-adrenergic drugs—if these do not work, a temporary surgical shunt may be established

who does BPH NOT develop in?

o males whose testicles were removed before puberty and because of this, researchers believe factors related to aging and the testicles may cause BPH; also may be due to a higher proportion of estrogen promoting prostate growth

manifestations of peyronie disease

painful erection, bent erection, and the presence of a hard mass at the site of fibrosis; 2/3rds of males' c/o pain as a sx and this pain usually disappears as the inflammation resolves

indications of surgery with peyronia disease

penile shortening, persistent pain, severe curvature, and penile narrowing or indentation

predisposing factors for penile cancer

phimosis