Male Repro

Disorders of the Male Reproductive System concepts to focus on

-concepts to focus on: -altered elimination urinary and stool -pain and inflammation -infection -impaired perfusion -sexual dysfunction -infertility -body image changes -health promotion and prevention (word document)

Dihydrotestosterone

-DHT: by product of testosterone and is associated with hair loss

Prostate Cancer Pathophysiology

-Proliferative growth in single or multiple areas -Gland enlargement -Metastasis to lymph nodes, bone different from BPH, this is cancerous growth -watch and wait may be the choice of the man, slow progessive cancer -patho:

Testicular Cancer risk factors

-risk factor: cryptorchidism (undescended teste), family history or medical history, Caucasian men highest at risk, higher in HIV men -occupational: chemicals and mining, oil and gas production, and leather

Anatomy Review

-structures to know: penis, (3 parts: shaft, glans, and foreskin) Encloses the urethra (starts at bladder and travels through prostate, pathway for both semen and urine) -circumcision: removal of foreskin -phimosis: unretractable foreskin -ductle system: epidytimis (long coiled tubes, store and mature sperm, contract to eject), vas deferens (stores and transports sperm), and ejaculatory ducts (in prostate where epididymis and vas deferens join) -testes: covers and protects, and maintains temperature for sperm (male reproductive glands), hold the seminuf tubules, store testosterone, (in the fetus they are in the abd and descend later) -other accessory glands that aide in sperm: seminal vesicles (create an alkaline fluid that has fructose and prostaglandins and it helps nourish the sperm Prostate: secretes milky fluid, alkalinity protects sperm in the urethra from urine and I the female vagina (increases sperm mobility) Bulb gland: alkaline fluid in the urethra and neutralize acidic -sperm itself is around 7.5pH, milky, etc *****not going to be quizzed on anatomy BUT: -location of the prostate: under the bladder, around the urethra, pain will be I the perineum (between scrotum and anus, where a person sits)

STi Screenings/tests

: if suspected or surveillance. Syphilis looks for antibodies to the bacteria -VDRL and RPR: both screening tests to use for possible syph infections -FTA-ABS: blood tests for antibodies and confirms the other two tests -chlamydia/gon: obtained via UA or swab of the urethra or oral or anal cavity -HIV: blood test for antibodies (western blot test to confirm HIV) -Tric: STI, swab of the urine or urethra

LH

: released by anterior pituitary, stimulates interstitial cells of Leydig cells which regulates production of testosterone with neg feedback (High levels of testosterone decrease LH secretion)

Hormonal Control of Male Reproductive System

Androgens -Testosterone -Dihydrotestosterone -Androstenedione Gonadotropins -Follicle Stimulating Hormone (FSH) -Luteinizing Hormone (LH) --------------------- -androgens: male sex hormone -testosterone: most abundant androgen, anabolic steroid developed by the male genitalia, proides primary and secondary male characteristics (gonadal function, external genitialia and accessory organs, male voice, skin, and hair distribution -anabolic effects: building up of complex molecules, promotes protein metabolism, promotes muscoskeletal growth, and influences subq fat distribution in the male -DHT: by product of testosterone and is associated with hair loss -andostenedione: precurser of testosterone, naturally produced by the adrenal glands, testes, and ovaries -gonadotrophins: stimulate the gonads -fsh: released by the anterior pituitary and stimulates Sertoli cells in the testes. Shapes spermatogenesis and controlled by negative feedback loop. Inhibin (produced by the Sertoli cells) inhibits fsh. When testosterone levels are too high, inhibin is released and fsh is reduced. -LH: released by anterior pituitary, stimulates interstitial cells of Leydig cells which regulates production of testosterone with neg feedback (High levels of testosterone decrease LH secretion) -production of sperm: is at a constant rate

PDE5

Inhibits PDE5 (phosphodiesterase 5), sincrease smooth muscle relaxation, allowing for increased blood flow needed for erection (end in -aphil) not trade name (viagra)

Physical Assessment

Breast assessment Lymph node assessment External genitalia Prostate assessment ------------------------------------ -breast: might find gynocomasteia (hormone induced), hard irregular nodule may indicate cancer -axillary, supraventricular, inguinofemoral lymph nodes -axillary and supra swelling or nodules may indicate breast cancer -inguinal or femoral nodules may indicate infection, cancer (lymphoma, melanoma, or testicular cancer) -external: hernia (bulge in scrotum), phimosis (unretractable foreskin on uncircumsided male), skin and hair assessment (ulcers, sores, nodules, scabies, lice), poorly developed scrotum may be congenital or hormonal -prostate: palpated through the rectum -normal prostate: wide, non tender, smooth, and rubbery -enlarged prostate may indicate BPH -enlarged with symmetry and tenderness: may indicate prostatitis -irregular and hard prostate may indicate prostate cancer

Benign Prostatic Hypertrophy:Therapeutic Management PHARM AND NON PHARM

Nonpharmacologic •Adequate fluid intake •Avoid meds causing urinary retention •Diet high in minerals •Prostatic massage •Regular sexual intercourse •Do not ignore sensation to void •Pharmacologic •Alpha-adrenergic blockers •5-alpha-reductase inhibitors •Monitor therapy, side effects -treatment of bph depends on many things (such as type, symptoms, cause, etc) -sometimes watchful waiting occurs --------------------------------------------------- -nonpharm: 2-3Liters of water a day Avoid meds like anticholigenics, antidepressants, decongestions tranquilizers if possible -alpha adrenergic blockers: relax smooth muscle of bladder, neck and prostate, will improve urine flow, minimize straining, and relieve symptoms of bph related to that. Side effects include: dizziness, headache, fatigue, postural hypotension, rhinitis, and sexual dysfunction -5: finasteride, affect hormonal manipulation. Prevents testosterone from converting to DHT (will decrease prostate size). Side effects: decreased libido, ejaculatory dysfunction, gynecomastia, flushing

Clinical Manifestations prostate cancer

early stage rarely produces symptoms •Urological symptoms: urinary frequency and urgency, reduced urine stream, nocturia, hematuria, retention •Painful ejaculation with blood •Sexual dysfunction Advanced symptoms with metastasis -different from BPH, this is cancerous growth -watch and wait may be the choice of the man, slow progressive cancer -patho: Weak stream -cancer itself isn't painful -usually systemic symptoms such as structures around it (backache, hip pain, perineal and rectal discomfort, anemia, weakness, nausea, spontaneous fractures (weakened bone)

orchiopexy

fixation of an undescended testis in the scrotum

Gonadotropins

hormones that stimulate the testes / gonads §Follicle Stimulating Hormone (FSH) §Luteinizing Hormone (LH)

•Prostatic Acid Phosphatase

measures the phosphatase enzymes mostly found in the prostate, elevated levels are sus of prostate cancer (screening)

testosterone

most abundant androgen, anabolic steroid developed by the male genitalia, proides primary and secondary male characteristics (gonadal function, external genitialia and accessory organs, male voice, skin, and hair distribution -anabolic effects: building up of complex molecules, promotes protein metabolism, promotes

what to know about anatomy

not going to be quizzed on anatomy BUT: -location of the prostate: under the bladder, around the urethra, pain will be I the perineum (between scrotum and anus, where a person sits)

Androstenedione

precursor of testosterone, naturally produced by the adrenal glands, testes, and ovaries

•Prostate Specific Antigen (PSA)

protein produced by both normal and malignant cells of the prostate, when elevated may be an indicator of prostate cancer, this is screening blood test that measures the level of prostate-specific antigen in the blood -normal PSA levels are hard to define, may be falsely high or low, these levels fluctuate a lot over a man's lifetime. Not diagnostic of prostate cancer, just a screening. Digital rectal exam if the man is symptomatic and having issues with the prostate as well (in conj. With the psa)- both together can help track the course of prostate cancer -PSA and if that screening is questionable, then go onto biopsy (which is diagnostic)

FSH

released by the anterior pituitary and stimulates Sertoli cells in the testes. -Shapes spermatogenesis and controlled by negative feedback loop. -Inhibin (produced by the Sertoli cells) inhibits fsh. When testosterone levels are too high, inhibin is released and fsh is reduced.

Prostate Cancer Risk Factors

§Older than 50 §African American §First-degree family history §High fat diet -2nd most common in men (lung wins) -risk factors: age, yearly screenings start at 50 -black men are 2x more likely to die. -father or brother puts patient's at higher risk -high fat, dairy, red meat (western diet)

3 androgens

§Testosterone §Dihydrotestosterone §Androstenedione

Male Assessment

´Health assessment interview ´Physical assessment ´Diagnostic testing

prostate cancer Management

•"Watchful Waiting" •Early disease •Short life expectancy •Surgery •Radical prostatectomy •Many different routes •Radiation •Teletherapy (external) •Brachytherapy (internal) •Hormonal Strategies •Surgical or medical castration ----------------------------------------- -surgery: lap, through rectum or perineum -radiation: Brachy: radioactive seeds in the prostate and they target the cancerous lesions (guided by US) Can cause inflammation to surrounding tissues and cause urinary dysfunction -hormonal: Removal of testes, castration to lower testosterone levels, stimulis or prostatic growth removal to result in atrophy of prostate -hemotherapy and gene based is emerging.

Benign Prostatic Hypertrophy:Management of CBI post TURP

•3-way drainage system that irrigates the bladder and prevents clot formation •Drains, inflates, and irrigates •Monitor urine closely •Light red/red = normal for post-op and 1 day after •Clear/pale pink = normal at any time •Very dark red = venous bleeding? •Bright red = arterial bleeding? •Blood clots = normal if occasional -triple lumen cath is placed and irrigated. -irrigates titratable fluid at a constant rate -done to prevent bleeding -monitor urine closely, should not go back to red (post op and 1day) -pink is normal in hospitalization -bright red: notify surgeon, -dark reds: check CVI fluid rate and notify surgeon -may need to increase flow rate to avoid obstruction if blood clots occur a lot -close I&Os -transurethral removal of prostate -CBI is used to manage the trauma done to the urethra -Continuous bladder irrigation (promote bladder emptying, etc) -know what to expect when managing and monitoring CBI (urine color, clots, etc)

Orchitis

•Acute inflammation of one or both of the testes •Pathophysiology •Complication of systemic infection •Viral mumps (spreads from lymph nodes) •Extension of infection elsewhere - STIs, UTIs •Most commonly from epididymitis •Clinical Manifestations - abrupt onset •Testicular swelling/tenderness on one or both sides •Mild-severe pain, nausea, fever, blood in semen, discharge from penis •May result in abscess, atrophy, fibrosis and infertility •Risk Factors •Therapeutic Management •Medications •Comfort Measures ------------------------------------------ -rarely originates from testes -usually from elsewhere -mumps: 4-6 days after the swelling of the parotid gland -commonly from epididymitis -same ones that stis and utis: chlamydia, ghonnorhea, ecoli, pseudomonas, staph, strep -abrupt onset -risk factors: No immunity to mumps Recurring UTIs Being older than 45 Recent surgeries of genitals or UT Congenital malformations (that cause urinary obstruction Multiple partners (sexual) -meds: such as antibiotics, analgesics, antiemetics (nausea) Ice and elevate

Testicular Cancer •Diagnosis/Monitoring

•Scrotal US, CT, MRI, IV pyelogram •Alpha fetoprotein (AFP) and beta unit of HCG ------------------------- US to identify the tumor CT/MRI/Pyelogram: to identify metastasis AFP and beta unit: level that indicates pregnancy, may be monitored for therapeutic response to therapy, some types of cancer will cause a false positive preg test

Hydrocele

•Collection of fluid around the testis within the scrotum •Pathophysiology •fluid accumulation reduces blood flow to testis •Acute - related to other disease process •Inflammation, infection, epididymitis, local injury •Chronic - fluid imbalance •Congenital - self-limiting within 1 year •Clinical Manifestations •Scrotal swelling, tenderness •Transillumination of extra-testicular mass •Therapeutic Management - usually conservative •Surgical excision - hydrocelectomy •Needle aspiration •--------------------------------------- -acute: more common in men greater than 50, this type is related to inflammation (from radiation, etc or systemic infection (mumps)) -congenital: resolves without treatment (1 in 10 infants), babies born -fluid will light yp (used to diagnose), hernias and tumors will not light up -may be unilateral or bilateral -treatment depends on cause -hydroectomy: drainage tube, dressing, to remove fluid -needle: most conservative way, removal of excess fluid

Andropause: Male Menopause

•Decreased production of testosterone •Gradual process •Begins at age 30 •Low testosterone levels at ages 40-70 •maintain fertility •Signs/Symptoms •Sexual function •Sleep patterns •Physical changes •Emotional changes •Treatment •Healthy lifestyle •Testosterone supplement controversial ----------------------------------------- -geriatric considerations -gradual: more so than menopause for women -production decreases -sexual function: ED, fewer spontaneous erections, fertility (eventually), and smaller testes -sleep: insomnia and increased sleepiness -physical: decrease muscle mass/strength, increase fat, decrease bone density, decreased hair, swollen or tender breasts, loss of energy -emo: decrease motivation, depression, self image decrease, decrease concentration/memory -treatment: -diet, physical activity -testosterone controversy: sleep apnea, stimulates growth of prostate (cancerous and non), increases risk for heart attack, stroke, and formation of blood clots

Prostate Cancer Screening/Diagnosis

•Elevated PSA levels •Often greater than 10ng/mL •Prostatic Acid Phosphatase •Digital Rectal Exam •Nodule or hardening detected •Transrectal US with biopsy •Confirms diagnosis •Mets: Bone scan, MRI, CT, skeletal X-rays ----------------------------------------- -usually found when a man seeks treatment for urological problems or the routine screening -PSA and PAP are not diagnostic, just elevated -nodules and hardened fixed lesion: sign of later stage of cancer -early: watchful waiting may be one of them -monitoring levels

Varicocele

•Enlargement of veins within the scrotum - Bag of Worms •Pathophysiology •Dilation of the network of veins from the testis and the epididymis •Veins become tortuous and dilated •Clinical Manifestations •Often asymptomatic •Scrotal pain, tenderness, heaviness, infertility •Therapeutic Management •Scrotal support •no treatment if mild •Corrective surgery - if fertility is concern, discomfort not relieved •----------------------------------------- -abnormal dilation of network of veins in testicles, blood flow backs up -tumor or thrombosis blocking the IVC, left sided only obstruction -renal tumor may alter blood flow -heaviness in inguinal area -no treatment if infertility is not a concern and symptoms are mild -

Erectile Dysfunction (ED) (patho, diagnosis, treatment)

•Inability to maintain erection •Pathophysiology •Psychogenic •Organic •Age-related •Diagnosis •Treatment •Therapy •Treatment of underlying conditions/disease •Medications •Assistive Devices •Surgery/Implants/Prosthetics --------------------------------------- -inpetence = ED -4 different types: -total inability -inconsistent erections -inability to sustain erection -inability to penetrate (erection not strong enough) -psycho: anxiety, negative body image, relationship issues, depression, lack of energy, etc -organic: cardiovascular disease (bloodflow impaired), endocrine disorders such as diabetes, hyper or hypo thyroidism, cirrhosis, Chronic kidney failure, many body systems that can affect this -GU: recent pelvic surgery, recent prostate surgery or removal, hematologic systems; hotschins lymphoma or leukemia -neuro disorders: neuropathy or parkininism, spinal cord injuries, or MS -trauma to genital etc, life style (excessive alcohol or drugs) -medications such as antihypertensives and psychotrophic agents -age related: cellular and tissue changes, decrease sensory activity, decrease testosterones, and chronic illnesses such as DM -diagnosis: require sexual history and assessment, and different tests (nocturnal or atrial blood flow with Doppler probe or psycho eval) -treatment: Psycho may require therapy or counseling -organic: treatment of underlying (such as changing medications) -ed meds: Viagra, vardeiful, phosphodia... 5 inhibitors or PDE5 (increase blood flow to the penis with stimulation) -side effects can cause flushing, headache, lightheadedness, dyspepsia, diarrhea, nasal congestion (d/t vasodilation effect) -contraindicated in men who take organic nitrates that also cause vasodilation (severe hypotension) -not to be used more than once a day -assisted devices: external vacuum pump cons is clumsy -surgery such as vascular surgery, -PDE5s (end in -aphil) these are the medications ****** generic names, not Viagra

Epididymitis

•Inflammation/infection of the epididymis •Pathophysiology •Infection migrates upward from the urethra, bladder or prostate •UTI, urinary obstruction, STI •Clinical Manifestations - gradual onset over 1-2 days •Low-grade fever, chills, heaviness in testicle •Increasing tenderness/swelling epididymis, testicle and beyond •Progresses to extreme pain in lower abdomen/pelvis •Sterility possible if bilateral or recurrent •Risk Factors •Therapeutic Management •Medication •Comfort measures ----------------------------------------- -small coiled like structure, most common intrascrotal infection -bacteria moving from another source , ecoli most common -usually on one side, may be enlarged lymph nodes -blood in semen, pyuria, bacteruria, pain ejaculating, urinary frequency, dysuria, -risk factors: UTI (recent or recurrent) - most common in prepubescent, older, or homosexual men High sexual risk (younger) Urinary obstruction (older men) Catheterization or instrumentation in the urethra -meds: antibiotics, anti-inflammatory -scrotal support, elevation, cold compresses, sitz baths

Testicular Cancer patho

•Most common cancer among men between ages 15 and 35 •Pathophysiology •Growth of cancerous cells within the testicles Secondary tumors from other organs/tissue --more than doubled in the past 40 years -could be a secondary tumor (most commonly lymphoma)

Benign Prostatic Hyperplasia(BPH)

•Noncancerous enlargement of the prostate from hyperplasia or hypertrophy •Affects the older man, 40 and older •Risk factors •Pathophysiology - develops over prolonged period •Shift in hormone levels and sensitivities •Enlarged lobes of prostate cause obstruction of urethra •Incomplete emptying of bladder, urinary retention •Dilation of ureters and kidneys •Clinical Manifestations •Signs/Symptoms •Classic presentation vs. development of infection •Assessment/Diagnostics/Labs --------------------------------------------- -overgrowth of prostate -over age of 60, 50% of men are diagnosed, 90% of men over age of 85 -risk factors: smoking, heavy alcohol consumption, obesity, reduced activity level, htn, heart disease, diabetes, western diet (high fat, high meat) -evolves over time -elevated estrogen level and lowered testosterone levels -less sensitivity to DHT (metabolite of testosterone that mediates prostate growth - manages growth, less managing d/t less sensitivity) -lobes become bigger cause obstruction to urethra, (can't empty), eventually causes dilation -s/s: urinary frequency, nocturia, difficulty starting and stopping stream, weak stream, dribbling, feeling of being unable to completely empty the bladder -may be an infection or cystisis (infection of bladder from retained uria), pyuria (pus), fever, dysuria -infection is not a symptom of infection, it's from the retention in the bladder (UTI), not underlying cause -assessment/diagnosis: voiding diary (throughout the day, stream, feelings, volume, time, etc) digital rectal exam-- prostate may feel large and rubbery and nontender, UA and culture, acid phosphatase and prostate specific antigen testing *to rule out prostate cancer), urodynamic testing for urinary obstruction, post voiding catherization to measure residual of urine after voiding (in bladder to see how much is left), high volume after voiding is anything greater than 100mls left over in bladder (may be indicator of BPH), cystoscopy of bladder or ultrasound -big difference between prostatitis: BPH isn't inflammation and painful like prostatitis (unless surrounding structures, or hard to have bm, etc)

Testicular Cancer therapeutic Management

•Surgery - orchiectomy/lymphadenectomy •No lasting effect on sexual or reproductive function (if other testicle is present) •Radiation/chemotherapy ---------------------------- depend on type of cancer -highly responsive to treatment, one of the most curable cancers -removal of testicle and surrounding lymph nodes -still have sperm production if have other functioning testicle

Benign Prostatic Hypertrophy:Therapeutic Management. (Non surg and surg)

•Nonsurgical - invasive •Catheterization - may require stylet •Heat application •Balloon dilation •Transurethral needle ablation (TUNA) •UroLume stent •Surgical •Transurethral resection of the prostate (TURP) •Transurethral incision of the prostate (TUIP) •Open Prostatectomy - suprapubic, retropubic, perineal, or laparotscopic ------------------------------------------ -heat: microwave transdermal therapy, tissue becomes necrotic and slugs off -balloon: better blood flow to where the prostate is constricted -needle: radiofrequency through needles places in the prostate to destroy targeted tissues to shrink size of prostate -stent: placed in urethra for retention in patients who are unable to go to surgery (complications involve pain, infection, incrustation) -TURP: removal via endoscope inserted in the urethra (with US), benchmark treatment. Following this treatment includes bladder irrigation -TUIP: incisions are made to reduce constriction, but no tissue is removed -open: removal (pretty common for older man)

Testicular cancer Clinical Manifestations - appear gradually

•Painless enlargement of testis •Mass/lump on testicle •Heaviness in scrotum, inguinal area, lower abdomen Metastasis - backache, abdominal pain, weight loss, malaise ------------------------------------- -some difference in size may be normal, but in the occurance in cancer is a sustanial size (most significant finding)

Priapism

•Persistent penile erection lasting longer than 6 hours •Pathophysiology •Neural or vascular cause •May be caused by medications/treatments •Clinical Manifestations •Ischemic •Non-ischemic •Stuttering •Therapeutic Management •Ischemic - prompt treatment to prevent damage •Aspiration of corpora cavernosa •Intracavernous injection of sympathomimetic agent (phenylephrine) •Surgery - allows blood flow and drainage within the penis •Nonischemic and stuttering - not emergent •May resolve without treatment •Conservative treatment - ice/compression ---------------------------------------------- -erection that is painful and it becomes large and hard, uncommon, may or may not be related to sexual stimulation -could be caused by a vascular or neurological disorder. Such as sickle cell, leukemic cell infiltration, polycythemia (thickening of the blood), spinal cord injury or tumors -may be related to meds (vasoactive agents that affect CNS, antihypertensive agents, antipsychotics, antidepressants, and injected meds for ED or use of alcohol or cocaine -ischemic: non-sexual, little to no blood flow from (OUT) the penis, -nonischemic: still blood flow in and out of the penis, but still an erection -stuttering: interment erection -if priapism is d/t sickle cell crisis other measures of treatment will occur -ischemic: PROMPT, to prevent permanent damage. Physiological changes occur around 6 hours, cellular changes occur around 24 hours, and fibrosis by 36 hours. Goal is to encourage venous draining -aspiration of excess fluid: with or without the use or normal saline. Remove fluid then irrigate -injection: constricts blood vessels that carry blood to the penis -surgery: through the glans, a big needle, creates fistulas, to try and restore blood flow -nonischemic: still blood flow somewhat, they often resolve without treatment

Diagnostic Tests: Radiology/Cytology

•Prostate •Transrectal Ultrasound •CT Scan/MRI •Biopsy •Nocturnal Penile Tumescence ---------------------------- -prostate: trans rectal US if abnormal digital rectal exam or elevated PSA, used to guide needle for biopsy or guided treatment -CT or MRI: picture of tumor, helpful for grading cancer, help guide treatment -biopsy: tissue cells. Transperineal collection is a small incision in the perineum (guided by MRI or CT) but more commonly is a transrectal biopsy which is a needle passed through the rectal wall which is guided by US (requires cleansing enemas, soreness and slight bleeding from rectum, and normal finding is blood or urine in stool, and a small amount of blood in the semen for a few weeks after the procedure -Noc: used to find the cause of tumescence: so this measures penile rigidity during sleep (which are normal, erections), will help identify psychogenic - if a man can become erect during sleep but not during the day it could be more psychogenic -unable to achieve erection during sleep: more organic cause such as anatomy or something more physical

Diagnostic Tests: Labs

•Prostate Specific Antigen (PSA) •Prostatic Acid Phosphatase •Semen analysis •Testosterone •STI Screenings/Tests: •Syphilis screening ---VDRL, RPR, FTA-ABS •Chlamydia/Gonorrhea •HIV - blood Trichomoniasis ---------------------------------------------- -psa: protein produced by both normal and malignant cells of the prostate, when elevated may be an indicator of prostate cancer, this is screening -screening for prostate cancer starts at age 50 and over, if family history or black americans may start screening between 40 and 45 d/t their risk -normal PSA levels are hard to define, may be falsely high or low, these levels fluctuate a lot over a man's lifetime. Not diagnostic of prostate cancer, just a screening. Digital rectal exam if the man is symptomatic and having issues with the prostate as well (in conj. With the psa)- both together can help track the course of prostate cancer -PSA and if that screening is questionable, then go onto biopsy (which is diagnostic) -phosohatase: measures the phosphatase enzymes mostly found in the prostate, elevated levels are sus of prostate cancer -semen analysis: collected directly from the client or from sexual partner. Can be used for rape victims. May be used to evaluate male fertility and effectiveness of vasectomies. -testosterone levels may be drawn to evaluate male infertility and sexual dysfunction. Can help diagnose male sexual precocity and in women it may evaluate hirsutism (excessive body hair and male characteristics) -sti: if suspected or surveillance. Syphilis looks for antibodies to the bacteria -VDRL and RPR: both screening tests to use for possible syph infections -FTA-ABS: blood tests for antibodies and confirms the other two tests -chlamydia/gon: obtained via UA or swab of the urethra or oral or anal cavity -HIV: blood test for antibodies (western blot test to confirm HIV) -Tric: STI, swab of the urine or urethra -not all of these are diagnostic, some are screening (not diagnostic means we need more testing)

Testicular Torsion

•Rotation of the testis - twisted blood vessels in the spermatic cord •Pathophysiology •Impeded arterial/venous blood flow to testicle •Vascular engorgement •Ischemia •Clinical Manifestations •Symptoms: Sudden pain over 1-2 hours, nausea, lightheadedness •Exam: Scrotal swelling, testicular tenderness, elevated testis, thick spermatic cord, reduced blood flow via Doppler study •Risk Factors •Therapeutic Management •Surgical emergency •Post-op Care and comfort measures --------------------------------------- -spermatic cord is highly vascular, impedes blood flow -tissue loss if not relieved -sudden or extreme pain with no cause -bruising as well, one higher than the other, feel thicker than normal/other side, -loss of cremasteric reflex: stroke or pinch of inner thigh (testicle will rise in normal reflex) - effective in diagnosing about 99% (have to be standing) -most common is during 12-18 years of age -fmily history or previous thing -surgical! Torsion must be relieved -orchiopexy: surgical fixation of teste to the scrotal wall so it doesn't occur again -orchietomy: removal of teste -post op: pain control, scrotal support, icepacks

Testicular Self-Exam

•The nurse instructs the patient to: •Use both hands to palpate the testis. The normal testicle is smooth and uniform in consistency. •Place the index and middle fingers under the testis and the thumb on top; roll the testis gently in a horizontal plane between the thumb and fingers (A). •Feel for any evidence of a small lump or abnormality. •Follow the same procedure and palpate upward along the testis (B). •Locate and palpate the epididymis (C), a cordlike structure on the top and back of the testicle that stores and transports sperm. In addition, locate and palpate the spermatic cord. •Repeat the examination for the other testis, epididymis, and spermatic cord. It is normal to find that one testis is larger than the other. •If you find any evidence of a small, pealike lump or if the testis is swollen (possibly from an infection or tumor), consult your primary provider. •--------------------------------- -be able to teach this -health promotion! -once a month, instruct a day of month (they'll remember) -best to perform after a warm shower, or during a warm shower -remaining testicle (if history of cancer, missing)

Cryptorchidism

•Undescended testicle(s) •Pathophysiology •Failure to descend in late gestation •Various and unknown causes •May cause sterility •Increased risk of testicular cancer •Risk Factors •Therapeutic Management •Orchiopexy •---------------------------------- -failure to descend from inguinal canal, still in ABD from when early gestation -most common gu genital anomality or preemies (expected finding) -causes are various (may be mechanical, chromosomal, enzymatic, or hormonal) -sterility d/t the sperm being at a constant high temperature -risk of cancer due to developmental differences (between a teste developed in the body vs out of the body) -risk: preemie, first born child, c-section birth, low birth weight, hypospadias (opening of the urethra from the underneath of the peis instead of from the end) -management: surgery is necessary, spermatic cord is released and testicle is pulled into the scrotum if not released on it's own -proactive: 6 months when corrected to tern, conservative is around one year (when it becomes a problem) -potential sexual dysfunction at a later date

Health Assessment Interview

•Urinary function and symptoms •Chronic diseases •Family history of testicular or prostate cancer •Mumps vaccination •Use of DES by mother •Sexual history/sexual problems •Concerns of infertility •Medication use •Lifestyle ------------------------------------------- -comorbidities -mumps: viral infection of mumps can cause inflammation of one or both testes -DES: Synthetic estrogen prescribed to prevent birth complications and miscarriage, can cause cryptorchidism non-cancerous epididymal cysts -if taking care of a man and you see this, note if his mother has this. -sexual: past history, etc