Advanced Health Assessment

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Advanced Health Assessment

• July 27, 1999

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ASSESSMENT OF MALE GENITALIA

• Jay Gilbaugh, M. D.
• 851 N. Hillside, Wichita
• 316-685-1371

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Anatomic Review

• Penis
• Scrotum
• Inguinal Canal
• Testes

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Anatomic Review

• Epididymis
• Spermatic Cord
• Prostate
• Seminal Vesicles

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Genitourinary History

• Previous surgeries, conditions
• Previous UTI or STD
• Testicular pain or mass
• Penile lesion or discharge
• Voiding history

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Voiding History

• Quality or urine stream
• Nocturia - quantitate
• Urinary frequency
• Hesitancy, urgency, double voiding, post-void
  dribbling or feeling of incomplete emptying

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Voiding History

• Dysuria
• Hematuria
• Incontinence
• Stress
• Urge

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Sexual History

• Quality of libido
• Quality of erections
• Problems with ejaculation

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Physical Exam

• General
• Penis
• Common abnormalities
• Scrotum
• Scrotal contents
• Groin
• Prostate

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General Exam

• Inspection, palpation, transillumination
• Patient standing (easiest)
• Professional, straight-forward
• Minimize patient anxiety

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Exam of Penis

• Inspect shaft for gross lesions
• Palpate shaft for plaques
• Retract foreskin (except infants)
• Examine glans for gross lesions

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Exam of Penis

• Examine meatus for size location
• Evert meatus to inspect fossa navicularis
• Examine for urethral discharge
• Reduce foreskin after exam!

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Common Abnormalities Shaft

• Peyronies disease
• Skin lesions
• herpes
• condylomata accuminatum (venereal warts)
• molluscum contagiosum
• Priapism - persistent, prolonged erection

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Common Abnormalities Prepuce

• Phimosis
• Paraphimosis

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Common Abnormalities Glans

• Balanitis/balanoposthitis
• Pearly papules
• Chancre/ulcer

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Common Abnormalities Meatus

• Stenosis
• Position
• Epispadias
• Hypospadias

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Exam of Scrotum

• Inspect for gross lesions
• Palpate for thickness
• Palpate inguinal canals

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Common Abnormalities Scrotum

• Sebaceous cysts of scrotum
• Scrotal edema
• Scrotal erythema
• Yeast infection
• Fourniers ganrene (necrotizing fasciitis)
• Inguinal hernias

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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

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Common Abnormalities Testes

• Hydrocele - transilluminate
• Testicular cancer
• Testicular torsion

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Common Abnormalities Epididymis

• Epididymitis
• Spermatocele (epididymal cyst)

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Common Abnormalities Spermatic Cord

• Varicocele

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Exam of Groin

• Palpate for inguinal adenopathy

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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

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Common Abnormalities

• Prostatic hypertrophy
• Prostatitis syndromes
• Prostate Cancer