L/ Hanaa Hammad 2015 - 2016

Male reproductive system

At the end of this Lesson the study participants will be able to:

1.Name the anatomic landmarks of the male genitalia.2.Describe the characteristics of the most common male reproductive chief complaints.

3.Perform inspection, palpation, and auscultation on an adult male.4.Explain the pathophysiological rationale for abnormal findings.

Learning outcome

4.Document male reproductive assessment findings.

5.Describe the pathological changes that occur in the

male reproductive system with the aging process.

Learning outcome cont’d

Anatomy and Physiology

Anatomy and Physiology cont’d

1. Penis

2. Testes

3. Scrotum

4. Bulbourethral glands

5. Seminal vesicles

6. Epididymis

7. Ejaculatory ducts

8. Urethra

9. Glands penis

10. Spermatic cord

11. Ductus deferens

Testes: Are two-egg shaped structure.

Function of Testes:• Testosterone hormone secretion.• Spermatogenesis = sperm production

Epididymis: A comma shaped tube, lies along & sides of each testis.

Function: It is a storage & maturation site of sperm which takes from 1 to 3 weeks.

Anatomy and Physiology cont’d

Seminal vesicles: Are two pouches along the posterior surface of the urinary bladder, directly in front of the rectum?

Function: Secret about 60% of fluid volume of semen.

Prostate Gland: Doughnut-shape, encircle urethra, lies just below the bladder.

Function: It secretes about 35% of fluid volume of semen.

Anatomy and Physiology cont’d

Bulbo urethral gland: A pea sized gland inferior to the prostate and Secretes about 5% of fluid volume of semen.

Penis: Three cylindrical masses of erectile tissue.

Function:–Micturition.– Introduce semen into vagina.

Anatomy and Physiology cont’d

Health History

1. Personal history

2. Present & past history.

3. Common Chief Complaints(Urethral discharge

Palpable mass ,Erectile dysfunction ,Penile lesion,

Scrotal pain

Characteristics of Chief Complaint

1. Quality , Quantity , Associated manifestations ,

Aggravating and alleviating factors , Setting , Timing

2. Assessment

Examination Equipment Needed for Male

1. Gloves.

2. Glass slide for urethral

specimen

3. Materials for cytology

4. Flashlight

Positioning for Male Examination

1. Position male standing with undershorts down, with appropriate draping.

2. Examiner should be sitting. (Male may be supine for first part of exam, standing for hernia check.

3. Take time for patient to discuss genitourinary history.

Assessment Normal Finding

1. Inspect Penis

& Glands

1. Penis skin wrinkled, hairless, no

lesions the glands, smooth no

lesions.

2. Retract uncircumcised foreskin

to original position.

Inspection & palpation of male reproductive system

Inspection & palpation of male reproductive system

Deviations from Normal: 1. Pubic lice or nits-2. Hypospadias- ventral location of meatus.3. Epispadias- dorsal location of meatus4. ulcer, grouped vesicles5. Himosis - unable to retract foreskin6. Stricture- narrowed opening7. Edges that are red, edematous, purulent discharge8. Nodule, tenderness

Assessment Normal Finding

1. Inspect scrotum as male holds penis.

2. Palpate gently each. Half between thumb and first two fingers

• Asymmetrical (left scrotal half lower than right)

• Scrotal size varies with room temp.

• Contents should easily slide. Testes palpable, oval, firm, rubbery, smooth, equal bilateral and freely movable.

• Epididymis feels discrete, softer than testis, smooth, nontender

Inspection and palpation of male scrotum

Inspection & palpation of male scrotum

Deviations from Normal: • Scrotal swelling (edema). Lesions• Absent testes , Nodules swollen, tender epididymis• Hernia, hydrocele, tumor.

Assessment Normal Finding2. Inspect each spermatic

cord between thumb and forefinger along its length from Epididymis to external inguinal ring

• Should feel smooth, nontender cord.

•

Assessment1. Inspect inguinal region for bulge as patient stands and

strains2. Palpate right side of inguinal canal by asking patient.

to shift wt. onto left leg. Place right index finger low in the right scrotal half. Palpate up length of spermatic cord

Inspection for hernia

Deviations from Normal: •Feels like triangular slit like opening, may go easier if you ask patient . to bear down. •Bulge at external inguinal ring or femoral canal

Palpate for hernia

Assessment Normal Finding•Palpate inguinal lymph nodes by palpating horizontal chain along groin inferior to ligament and vertical chain along inner thigh

• feels small, soft, discrete, and movable.

Deviations from Normal: •Palpable herniatino mass bumps your fingertip or pushes against the side of your finger.

Palpate for hernia

Gerontological Variations

Thinner pubic hair Decreased testosterone levels Penile and testicular atrophy Slightly decreased spermatogenesis Increased time to obtain erection Increased risk for impotence

Special Techniques

Androscopy :Used to identify skin lesions

Urethral culture: Used to identify causative organism of penile discharge

Transillumination of the scrotum : Used to determine the etiology of a scrotal mass

Thank you