The Male GU

• 15-35
• after shower bc testes are descended

Phimosis --> tight prepuce that cannot be retracted over glands

Paraphimosis --> tight prepuce once retracted, cannot be returned – edema ensues

Ask pt to strain down while inspecting. – bulge that appears with straining suggest hernia

• If scrotum hernia is suspected, ask pt to lie
• down, if mass comes up to abdomen than it is an hernia. 
• If not, can you get your hand above the hernia ? If yes = hydrocele

• Incarcerated hernia = contents cannot be
• returned to abdomen
• Strangulated hernia = when blood supply
• to the entrapped content is compromised ( usually come w/ tenderness, n/v)

• Rounded, heart shaped, firm structure
• about 2.5 cm in length, lobes divided by shallow median sulcus or groove.
• At exam, prostate measures 2 fingerbreaths or less.

• Direct inguinal hernia: 
• - occurs in an area where the abdominal wall is naturally slightly thinner.
• - rarely will protrude into the scrotum.
• - tends to occur in the middle-aged and
• elderly bc their abdominal walls weaker.

• Indirect inguinal hernia: 
• - descending from the abdomen into the scrotum. Sometimes the hernia sac may protrude into the scrotum.
• - may occur at any age.

• Femoral hernia: 
• - causes a bulge just below the inguinal
• crease in roughly the mid-thigh area.
• - Usually occurring in women, femoral
• hernias are particularly at risk of becoming irreducible and strangulated.
• - Not all hernias that are irreducible are
• strangulated, but all hernias that are
• irreducible need to be evaluated by a health-care provider.

• obstruct the bowel, leading to severe
• pain, n/v and the inability to have a BM or pass gas.
• diminish blood flow to the trapped portion of the intestine à strangulation which may lead to the death of the affected bowel
• tissues.  
• A strangulated hernia is life-threatening and
• requires immediate surgery

• Urinary Frequency; Nocturia
• Urinary Urgency
• Change in stream, Weak
• Difficulty starting
• Post void dribbling
• Painful urination, ejaculation

• Blood in the urine
• Decreased urine stream
• Frequent urination
• Incontinence
• Low-grade fever
• Pain with urination
• Urinary hesitancy (delayed start of urination)

- Age 50, No Risk factors:  screening not advocated but may be offered

- Age 45: AA men, 1st degree relative with PCA diagnosed before age 65

- Age 40: men with several 1st degree relatives with early Prostate CA diagnosis.

- Age >75:  poor risk/benefit for screening/treatment; not recommended