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What are some of the external anatomical traits of the penis?
- darker than other skin/hairless
- visible dorsal vein
- urethra at tip of glans
What two structures make up the external part of the penis
shaft and glans
What is the glans penis?
the head/ dorsal tip of the penis
What is circumcision? complications? common populations
- removal of the foreskin
- risk of infection and ischemia necrosis of the penis
- most common in the US among caucasians and Jewish descent
Risk for being uncircumcised?
Increased risk for some STI's, penile cancer, and cervical cancer among partners
What is smegma? Who gets it?
- white cheesy material on glans penis formed from sebaceous material (from glans) and desquamation of epithelial cells (the foreskin)
- Those that are uncircumcised
What 3 structures make the internal anatomy of the penis?
- corpus cavernosa
- corpus spongiosum
- bulbourethral gland (cowpers gland)
Where is the corpus cavernosa located?
dorsum (top) and sides of penis
where is the corpus spongiosum located and what does it contain?
ventral (underneath) portion of penis- contains the urethra
What does the bulbourethral gland do?
produces pre-ejacualte fluid, lubricates the urethra for sperm to pass through and neutralizes acidic urine
What are some of the physical characteristics of the scrotum?
- it is darker than other skin
- scant amount of hair
- rugae (folds) with deeply pigmetned skin and large sebaceous follicles
- septum that divides the scrotal sac
what is the scrotum?
sac of skin and muscle, between the penis and the anus that contains and protects the testis
What is the purpose of the testes? what are their average size?
- producer sperm and testosterone
- 4x3x2 cm (left is usually lower than the right)
What is the epididymis? and where is it located?
- tightly coiled tube that collects and provides transit for sperm
- located on posterior side of testes
Starting from the testes, name the different structures sperm travels through to ultimately reach the urethra
vas-deferens, spermatic cord, seminal vesicles, ejaculatory duct, urethra
What is the purpose of the seminal vesicles?
secretes a fluid that nourishes sperm
What is the Cremaster muscle?
muscle that raise and lowers the testes - (helps regulate temperature)
Describe the prostate
- surrounds the urethra at the bladder neck
- secretes ejaculatory fluid to help sperm motility
- 2 lobes, separated by a median sulcus
Where are the testes located prenatally?
located in the abdomen and descend down the inguinal canal to the scrotum
During puberty, what developments occur to male genitalia?
- Enlargement of the testes
- Pubic hair growth
- enlargement of the penis
- prostate doubles in size
What developments occur to the male genitalia in adulthood?
- Prostate enlarges throughout life (may impede urine flow, symptoms after 50)
- testosterone production gradually declines after 60
What is Benign Prostatic Hypertrophy?
BPH- enlargement of the prostate; may impede urine flow; symptoms usually around age 50
What does decreased testosterone production cause?
- Lower sperm count (fertility may decline)
- erectile dysfunction (decreased firmness of erections)
What are potential causes for increased urinary frequency?
- bladder irritation (UTI)
- urethritis (STI/chlamydia)
What are possible causes of increased urinary urgency?
UTI and BPH
What are symptoms of BPH?
- increased frequency
- increased urgency
- decreased force of stream
- post void dribbling
- post void fullness
what is nocturia? causes?
awakening at night to urinate due to incomplet bladder emptying and mobilization of fluid and increased renal blood flow in recumbant position (seen in renal failure)
what is dysuria? causes?
pain or burning during urination du to UTI or STI
what is pyuria?
Pus in the urine- sign of infection
What may cause purulent urethral discharge?
What may cause clear urethral discharge?
What is polyuria? what population does it affect?
- abnormal large production and passage of urine
- Seen in DM pts (glucose causes osmotic diuresis)
What is enuresis?
bed wetting- nighttime incontinence after age 5-6 yo; may be psychological or structural problem with urinary tract
what is incontinence?
involuntary leakage of urine
What is overflow incontinence?
- bladder is constantly dribbling, or can not stop bladder from dribbling after urination.
- Due to incomplet bladder emptying, prostatism
What is stress incontinence?
- Associated with rapid movement of the diaphragm-
- urination with coughing, sneezing, or laughing ( more common in women)- insufficient strength of the pelvic floor muscles
What is urgency incontinence?
- Involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.
- seen with infection, prostatism or neurological disorder
What is hematuria
Blood in the urine
What are 2 kinds of hematuria?
- macrohematuria- visible blood in urine (red)
- microhematuria- blood seen with microscope
what is a chancre?
painless sore from syphilis
What is phimosis?
foreskin cant be retracted associated with poor hygiene
what is balanitis?
inflammation of glans (bacterial or fungal) in uncircumcised pts
What is paraphimosis?
the foreskin is permanently retracted
What is priapism?
- prolonged painful erection (dangerous if > 4hrs)
- Occurs with leukemia, hemoglopinapathies (sickle cell traits) and ED meds (Viagra, cialis, levitra)
- may cause sterility
What is peyronies disease?
- The corpus cavernosis develops scar tissue (etiology unknown) and the penis curves when erect
- usually occurs afte age 45
What is hypospadias?
urethral meatus (opening) is underneath/ ventral side of penis (most common)
what is epispadias?
the urethral meatus (opening) is on the dorsal/top part of the penis
What is a potential cause for scrotal lumps?
sebaceous cysts ( common)
What is scrotal edema a sign for?
CHF or renal failure
What is hydrocele? causes?
- serous fluid around the testicle
- often due to trauma (resolves spontaneously)
- detected by transillumination (fluid glows red as light reflects off of it)
What is cryptorchridism?
- undescended testicle
- leads to decreased spermatogenesis and fertility
What is orchitis?
acute inflammation of testis (seen with mumps)
What is epididymitis?
acute infection of epididymis
What is a spermatocele?
- a retention cyst- a collection of sperm in the epididymis
- most common after a vasectomy
what is testicular torsion?
- The sudden twisting of spermatic cord ( more common on the left)
- rare after age 20
- may occur spontaneously during sleep or after trauma
- considered a surgical emergency due to compromised blood supply
what is a varicocele?
- dialted veins of the spermatic cord
- more common on the left side
- may be visible when pt stands
- may cause infertility due to increased venous pressure and testicular temp
What are symptoms of a varicocele?
- dull ache along spermatic cord
- scrotal pain or heaviness
Which lymph nodes does the penis drain into? are they palpable
Which lymph nodes do the testes drain into?
- ABD nodes- not palpable
- and left supraclavicular nodes
How do you detect a inguinal hernia?
- Examine with pt standing
- put finger up through scrotum and into inguinal canal
- ask pt to cough
- should feel soft tissue of intestines if hernia is present
what is an indirect hernia?
- most common in children and young males
- herniation into inguinal canal (palpated in inguinal canal)
- most common
What is a direct hernia?
- Herniation through the external inguinal ring (bulge seen over inguinal canal)
- more common in men after 40
- 2nd most common hernia
what is a femoral hernia?
- herniation through the femoral ring (bulge seen in groin)
- higher incidence in women
- least common
What is an incarcerated hernia
- strangulated hernia
- non reducible; cant push back in
- may lead to compromised blood supply (surgical emergency)