Issues Re:

Men’s Health

Health Assessment Block 2.0Fall, 2009 J. Carley MSN MA RN CNE

!

Objectives:(From “Genitourinary Assessment Objectives”)

• 4. Techniques of Genitourinary Assessment: visualization, palpation, & transillumination of the scrotum

• 6. Describe changes in genitourinary assessment findings for different age groups.

• 7. Recognize disease processes by assessment clues of the genitourinary system

• 9. Describe equipment necessary to perform assessment of the rectum and/or prostate.

• 10. Describe the structure and function of the prostate. • 11. Describe changes in the prostate• 12. Identify risk factors, screening measures for prostate

cancer.• 14. Men’s Health Issues: Vasectomy, BPH, Prostate

Cancer, Medications & Sexual Health

Specific Issues

• Anatomy & Physiology• External Structures:• Scrotum & penis• Internal Structures:

Examination Procedure

• Inspect & palpate penis• Skin condition• Circumcised –Uncircumcised• Smegma• -- a combination of exfoliated (shed)

epithelial cells, transudated skin oils, and moisture

• Glans• Urethral meatus• Shaft

Examination Procedure (continued)

• Inspect & Palpate Scrotum• Rugae is a term used in anatomy that refers

to a series of ridges produced by folding of the wall of an organ.

• Testes• Spermatic cord (‘rope-like’)• Trans-illumination (transillumination)• Inguinal Hernias

!

Silicone Testicular Implants

Specific Issues

• Examination of the Male Genito-Urinary System

• epispadias & hypospadias • Prostate Cancer• BPH• Testicular Cancer• TSE• STD’s / Other Infections condyloma

accuminata

Normal Scrotal Contents DO NOT Transilluminate

Prostatitis

• S: fever, chills, malaise, urinary frequency, and urgency, dysuria, urethral discharge; dull aching pain in perineum and rectal area

• O: “Exquisitely tender prostatic enlargement” upon DRE

BPH(Benign Prostatic Hypertrophy—Benign Prostatic Hyperplasia)

• The prostate continues to grow during most of a man's life, but generally the enlargement doesn't usually cause problems until late in life.

• BPH rarely causes symptoms before age 40• More than half of men in their sixties and

as many as 90 percent in their seventies and eighties have some symptoms of BPH.

• Treatment: Medications or Surgery

Symptoms of BPH

• Stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder.

• The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

• …a hesitant, interrupted, weak stream• …urgency and leaking or dribbling• …more frequent urination, especially at

night

All Died of Prostate Cancer……….

Prostate Cancer

• RISK FACTORS:• 1) Age is the most common risk factor, with nearly 63

percent of prostate cancer cases occurring in men age 65 and older .

• 2) Family History (Men who have a father or brother with prostate cancer have a greater chance of developing prostate cancer.)

• 3) Race (African American men have the highest rate of prostate cancer, while Asian and Native American men have the lowest rates. )

• 4) possibly Diet. ( There is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.)

http://www.cancer.gov/cancertopics/factsheet/detection/PSA

DRE (Digital Rectal Exam)

The PSA Test

• The PSA test is a simple blood test to measure how much PSA (prostate specific antigen) a man has in his bloodstream at a given time.

• The PSA test is the most effective test currently available for the early detection of prostate cancer.

US guidelines for prostate cancer screening recommend annual PSA and digital rectal exam (DRE)

• At age 40 for African American men and all men with family history of prostate cancer or a mother with breast cancer.

• (Many survivor advocates urge testing from age 35 up for men at high risk. )

• At age 50 - 70 for all men.

• Men in their seventies and eighties may or may not wish to continue annual testing to protect themselves against advanced prostate cancer in their final years.

Da Vinci

http://www.youtube.com/watch?v=wQ3OKMjYHlI

Testicular Cancer

Testicular Cancer

…the most common cancer in American males between the ages of 15 and 34

Testicular Cancer

TSE…………..• How do you do a testicular self-exam?

• It's a good idea to examine your testicles once a month, after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to check for anything unusual. To do a testicular self-exam, follow these steps:

• Stand in front of a mirror (or in the shower…). Look for any swelling on the skin of the scrotum.

• Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.

• Gently roll the testicle between the thumbs and fingers. Feel for lumps and bumps. Remember that the testicles are usually smooth, oval shaped and somewhat firm.

• If you find a lump, call your doctor as soon as possible. Signs and symptoms of cancer include lumps, swelling, a heavy-feeling testicle and pain. Don't be embarrassed about calling your doctor if you find a lump or other problem.

• Early diagnosis is important — over time, testicular cancer can spread and it becomes more dangerous and difficult to treat.

IncorrectTechnique !

STD’s

Condyloma Accuminata & HPV

Herpes genitalis

Impotence & “Sexual Problems”

• Antihypertensive:. • Associated with decreased libido, decreased arousal and orgasmic disorder in

women. Associated with decreased libido, decreased arousal, orgasmic disorder and erectile dysfunction in men.

• Antidepressants, anti- anxiety and sedatives:

• Associated with erectile dysfunction, orgasmic disorders in men and orgasmic disorders, loss of sexual desire and arousal in women

• Antihistamines: • Associated with lack of lubrication in women leading to dyspareunia. In men, erectile

dysfunction and decreased libido.

• Anticonvulsants: • Associated with decreased libido, decreased arousal and orgasmic disorder in women

and erectile dysfunction and decreased libido in men.

• Medication used to treat gastric disorders: • Associated with erectile dysfunction in men and decreased libido, decreased arousal

and orgasmic disorder in women.

Impotence & “Sexual Problems”(continued)

• Anti-Lipemics: • Associated with erectile dysfunction in men.

• Medication used to treat cancer: • Associated with deceased libido and erectile dysfunction in men and dyspareunia in

women.

• Birth Control: • Associated with decreased libido, arousal disorder and vaginal dryness in women.

• Anti Parkinson's: • Associated with erectile dysfunction and increased libido in men and women.

Changes in Aging…..

Issue: Reflective Practice

http://www.impactednurse.com/?p=1331

finis