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CS1 Male Pelvis

Developmental changes: Infants 1.Sexual differentation 8-12 weeks. 2.Seperation of prepuce from glans (3-4yrs old).
Developmental changes: Adolescents 1.pubic hair. 2.Genital enlargement.
Developmental changes: Elderly 1.Thinning of pubic hair. 2.Pendulous scrotum. 3.Slower erction/ ED
Tanner Stage 1 Prepubertal
Cryptorchidism Failure of one or both testicles to descend from the abdomen into the scrotum. **Increases risk of scrotal cancer and infertility.
Testicular Torsion EMERGENCY that occurs in newborns/adolescents where the spermatocords twist. Cuts off BL supply to the testis. **Will lack a cremasteric reflex due to Genital branch of Genitofemoral N impengement.
Epididymitis Inflammation of the epididymis associated with bacterial infections (UTI or STI).
Varicoceles Abnormal dilation of veins of the pampiniform plexus. "Bag of worms" in the scrotum. **Most common on the left side since the L testicle hangs lower due to increased venous pressure.
Testicular Carcinoma Painless mass in the testicles.
Cuases of scrotal enlargement 1.Testicular torsion. 2.Varicocele. 3.Hyrdocele (clear fluid in tunica vaginalis, Transilluminates). 4.Spermatocele (non-tender mass on epididymis, Transilluminates). 5.Hernia (Pre-peritoneal fat and bowl can enter the scrotum). 6.Tumor. 7.Epididy
Most common form of male hernias Indirect Inguinal. Passes through both inguinal rings and the inguinal canal. Usually congenital from the descention of the testicals. **Will feel on finger tip when palpating.
Direct Inguinal Hernia Pre-peritoneal fat and bowel Pass through the inguinal triangle and exit the SUPERFICIAL Inguinal ring. **Usually do not enter the scrotum and Dr will feel it against the side of finger tip.
Femoral Hernia Bowel passes through the fossa ovalis and enters the femoral canal. **More common in women.
Penile Cancer Risks 1.Lack of circumcision. 2.Condyloma acuminatum.
Hypospadias CONGENITAL. Urethra is located on the ventral surface.
Epispadias CONGENTIAL. Urethra is located on the dorsal surface.
Phimosis Inability to retract foreskin from the glans.
Priapism Pain due to thromobosis of corpora caversnosa. **Could be from sickle cell or leukemia.
Balanitis Inflammation of the glans ONLY
Balanoposthitis Inflammation of the glans AND prepuce
Smegma cheesy white material under foreskin
ED Inability to Acheive or Maintain an erection.
Penile Discharges 1.Purulent (gonococcal, chronic prostatitis). 2.Bloody (ulceration, neoplasm, urethritis).
Dysuria Painful urination due to UTI, urethral stenosis, urethral stricture. **Could be due to Pneumaturia, Fecaluria, Pyuria.
Polyuria Excessive volume of urine (>2L/day)
Nocturia Increased night time urination (>2X/night)
Incontinence inability to voluntarily urinate
Hematuria BL in urine. **Only initially: urethral bleeding. **Terminally: bladder neck/posterior urethra
Width and lobes of prostate Two fingers width wide (3-4cm). 5 lobes **Two lateral lobes and dividing sulcus are the only ones palpable
Normal Prostate texture Firm, smooth, slightly movable, non-tender. **it should slightly protrude into the rectum.
Benign Prostatic Hyperplasia (BPH) When natural prostatic enlargement from testosterone with age becomes problematic. Usually seen with middle and lateral lobe enlargement. **Symptoms: Dysuria, inc frequency, urgency, nocturia, weak stream.
Risk Factors of Prostate Cancer 1.Age > 50yrs. 2.African American. 3.Family Hx. 4.Diet high in animal fat
What lobe of the prostate is most prone to cancer? Posterior Lobe **May be able to palpate stoney or hard nodules.
Prostate specific Antigen (PSA) Protein produced by the prostate that increases with cancer. **Difficult to use to differentiate b/w BPH and cancer
Prostatic Grades (Normal to +4) +1: 3 fingers. +2: 4 fingers. +3: > 4 fingers. +4: Most anterior pelvic outlet.
ColoRectal Cancer Risk factors 1.Age > 50y/o. 2.Family Hx: polyposis, Gardner's syn, Peutz Jegher's syn. 3.PMHx of polyps, Crohn's disease, Gardener's syn, ovarian/endometrial cancer.
Internal vs External Hemorrhoids Internal: Vericosities above the anorectal junction (pectinate line). No pain, bleeding. External:Varicosities below the anorectal junction (pectinate line). Protrude with pressure, cause pain.
Fissures tares in the anal mucosa posterior to midline. Caused by passage of large hard stool. Painful with itching
Puritus Ani Perianal burning and irritation caused by chronic inflammation of perineal skin. **usually caused by fungal infection (adults), parasites (children).
T12-L2 Sympathetics control? Ejaculation/orgasm, inhibits bladder contraction (Detrusor muscle), decreases ureteral peristalsis.
S2-S4 parasympathetic control? Erection, bladder contraction
Infertility 30% of the time caused by males
What two causes of scrotal enlargements would cause severe pain? 1.Epidydimitis (increases). 2.Torsion (sudden, <20y/o)
Created by: WeeG
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