Male Genitourinary Assessment

Question 1

Health History Points (10)

Answer 1

1. Urination Habits - Frequency, Urgency, Nocturia
2. Dysuria
3. Hesitancy and Straining - may be indicative of
   prostate enlargement compressing the urethra
   (when combined with needing to urinate after
   going)
4. Urine Colour
5. Past GU history - incontinence, kidney disease,
   medications
6. Penis - pain, lesions, discharge
7. Scrotum - lumps, swelling
8. Sexual Activity and Contraceptive Use - concerns
   with performance
9. STI contact - known STI contact, treatment
10. STI Risk Reduction - precautions to reduce risks

Question 2

Polyuria

Answer 2

excessive urination (6+ times per day)

Question 3

Oliguria

Answer 3

diminished quantity of urination (<400mL/24h)

Question 4

Urgency to Urinate

Answer 4

urge to urinate even when the bladder is not near maximum capacity
- may be indicative of infection or conditions
causing irritations, inflammation or obstructions

Question 5

Nocturia

Answer 5

the urge to urinate is so strong that it wakes you up at night
- occurs together with frequency and urgency in urinary tract disorders

Question 6

Dysuria

Answer 6

burning sensation with urination

Question 7

True Incontinence

Answer 7

inability to control urination, urination occurs without warning

Question 8

Urge Incontinence

Answer 8

involuntary urine loss from overactive detrusor muscle in the bladder
(excessive contraction of bladder muscles causes
increased urgency to void)

Question 9

Stress Incontinence

Answer 9

involuntary loss of urine with physical strain, sneezing, or coughing
- increased intra-abdominal pressure + weakness
in pelvic floor muscles

Question 10

Physical Exam Points:

Answer 10

1. Inspection
2. Palpation

Question 11

Inspection and Palpation: Penis

Answer 11

1. Penis - wrinkled, hairless, no lesions
   
   • palpate shaft between thimb and first 2 fingers =
     penis should be smooth, semi-firm, and
     nontender
   • hair distribution should be consistent with age
2. Glans - smooth, no lesions, easy retraction of foreskin with ability to slide back to normal position
3. Urethral Meatus - meatus edge should be central, pink, smooth and with no discharge
   
   • compress glans anteroposterior between the
     thumb and forefinger to palpate

Question 12

Hypospadias

Answer 12

ventral location of the urethral meatus (in comparison to the normal medial positon)

Question 13

Epispadias

Answer 13

dorsal location of the urethral meatus (in comparison to normal medial position)

Question 14

Phimosis

Answer 14

inability to retract foreskin

Question 15

Paraphimosis

Answer 15

inability to return the foreskin to its original position when retracted

Question 16

Inspection and Palpation: Scrotum

Answer 16

ask the patient to hold their penis out of the way

Inspection - scrotal size dependent on temperature (smaller when cold, larger when warm), asymmetry is normal (left normally lower than right)

Palpation - the scrotal sac should slide easily, be smooth, movable, feel oval, firm and rubbery bilaterally –> tender to mild pressure

Question 17

Inspection and Palpation: Hernias

Answer 17

Bulging of internal organ or fatty tissue through an opening in the muscle anterior to it
- Inspect the inguinal region for a bulge as the
patient stands and as the patient strains down
→ normally none is present
- Palpate for bumps/ mass

Question 18

Older Adult Considerations

Answer 18

• no end to fertility –> sperm production decreases
  ≥ 40 years old
• gradual decrease in testosterone production ≥ 55
  years old = slower/ less intense sexual response
• decreased amount of pubic hair, turns grey/while
• decreased penis + testes size = less firm to
  palpation
• decreased tone of dartos muscle = scrotum hangs
  lower
• decreased rugae = pendulous look to scrotum