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Inflammatory Disorders of the Male

Inflammatory Disorders of the Male. Penne Mott. Gonococcal /Non Gonococcal (NGU) Urethritis. Causes Gonorrhea Chlamydia (NGU). Gonococcal /Non Gonococcal (NGU) Urethritis. Thick yellowish green purulent discharge Appears 3 – 14 days after sexual exposure NGU – scant to moderate amount

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Inflammatory Disorders of the Male

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  1. Inflammatory Disorders of the Male Penne Mott

  2. Gonococcal /Non Gonococcal (NGU) Urethritis • Causes • Gonorrhea • Chlamydia (NGU)

  3. Gonococcal /Non Gonococcal (NGU) Urethritis • Thick yellowish green purulent discharge • Appears 3 – 14 days after sexual exposure • NGU – scant to moderate amount • Pain in urethra • Redness / irritation

  4. Gonococcal /Non Gonococcal (NGU) Urethritis • Treatment • Rocephin or Zithromax – Gonorrhea • Doxy or tetracycline – Chlamydia • Condom use • Treatment of sex partners

  5. Epididymitis • Convoluted tubules top of each testicle • Inflammation / infection epididymis • High incidence young males

  6. Epididymitis - Causes • Infection – E-coli from lower urinary tract or prostate • Trauma • STD’s – Chlamydia / gonorrhea

  7. Epididymitis - Assessment • “Duck Waddle” walk • Acute painful scrotal swelling (unilateral) • Prehn’s sign – lifting the scrotum onto symphysis relieves pain • NV • Fever / chills • Dysuria, frequency, urgency

  8. Epididymitis - Treatment • Bedrest • Scrotal elevation • Ice • Sitz • Analgesics / antipyretics • Antibiotics • Treatment of STD

  9. Epididymitis - Complications • Epididymal Abscess – may extend testicles • Chronic epididymitis • Tx epididymectomy • Sterility

  10. Orchitis • Rare, acute testicular inflammation • Associated with mumps, pneumonia, TB, syphilis, parasites, trauma • Can be SE • Epididymitis • Mono • Flu • catheterization

  11. Orchitis- Assessment • Red, edematous extremely tender testicles • Fever

  12. Orchitis - Treatment • BR • Scrotal Support • Local heat • Analgesics • Antibiotics • ***Preventable with immunization

  13. Testicular Torsion • Torsion of spermatic cord = twisting of the testis that cuts off blood supply to testis • Adolescent males

  14. Testicular Torsion – S/S • Acute scrotal pain • Nausea • Vomiting • No urinary complaints • U/A – no WBC’s or bacteria • MEDICAL EMERGENCY!!!!

  15. Testicular Torsion - Treatment • Surgery – Surgical exploration of the scrotum & bilateral testicular fixation • Necrosis – orchiectomy

  16. Hydrocele • Collection of fluid between visceral & parietal membranes of the tunica vaginalis (membranes that surrounds the testis)

  17. Hydrocele - Causes • Trauma • Infection (Epididymitis or orthitis) • Cancer of testis • Most commonly occurs • Infants • Males > 40

  18. Hydrocele – S/S • Painless swelling scrotum • Positive transillumination

  19. Hydrocele - Treatment • None unless swelling large & uncomfortable • Fluid aspiration – may be repeated 1-3 mos • Hydocelectomy –excision of membrane

  20. Varicocele • Distention of testicular veins • Infertility

  21. Varicocele – S/S • Wormlike mass “Bag of Worms” above the testis when patient stands • Dragging sensations • Dull aching • Pain relieved by masturbation or sex (relieves venous congestion)

  22. Varicocele - Treatment • Scrotal support • Varicocelectomy • Sclerosing agent injections

  23. Priapism • Prolonged state of erection not associated with sexual desire • Painful • Rare • Urologic emergency

  24. Priapism - Treatment • Ketamine HCL (Ketalar) • Rapid acting nonbarbiturate anesthetic • IM / IV • SE: unpleasant psychic sx. (dreams, hallucinations) vomiting, hypersalivation, skin rashes

  25. Hypospadias • Congential malposition of the meatus on the ventral side of the penis • Associated with infertility

  26. Cryptorchidism • Failure of the testes to descend

  27. Cryptorchidism – S/S • No palpable testes

  28. Cryptorchidism - Treatment • Orchiopexy before age 2-3 • After age 3 increased risk infertility • *Increased risk of Testicular CA

  29. Cryptorchidism – Pre op • Psychologic Problems RT genital surgery in children • Fear / punishment • Body mutilation • Castration

  30. Cryptorchidism – Pre op • The earlier a repair can be made, the more likely the possibility that the child will develop a normal body image • Ideal time 6-15 months

  31. Cryptorchidism – Post op • Care of the surgical site • Tub baths often discouraged 1st week • Catheter care • Restriction of activites –pushing, lifting, playing with staddle toys, sandboxes, rough activites

  32. Testicular Exam • Testicular cancers can occur as early as adolescence • Monthly • Shower – warms the scrotum • Use both hands to palpate scrotal contents • Roll each testicle between thumb and 1st three fingers

  33. Testicular Exam • ID structures • S –permatic cord • V –as deference • E –pididymis • T -estes

  34. Testicular Exam • Testis should feel round soft – hard boiled egg without shell • Epididymis – not as smooth • One testicle may be larger • Spermatic cord -firm smooth • Check – lumps, irregularities, pain, dragging sensations

  35. Testicular Exam • Consult health care provider when abnormalities are discovered

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