THE MALE GENITOURINARY ASSESSMENT

A LOOK AT THE MALE GU SYSTEM

● Remember, your patient will take his cue from you. If you’re comfortable discussing his
problem, he’ll be encouraged to talk openly.

OBTAINING A HEALTH HISTORY

Putting your patient at ease

● Here are some tips for helping your patient feel more comfortable during the health
history:
● Make sure that the room is private
● Tell the patient that his answer will remain confidential.
● Start with less sensitive areas
● Don’t rush or omit important information
● Be especially tactful with older men
● When asking questions, keep in mind that many men view sexual problems as a sign of
diminished masculinity. Phrase your questions carefully, and offer reassurance as
needed.
● Consider the patient’s educational and cultural background.

ASKING ABOUT PAST HEALTH AND FAMILY HEALTH

● Ask the patient about his medical history, especially the presence of diabetes or
hypertension
● Inquire about the health of the patient’s family to get information on the patient’s risk of
developing renal failure or kidney disease.

ASKING ABOUT CURRENT HEALTH

● Ask the patient whether he’s circumcised (an inability to retract the prepuce is called
phimosis; an inability to replace it is called paraphimosis)
● Inquire whether the patient has noticed sores, lumps, or ulcers on his penis. These can
signal a sexually transmitted disease (STD)

DRUG CONNECTION
● Some drugs can affect the appearance of urine or alter GU function

ASKING ABOUT SEXUAL HEALTH AND PRACTICES

● Ask the patient about his sexual preference and practices so that you can assess
risk-taking behaviors.

TESTICULAR SELF-EXAMINATION
● During the patient history, ask your patient whether he performs monthly testicular
self-examinations.
TESTICULAR CANCER
● The most common cancer in men ages 20 to 35, can be treated successfully when it’s
detected early.

DON’T FORGET TO ASK ELDERLY PATIENTS

● Most people erroneously believe that sexual performance normally declines with age.
● Some also believe - also erroneously - that elderly people are incapable of having sex,
that they aren’t interested in sex, or that they can’t find other elderly partners who are
interested in sex.

TAKING PRECAUTIONS
● Also ask the patient about his sexual health. Has he ever had trauma to his penis or
scrotum?
● Was he ever diagnosed with an undescended testicle?
● Has he ever had surgery involving his penis or reproductive system?
● Has he ever been diagnosed with a low sperm count?

ASSESSING THE MALE GU SYSTEM

● To perform a physical assessment of the male GU system, use the techniques of
inspection, percussion, palpation, and auscultation.
● Assessment of the urinary system may be done with assessment of the GU system or
as part of the GI assessment

EXAMINING THE URINARY SYSTEM

● Before examining specific structures, check the patient’s blood pressure and weight
● Also, SCAN the skin

INSPECTION
● Watch for abdominal distention with tight, glistening skin and striae (silvery streaks
caused by rapidly developing skin tension) - Signs of ASCITES

PERCUSSION AND PALPATION

● First, tell the patient what you’re going to do; otherwise, he may be startled and you
could mistake his reaction for a feeling of acute tenderness

DULLNESS = RETENTION
● A dull sound instead of the normal tympany may indicate retained urine in the bladder
caused by bladder dysfunction or infection.

PERFORMING FIRST PERCUSSION

● Costovertebral angle

AUSCULTATION
● Auscultate the renal arteries to rule out bruits, which signal artery stenosis
 ● You can do this during assessment of the GU system or as part of an abdominal
assessment

EXAMINING THE REPRODUCTIVE SYSTEM

● Before examining the reproductive system, put on gloves.
● Make the patients as comfortable as possible, and explain what you’re doing every step
of the way.
● Make sure that the privacy curtain is fully drawn or that the door is closed to help the
patient feel less embarrassed.

INSPECTION
● Inspect the penis, scrotum, and testicles as well as the inguinal and femoral areas

PALPATION
● Palpate the penis, testicles, epididymides, spermatic cords, inguinal and femoral areas,
and prostate gland.

PALPATING THE TESTICLE

● A normal response is a deep visceral pain
● The shadows know
● Inguinal Area
● Femoral Area
○ THREE FINGER TEST/ ZIEMAN’S TECHNIQUE
■ Index finger: deep inguinal ring (indirect hernia)
■ Middle finger: superficial ting (direct hernia)
■ Ring finger: saphenous opening (femoral hernia)

ABNORMAL FINDINGS
● Your assessment may uncover abnormalities of the GU system.
● Although the urinary problems discussed here also occur in women, the causes
described are unique to men.
● Urinary Problems
○ Possible urinary problems include hematuria; urinary frequency, urgency, and
hesitancy; nocturia; and urinary incontinence.

MALE GENITOURINARY SYSTEM

● To remember which findings suggest prostate cancer, think of the mnemonic PAINS:
○ P - rostate cancer
○ A - symmetric
○ I - rregular
○ N - odules
○ S - tony (hard) and fixed
PROSTATE GLAND ENLARGEMENT
● A smooth firm, symmetrical enlargement of the prostate gland indicates benign prostatic
hyperplasia, which typically starts after age 50.
● These findings may be associated with nocturia, urinary hesitancy and frequency, and
recurring UTI’s.
● In acute prostatitis, the prostate gland is firm, warm, and extremely tender and swollen.
Because bacterial infection causes the condition, the patient usually has fever.

PROSTATE GLAND LESIONS

● Hard, irregular, fixed lesions that make the prostate feel asymmetrical suggest prostate
cancer. Palpation may be painful.
● This condition also causes urinary dysfunction. Back and leg pain may occur with bone
metastases in advanced stages.

ERECTILE DYSFUNCTION
● Erectile dysfunction is the inability to achieve and maintain penile erection sufficient to
complete satisfactory sexual intercourse; ejaculation may or may not be affected.

PRIAPISM
● A urologic emergency, priapism is a persistent, painful erection that’s unrelated to sexual
excitation. It may last for several hours or days and is usually accompanied by a severe,
constant, dull aching in the penis.