Badanie fizykalne układu płciowego męskiego | Male Reproductive System Examination

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płciowe”, “Penis”: “Prącie”, “Scrotum”: “Moszna”, “Testes”: “Jądra”, “Epididymis”: “Najądrze”, “Vas deferens”: “Nasieniowód”, “Seminal vesicles”: “Pęcherzyki nasienne”, “Prostate gland”: “Gruczoł krokowy (prostata)”, “Bulbourethral glands”: “Gruczoły opuszkowo-cewkowe”, “Corpora cavernosa”: “Ciała jamiste”, “Corpus spongiosum”: “Ciało gąbczaste”, “Glans penis”: “Żołądź prącia”, “Prepuce”: “Napletek”, “Foreskin”: “Napletek”, “Urethra”: “Cewka moczowa”, “Dartos muscle”: “Mięsień kurczliwy moszny”, “Cremaster muscle”: “Mięsień dźwigacz jądra”, “Spermatogenesis”: “Spermatogeneza”, “Tunica albuginea”: “Błona biaława”, “Seminiferous tubules”: “Kanaliki nasienne”, “Sertoli cells”: “Komórki Sertolego”, “Leydig cells”: “Komórki Leydiga”, “Testosterone”: “Testosteron”, “Secondary sexual characteristics”: “Wtórne cechy płciowe”, “Head of epididymis”: “Głowa najądrza”, “Body of epididymis”: “Trzon najądrza”, “Tail of epididymis”: “Ogon najądrza”, “Ampulla”: “Bańka nasieniowodu”, “Spermatic cord”: “Powrózek nasienny”, “Pampiniform plexus”: “Splot wiciowaty”, “Fructose-rich fluid”: “Płyn bogaty we fruktozę”, “Prostaglandins”: “Prostaglandyny”, “Ejaculatory ducts”: “Przewody wytryskowe”, “Prostate-specific antigen”: “Antygen swoisty dla prostaty (PSA)”, “PSA”: “PSA”, “Citric acid”: “Kwas cytrynowy”, “Pre-ejaculate”: “Preejakulat”, “Spongy urethra”: “Cewka moczowa gąbczasta”, “Testicular arteries”: “Tętnice jądrowe”, “Internal pudendal artery”: “Tętnica sromowa wewnętrzna”, “Cremasteric artery”: “Tętnica mięśnia dźwigacza jądra”, “Deferential artery”: “Tętnica nasieniowodu”, “Prostatic venous plexus”: “Splot żylny prostaty”, “Penile venous drainage”: “Odpływ żylny prącia”, “Deep dorsal vein”: “Żyła grzbietowa głęboka”, “Pudendal nerve”: “Nerw sromowy”, “Pelvic splanchnic nerves”: “Nerwy trzewne miedniczne”, “Hypospadias”: “Spodziectwo”, “Cryptorchidism”: “Wnętrostwo”, “Micropenis”: “Mikroprącie”, “Testicular torsion”: “Skręt jądra”, “Bell clapper deformity”: “Deformacja typu „dzwonek na sznurku””, “Penile curvature”: “Krzywizna prącia”, “Chordee”: “Zwłóknienie prącia”, “Congenital absence of the vas deferens”: “Wrodzony brak nasieniowodu”, “CAVD”: “CAVD”, “Cystic fibrosis”: “Mukowiscydoza”, “Epispadias”: “Wierzchniactwo”, “Bladder exstrophy”: “Wytrzewienie pęcherza”, “Gamete transport”: “Transport gamet”, “Testicular function”: “Funkcja jąder”, “Sperm maturation”: “Dojrzewanie plemników”, “Androgen-binding protein (ABP)”: “Białko wiążące androgeny (ABP)”, “Hypothalamic-pituitary-gonadal axis”: “Oś podwzgórze-przysadka-gonady”, “Luteinizing hormone (LH)”: “Hormon luteinizujący (LH)”, “Follicle-stimulating hormone (FSH)”: “Hormon folikulotropowy (FSH)”, “Ejaculation”: “Wytrysk”, “Emission phase”: “Faza emisji”, “Expulsion phase”: “Faza wydalenia”, “Nitric oxide (NO)”: “Tlenek azotu (NO)”, “Cyclic GMP (cGMP)”: “Cykliczny GMP (cGMP)”, “Bulbospongiosus muscle”: “Mięsień opuszkowo-gąbczasty”, “Ischiocavernosus muscle”: “Mięsień kulszowo-jamisty”, “General inspection”: “Ogólne badanie”, “Skin changes”: “Zmiany skórne”, “Rashes”: “Wysypki”, “Ulcers”: “Owrzodzenia”, “Lesions”: “Zmiany chorobowe”, “Hydrocele”: “Wodniak jądra”, “Testicular cancer”: “Rak jądra”, “Varicocele”: “Żylaki powrózka nasiennego”, “Redness”: “Zaczerwienienie”, “Bruising”: “Siniaki”, “Venous stasis”: “Zastój żylny”, “Penile cancer”: “Rak prącia”, “Palpation”: “Palpacja”, “Fibrous plaque”: “Płytka włóknista”, “Bacterial infections”: “Infekcje bakteryjne”, “Inguinal region”: “Okolica pachwinowa”, “Hernia”: “Przepuklina”, “Reducible hernia”: “Przepuklina odprowadzalna”, “Incarcerated hernia”: “Przepuklina uwięźnięta”, “Digital rectal examination (DRE)”: “Badanie per rectum (DRE)”, “Prostate exam”: “Badanie prostaty”, “Pelvic pain”: “Ból miednicy”, “Painful urination”: “Bolesne oddawanie moczu”, “Painful ejaculation”: “Bolesna ejakulacja”, “Early detection”: “Wczesne wykrycie”, “Seminal fluid”: “Płyn nasienny”, “Seminal vesicular proteins”: “Białka pęcherzyków nasiennych”, “Sexually transmitted infections (STIs)”: “Choroby przenoszone drogą płciową”, “Erectile dysfunction (ED)”: “Zaburzenia erekcji”, “Infertility”: “Niepłodność”, “Prostatitis”: “Zapalenie gruczołu krokowego”, “Hormonal imbalance”: “Zaburzenia hormonalne”, “Hypogonadism”: “Hipogonadyzm”, “Urinary retention”: “Zatrzymanie moczu”, “Fever”: “Gorączka”, “Antibiotics”: “Antybiotyki”, “Stress management”: “Zarządzanie stresem”, “Toxins”: “Toksyny”, “Oxidative stress”: “Stres oksydacyjny”, “Antioxidants”: “Przeciwutleniacze”, “Micronutrients”: “Mikroelementy”, “Zinc”: “Cynk”, “Selenium”: “Selen”, “Vitamin E”: “Witamina E”, “Vitamin C”: “Witamina C”, “Exercise”: “Ćwiczenia”, “Diet”: “Dieta”, “Testicular self-exam”: “Samobadanie jąder”, “PSA blood test”: “Badanie krwi na PSA”, “Prostate-specific antigen test”: “Test na antygen swoisty dla prostaty”, “Transrectal ultrasound”: “Ultrasonografia przezodbytnicza”, “Prostate biopsy”: “Biopsja prostaty”, “Malignancies”: “Nowotwory złośliwe”, “Herpes”: “Opryszczka”, “Blisters”: “Pęcherze”, “Syphilis”: “Kiła”, “Squamous cell carcinoma”: “Rak płaskonabłonkowy”, “Melanoma”: “Czerniak”, “Warts”: “Brodawki”, “Human papillomavirus”: “Wirus brodawczaka ludzkiego (HPV)”, “Genital warts”: “Kłykciny kończyste”, “Swelling”: “Obrzęk”, “Acute”: “Ostry”, “Epididymitis”: “Zapalenie najądrza”, “Orchitis”: “Zapalenie jądra”, “Perineum”: “Krocze”, “Lumps”: “Guzki”, “Plaques”: “Płytki”, “Areas of tenderness”: “Obszary bolesności”, “Peyronie’s disease”: “Choroba Peyroniego”, “Infection”: “Infekcja”, “Fibrosis”: “Zwłóknienie”, “Pain”: “Ból”, “Discomfort”: “Dyskomfort”, “Changes in erectile function”: “Zmiany w funkcji erekcji”, “Fibrotic changes”: “Zmiany włókniste”, “Testicles”: “Jądra”, “Soft mass”: “Miękka masa”, “Incarcerated”: “Uwięźnięta”, “Inguinal lymph nodes”: “Węzły chłonne pachwinowe”, “Enlargement”: “Powiększenie”, “Infection”: “Infekcja”, “Nodules”: “Guzki”, “Indurations”: “Stwardnienia”, “Benign prostatic hyperplasia”: “Łagodny przerost gruczołu krokowego”, “Prostate cancer”: “Rak prostaty” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value; } function processNode(node) { if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) { let content = node.nodeValue; // Regex to match only the main words (ignores parentheses) const regex = new RegExp( `\b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})\b`, ‘gi’ ); if (regex.test(content)) { const wrapper = document.createElement(‘span’); wrapper.innerHTML = content.replace(regex, (match) => { const tooltip = normalizedWordsToTooltip[match.toLowerCase().trim()]; return `${match}`; }); node.replaceWith(wrapper); } } else if (node.nodeType === Node.ELEMENT_NODE) { Array.from(node.childNodes).forEach(processNode); } } 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Szacowany czas lekcji: 15 minut
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General Inspection

The first step in the physical examination is the general inspection of the external genitalia and surrounding areas. During this stage, the clinician looks for any signs of pathology, such as skin changes, swelling, asymmetry, or discoloration.

Skin Changes

The clinician begins by inspecting the skin of the penis, scrotum, and perineum. The appearance of the skin can provide valuable insights into a number of conditions. For instance, the presence of rashesscarsulcers, or other lesions can suggest a range of potential issues, from sexually transmitted infections (STIs) to dermatological conditions or even malignancies. Herpes, for example, can present as painful blisters or ulcers around the genital area, while conditions like syphilis can cause chancre sores. Skin cancers, including squamous cell carcinoma or melanoma, may present as new or changing lesions on the penis or scrotum. When warts are observed, particularly around the penis or perineum, this could indicate human papillomavirus (HPV), which is associated with genital warts and may also be a risk factor for penile cancer.

Swelling

Next, the clinician carefully inspects the scrotum for any signs of swelling, which can be indicative of several different conditions. Common causes of swelling include:

  • Hydrocele: An abnormal buildup of fluid around the testicle, resulting in painless, smooth swelling of the scrotum.
  • Testicular torsion: A more urgent condition where the spermatic cord twists, cutting off blood supply to the testicle, and presenting with severe, acute pain and swelling.
  • Varicocele: Dilated veins in the scrotum that can cause discomfort and swelling. This condition often goes unnoticed unless it becomes large enough to be palpated or causes discomfort.

Asymmetry

It is important to note that some degree of asymmetry between the testicles is normal. Typically, the left testicle hangs slightly lower than the right. However, significant discrepancies in size, shape, or positioning should be noted. Conditions that may cause asymmetry include:

  • Testicular cancer: Often presents as a firm, non-tender mass.
  • Epididymitis or orchitis: Inflammation of the testicle or epididymis.
  • Hydrocele: Fluid-filled sac around the testicle.
  • Varicocele: Engorged veins in the scrotum, often described as feeling like a “bag of worms.”

Discoloration

The appearance of discoloration in the scrotum, penis, or perineum can signal various issues. Common types of discoloration include:

  • Redness: Often associated with inflammation, which could be caused by infection such as prostatitis or orchitis.
  • Bruising: May indicate recent trauma, and should be examined to determine the cause and extent of the injury.
  • Color changes: Can be indicative of venous stasis, a condition where blood flow is impeded, often due to varicocele or testicular torsion, where the blood supply to the testicle is compromised.

Once the visual inspection is complete, the clinician moves on to palpation, which is essential for confirming suspicions and assessing the consistency, tenderness, and size of the reproductive organs.

Palpation

Palpation is a key part of the physical examination of the male reproductive system, offering a deeper insight into the consistency and texture of the organs that cannot be obtained through visual inspection alone. It helps identify underlying conditions that may not be visible, such as testicular cancer or epididymitis. The clinician should use a gentle but firm touch, as too much pressure may cause discomfort or miss subtle abnormalities.

Penis

The clinician begins by palpating the penis, carefully feeling the shaft for any lumpsplaques, or areas of tenderness. Conditions like Peyronie’s disease, which causes abnormal curvature due to fibrous plaque formation, may be felt as lumps along the shaft. These plaques can cause pain during intercourse and may require medical management. The clinician also checks for signs of infection or fibrosis, which could result from trauma, surgery, or chronic inflammation. If the patient reports any paindiscomfort, or changes in erectile function, these should be documented carefully, as they may point to issues like penile cancerbacterial infections, or fibrotic changes.

Scrotum and Testicles

The clinician then palpates the scrotum to assess the testicles. Testicles should feel firm but not hard, with a smooth surface. Any mass, hardness, or tenderness in the testicles should be thoroughly investigated. For example, a firm massmay be indicative of testicular cancer, while a soft mass may suggest a hydrocele (a fluid-filled sac) or a spermatocele(a cyst in the epididymis). Testicular torsion should also be suspected in cases of severe, acute scrotal pain. The testicles should be assessed for mobility as well; they should move freely within the scrotum. Lack of mobility or pain upon movement could indicate infectiontorsion, or a mass.

The epididymis, a soft, tubular structure located at the back of each testicle, should be palpated gently. Normally, it feels smooth and non-tender. Any swelling or tenderness could suggest epididymitis (inflammation of the epididymis), which often results from an infection, including sexually transmitted infections (STIs). Orchitis (testicular inflammation) can also present with pain and swelling, making it important for the clinician to distinguish between these two conditions.

Inguinal Region

Finally, the clinician palpates the inguinal region for any signs of a hernia. Hernias are often palpable in this area, particularly when the patient coughs. The clinician assesses whether the hernia is reducible (easily pushed back into the abdomen) or incarcerated (unable to be reduced). Incarcerated hernias are more serious and may require surgical intervention. Additionally, the clinician should palpate the inguinal lymph nodes for any enlargement, which could indicate infection or malignancy in the genital or lower abdominal regions. Enlarged inguinal lymph nodes are common in STIs, local infections, or metastatic cancers, making this part of the exam crucial for diagnosis.

Once the visual inspection and palpation are complete, the clinician can begin assessing for further abnormalities through special tests or move on to the next stage of examination.

Prostate Exam

The prostate exam is an essential component of the male reproductive system examination, especially for men over 50 or those with a family history of prostate cancer or related conditions. The prostate is a small, walnut-shaped gland located just below the bladder and in front of the rectum. It plays a vital role in the male reproductive system by producing seminal fluid.

Due to its proximity to the rectum, the prostate is typically examined through a digital rectal examination (DRE). This allows clinicians to assess the prostate’s size, shape, consistency, and identify any abnormalities such as nodules or tenderness.

The DRE can be performed in several positions for optimal access:

  • Standing, bending forward at the waist: This position provides access to the rectal area.
  • Lateral decubitus (side-lying) with knees pulled up to the chest: Commonly used for easier rectal access.
  • Lithotomy position (lying on the back with knees bent) can also be used.

Lubrication and gloves are used for patient comfort and to minimize discomfort during the procedure.

The clinician inserts a lubricated, gloved finger into the rectum, asking the patient to relax. The prostate is palpated through the anterior rectal wall. A normal prostate feels firmsmooth, and slightly mobile, with a uniform size and shape. Any irregularities such as nodulesindurations (hard areas), or tenderness could indicate benign prostatic hyperplasia (BPH)prostatitis, or prostate cancer.

Key Findings in the Prostate Exam:

  • Benign Prostatic Hyperplasia (BPH): In cases of BPH, the prostate becomes enlarged but remains smooth, with no firm or hard areas. This condition is typically non-cancerous and common in older men. The enlargement can cause urinary symptoms like difficulty initiating urination, weak urinary stream, or frequent urination, especially at night. While BPH itself is not cancer, its presence may require monitoring and treatment to prevent complications such as urinary retention or bladder damage.
  • Prostatitis: If the prostate feels swollen, tender, and warm to the touch, it may indicate prostatitis, an infection or inflammation. Symptoms of prostatitis can include fever, pelvic pain, painful urination, and painful ejaculation. Acute prostatitis is typically caused by a bacterial infection and requires antibiotics, while chronic prostatitis may be harder to treat and could cause ongoing discomfort.
  • Prostate Cancer: The most concerning finding during a prostate exam is the presence of hard, irregular noduleson the prostate. These nodules often indicate prostate cancer, which can present as a firm, non-tender mass. Further diagnostic steps, such as a prostate-specific antigen (PSA) blood test, transrectal ultrasound, or biopsy, are typically required for diagnosis. Prostate cancer is highly treatable when detected early, particularly in men over 50 or those with a family history.

The prostate exam is an essential part of overall prostate health evaluation. Regular exams, combined with other diagnostic tests, are crucial for early detection of prostate conditions and improving patient outcomes.