Nurs 5432 module 4: men's health and STDs
cryptorchidism undescended testicles
Cryptorchidism treatment orchiopexy typically at ages 6-18m
cryptorchidism risks later in life testicular cancer
inflammation of the epididymis that is frequently caused by the spread of infection from
epididymitis the urethra or the bladder
o pain
o dysuria
o urgency/frequency
o low back pain/perineal pain
Epididymitis S/S o fever/chills/malaise
o scrotal edema!!
doxy 100mg BID x 10 days AND ceftriaxone 500mg IM once
Epididymitis treatment for sexually active
men under age 35
Levfloxacin 500mg PO daily x 10 days OR Ofloxacin 300mg BID X 10 days
epididymitis treatment for men over age 35
and you do not suspect STD
think they need to cover gram negative bacteria... e. coli lives in the colon so that is the
likely cause.
Epididymitis treatment for men who have
sex with men Ceftriaxone 500mg IM once AND Levofloxacin 500mg PO daily x 10 days
Prehn's sign is positive
normal cremasteric reflex
Epididymitis PE possible urethral discharge
enlarged and tender epididymis
Ultrasound: shows enlarged epidydimis and increased testicular blood flow
STD testing
US if they have pyuria and/or hematuria
epididymitis diagnosis elevated CBC
CRP and sed rate will be elevated
hydrocele scrotal swelling caused by a collection of fluid
communicating
are hydroceles in infants communicating or
non-communicating?
non-communicating
are hydroceles in adults communicating or
non-communicating?
10% of testicular malignancies present with a hydrocele
what is the connection between testicular
cancer and hydrocele
PAINLESS swelling
o Scrotum size will fluctuate with communicating hydrocele... because the opening is
not closed...the fluid has somewhere to go
o Scrotum feels heavy, especially after coughing, crying, and raising arms
hydrocele assessment o Noncommunicating hydroceles do NOT change shape with crying or straining
o Scrotum will transilluminate with both communicating and non-communicating
Hydrocele diagnostics none needed, but you have to do an ultrasound to rule out a tumor!
The majority of infants born with hydroceles will have spontaneous resolution by the
time they are 1 year old; thus reassurance and observation are the most appropriate
Hydrocele management forms of management.
sx only if persist for >1 year
2025/11/10
, Nurs 5432 module 4: men's health and STDs
· Benign, cystic scrotal mass along spermatic cord, usually at head of epididymis.
spermatocele Measures over 2cm and may contain non-viable sperm
o Palpable, painless, freely moveable cystic mass distinct from testis (pretesticular
lesion)
o Intratesticular lesions always require further workup
o Size 2-5cm
o Usually asymptomatic
spermatocele assessment
o Always located superior to testicle...hydrocele isn't. this is something that separates
the 2 diagnosis
none needed unless it is painful
aspiration will show non-viable sperm
Spermatocele management does not affect fertility
varicocele enlarged veins of the spermatic cord
grade 1: only palpable with valsalva maneuver
grade 2: cant see it, but can feel it when they stand
Varicocele grading grade 3: clearly visible
usually asymptomatic, they come in for fertility issues normally
varicocele assessment do a doppler US, IV pyelography to r/o renal tumor or venous obstruction
grade 1: reassure
grade 2-3 and there is <20% size difference in testicles: reassure and refer to urology if
they desire fertility
grade 2-3 and there is >20% size difference in the testicles: refer to urology
Varicocele management scrotal support
NSAIDS
semen analysis q2 years
· Urologic emergency that occurs when the spermatic cord twists and causes
Testicular Torsion constriction of the vascular supply to the testicle
most commonly 10-20 year olds
ACUTE onset of severe testicular pain
does not have any voiding symptoms
pain is made WORSE by prehn's sign
testicular torsion s/s no cresmeteric reflex noted
affected testicle will have a 'high lie"
US
testicular torsion management surgical referral... they need surgery quick to save the testicle
hypospadias abnormal congenital opening of the male urethra on the undersurface of the penis
o dorsal hooded foreskin
o their urine stream points downward
o first degree: urethra located within the glans or sub corona
o second degree: urethral opening on penile shaft
hypospadias s/s o third degree: urethral opening within the scrotum or perineum
o Chordee (penis bows down)
surgical reconstruction about 1 year old
Hypospadias treatment do NOT circumcise the babies... they use the skin in the repair
phimosis stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis
2025/11/10
cryptorchidism undescended testicles
Cryptorchidism treatment orchiopexy typically at ages 6-18m
cryptorchidism risks later in life testicular cancer
inflammation of the epididymis that is frequently caused by the spread of infection from
epididymitis the urethra or the bladder
o pain
o dysuria
o urgency/frequency
o low back pain/perineal pain
Epididymitis S/S o fever/chills/malaise
o scrotal edema!!
doxy 100mg BID x 10 days AND ceftriaxone 500mg IM once
Epididymitis treatment for sexually active
men under age 35
Levfloxacin 500mg PO daily x 10 days OR Ofloxacin 300mg BID X 10 days
epididymitis treatment for men over age 35
and you do not suspect STD
think they need to cover gram negative bacteria... e. coli lives in the colon so that is the
likely cause.
Epididymitis treatment for men who have
sex with men Ceftriaxone 500mg IM once AND Levofloxacin 500mg PO daily x 10 days
Prehn's sign is positive
normal cremasteric reflex
Epididymitis PE possible urethral discharge
enlarged and tender epididymis
Ultrasound: shows enlarged epidydimis and increased testicular blood flow
STD testing
US if they have pyuria and/or hematuria
epididymitis diagnosis elevated CBC
CRP and sed rate will be elevated
hydrocele scrotal swelling caused by a collection of fluid
communicating
are hydroceles in infants communicating or
non-communicating?
non-communicating
are hydroceles in adults communicating or
non-communicating?
10% of testicular malignancies present with a hydrocele
what is the connection between testicular
cancer and hydrocele
PAINLESS swelling
o Scrotum size will fluctuate with communicating hydrocele... because the opening is
not closed...the fluid has somewhere to go
o Scrotum feels heavy, especially after coughing, crying, and raising arms
hydrocele assessment o Noncommunicating hydroceles do NOT change shape with crying or straining
o Scrotum will transilluminate with both communicating and non-communicating
Hydrocele diagnostics none needed, but you have to do an ultrasound to rule out a tumor!
The majority of infants born with hydroceles will have spontaneous resolution by the
time they are 1 year old; thus reassurance and observation are the most appropriate
Hydrocele management forms of management.
sx only if persist for >1 year
2025/11/10
, Nurs 5432 module 4: men's health and STDs
· Benign, cystic scrotal mass along spermatic cord, usually at head of epididymis.
spermatocele Measures over 2cm and may contain non-viable sperm
o Palpable, painless, freely moveable cystic mass distinct from testis (pretesticular
lesion)
o Intratesticular lesions always require further workup
o Size 2-5cm
o Usually asymptomatic
spermatocele assessment
o Always located superior to testicle...hydrocele isn't. this is something that separates
the 2 diagnosis
none needed unless it is painful
aspiration will show non-viable sperm
Spermatocele management does not affect fertility
varicocele enlarged veins of the spermatic cord
grade 1: only palpable with valsalva maneuver
grade 2: cant see it, but can feel it when they stand
Varicocele grading grade 3: clearly visible
usually asymptomatic, they come in for fertility issues normally
varicocele assessment do a doppler US, IV pyelography to r/o renal tumor or venous obstruction
grade 1: reassure
grade 2-3 and there is <20% size difference in testicles: reassure and refer to urology if
they desire fertility
grade 2-3 and there is >20% size difference in the testicles: refer to urology
Varicocele management scrotal support
NSAIDS
semen analysis q2 years
· Urologic emergency that occurs when the spermatic cord twists and causes
Testicular Torsion constriction of the vascular supply to the testicle
most commonly 10-20 year olds
ACUTE onset of severe testicular pain
does not have any voiding symptoms
pain is made WORSE by prehn's sign
testicular torsion s/s no cresmeteric reflex noted
affected testicle will have a 'high lie"
US
testicular torsion management surgical referral... they need surgery quick to save the testicle
hypospadias abnormal congenital opening of the male urethra on the undersurface of the penis
o dorsal hooded foreskin
o their urine stream points downward
o first degree: urethra located within the glans or sub corona
o second degree: urethral opening on penile shaft
hypospadias s/s o third degree: urethral opening within the scrotum or perineum
o Chordee (penis bows down)
surgical reconstruction about 1 year old
Hypospadias treatment do NOT circumcise the babies... they use the skin in the repair
phimosis stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis
2025/11/10
