Chapter 25: Male Genitourinary System

Male Genitourinary System begins by outlining the fundamental structure and function of the male genitalia, detailing the anatomical components of the penis, including the corpora cavernosa, corpus spongiosum, glans, and urethra, as well as the protective structures of the scrotum containing the testes, epididymis, and the spermatic cord. The text explores developmental competence across the lifespan, from prenatal testicular descent and pediatric considerations to the predictable progressive physiological changes during puberty mapped by Tanner’s Sexual Maturity Ratings (SMR), while also addressing the natural decline in testosterone, benign prostatic hyperplasia (BPH), and changing sexual responses characteristic of aging adults. It critically examines the intersection of genetics, environment, and social determinants of health, providing evidence-based insights into elective circumcision, chronic kidney disease (CKD) progression to end-stage renal disease, bladder cancer risks linked to environmental and occupational exposures, and the rising prevalence of sexually transmitted infections (STIs) requiring targeted patient behavioral counseling. Furthermore, the chapter underscores the importance of inclusive healthcare practices by appropriately addressing sexual orientation and gender identity (SGM) to ensure holistic, welcoming, and confidential patient care. The clinical assessment protocol is systematically detailed, guiding practitioners through gathering subjective data—such as urinary symptoms, pelvic pain, and sexual history—and conducting an objective physical examination. This hands-on assessment covers the inspection and palpation of the penis, scrotal sac, and inguinal region to detect abnormalities like hernias (indirect, direct, and femoral), enlarged lymph nodes, or masses, utilizing techniques like transillumination to differentiate serous fluid from solid tissue. Diagnostic evaluations, including urinalysis and renal function tests evaluating creatinine, blood urea nitrogen (BUN), and glomerular filtration rate (GFR), are integrated to quantitatively assess urinary tract health. Finally, the chapter comprehensively categorizes abnormal genitourinary findings, illustrating clinical presentations of prevalent male genital lesions, urethritis, renal calculi, congenital penile anomalies like hypospadias and epispadias, foreskin complications including phimosis and paraphimosis, and critical scrotal pathologies ranging from testicular torsion and epididymitis to hydroceles and varicoceles, ultimately emphasizing the critical importance of teaching routine testicular self-examination (TSE) for the early detection of testicular carcinoma.