CHAPTER 7 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Male Reproductive System CHAPTER 7 Lesson 7.1 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2 OBJECTIVES Identify organs and structures of the male reproductive system. Define and spell word parts related to the male reproductive system. Define, pronounce, and spell disease and disorder terms related to the male reproductive system. Define, pronounce, and spell surgical terms related to the male reproductive system. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 THREADED CASE STUDY: FRANK As we learn about the male reproductive system, we will follow the case of Frank, a window washer, tells Dr. Kane about problems he's having with urination —urgency, frequency, and an inability to completely empty his bladder. "Actually, it's kind of a funny story," Frank says. "What happened was, I first noticed I had a problem when I was working on this tall skyscraper downtown. I'm all the way up on like the 32nd floor, when all of a sudden I feel like I have really got to go, you know?" "So I come down on the outside lift, and nobody pays much attention, and I go to the john and that's it. I go back up. Then I'm washing windows on the 33rd floor, and I have to go again!" Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 THREADED CASE STUDY: FRANK "You know, when you're up on those platforms on the outsides of tall buildings on a nice day, people like to watch. Some people in the office building across the way started noticing that I kept going up and down an awful lot — thirty -third floor to the ground all afternoon!" Frank laughs and shrugs. "I drew a crowd at that office window. What can I say? People just find me naturally entertaining, I guess. But—I think I'd like to choose how I entertain people. So I want to get this problem taken care of right away!" In addition to the urgency and frequency he's described, Frank reports that, occasionally, he has blood in his urine. Dr. Kane will perform a variety of diagnostic tests and procedures to identify the cause of Frank's symptoms. But first, let's get a better understanding of a healthy male reproductive system. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 MALE REPRODUCTIVE SYSTEM The male reproductive system is composed of the testes, urethra, penis, prostate gland, and associated tubes. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 MALE REPRODUCTIVE SYSTEM FUNCTION To produce, sustain, and transport sperm —the male reproductive cell—and to secrete the hormone testosterone Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 MALE REPRODUCTIVE ORGANS Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 MALE REPRODUCTIVE SYSTEM Testis, or testicle : primary male sex organs, paired, oval-shaped, and enclosed in a sac called the scrotum. The testes produce spermatozoa (sperm cells) and the hormone testosterone. Sperm (spermatozoon): the microscopic male germ cell, which, when united with the ovum, produces a zygote (fertilized egg) that with subsequent development becomes an embryo. Testosterone : the principle male sex hormone. Its chief function is to stimulate the development of the male reproductive organs and secondary sex characteristics such as facial hair. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 MALE REPRODUCTIVE SYSTEM (CONT’D) up to 900 coiled tubes within the testes in which spermatogenesis occurs. epididymis: a coiled duct (6-m) tube atop each of the testes that provides for storage, transit, and maturation of spermatozoa; continues with the vas deferens. vas deferens, ductus deferens, or seminal duct: duct carrying the sperm from the epididymis to the urethra. (The urethra also connects with the urinary bladder and carries urine outside the body. A circular muscle constricts during intercourse to prevent urination.) seminiferous tubules: Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 MALE REPRODUCTIVE SYSTEM (CONT’D) two main glands located at the base of the bladder that open into the vas deferens. The glands secrete a thick fluid, which forms part of the semen. prostate gland: encircles the upper end of the urethra. The prostate gland secretes a fluid that aids in the movement of the sperm and ejaculation. scrotum: sac suspended on both sides of and just behind the penis. The testes are enclosed in the scrotum. seminal vesicles: Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 MALE REPRODUCTIVE SYSTEM (CONT’D) male organ of urination and copulation (sexual intercourse) glans penis: enlarged tip on the end of the penis prepuce: fold of skin covering the glans penis in uncircumcised males (foreskin of the penis) semen: composed of sperm, seminal fluids, and other secretions genitalia (genitals): reproductive organs (male or female) penis: Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 SPERMATOZOON OR SPERM The sperm cell is about one five -hundredth of an inch long and resembles a tadpole in its appearance. It consists of a head, a cylindrical midpiece, and an elongated tail. Although approximately 300 million sperm cells are released into the female reproductive tract with each coital ejaculation, only 50 to 100 actually reach the ovum, and only one can penetrate and fertilize a single egg. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 ANIMATIONS/ACTIVIT Y https://evolve.elsevier.com/objects/lafleur8e_v1/mod07/media/07s01l0 503/07s01l0503p1.html https://evolve.elsevier.com/Courses/14615_sjohnson2458_1001#/cont ent/463633674?view=https:%2F%2Fevolve.elsevier.com%2Fobjects %2Flafleur8e_v1%2Fmod07%2F07s01l0505.html Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 COMBINING FORMS FOR THE MALE REPRODUCTIVE SYSTEM Balan/o Glans penis Epididym/o Epididymis Orchid/o, orchi/o, orch/o, test/o - Testis, testicle - Prostat/o Prostate gland Vas/o Vessel, duct Vesicul/o Seminal vesicle Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 COMBINING FORMS COMMONLY USED WITH MALE REPRODUCTIVE SYSTEM TERMS - andr/o Male sperm/o, spermat/o Spermatozoon, (pl. spermatozoa) sperm Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16 SUFFIX -ism - State of Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17 EXERCISE FIG A Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 CLICKER QUESTION Orchid/o, orchi/o, orch/o and test/o are all combining forms for testicle. a) T b) F Answer) True Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 ORIGINATION AND TRANSPORTATION OF SPERM Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 THREADED CASE STUDY: FRANK Frank tells Dr. Kane that he has had a vasectomy. The purpose of a vasectomy is male sterilization. "After our third," Frank says, "my wife and I decided not to have any more kids." Frank's vasectomy reduced his sperm cell count to zero. The male reproductive system produces and maintains the spermatozoa (sing.,spermatozoon), the male sex cells, and also secretes several hormones. Two very important hormones are androgenand testosterone, which stimulate the development of male physical characteristics. Sperm cells contain half of the genetic material that forms each living being. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21 DISEASE AND DISORDER TERMS BUILT FROM WORD PARTS Anorchism State of absence of testis Balanitis Inflamation of the glans penis Balanorrhea discharge from the glans penis benign prostatic hyperplasia (BPH) − Excessive development pertainting to the prostate gland − Cryptorchidism State of hidden testes Epididymitis Inflammation of an epididymis Orchiepididymitis − Inflammation of the testis and epididymis − − Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22 DISEASE AND DISORDER TERMS BUILT FROM WORD PARTS orchitis, orchiditis, testis Inflammation of the testis or testicle Prostatisis − Inflammation of the prostate gland Prostatocystitis − Inflammation of the prostate gland and the bladder Prostatolith Stone in the prostate gland Prostatorrhea Discharge from the prostate gland Prostatovesiculitis − Inflammation of the prostate gland and seminal vesicles − − Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23 BENIGN PROSTATIC HYPERPLASIA Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 24 DISEASE AND DISORDER TERMS NOT BUILT FROM WORD PARTS erectile dysfunction − Inability of the male to attain or maintain an erection suf ficient to preform sexual intercourse Hydrocele − Scrotal swelling caused by a collection of fluid Phimosis − Tightness of the prepuce (foreskin) that prevents its retraction over the glans penis Priapism − Persistent abnormal erection of the penis accompanied by pain and tenderness Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 25 DISEASE AND DISORDER TERMS NOT BUILT FROM WORD PARTS prostate cancer − Cancer of the prostate gland; usually later in life testicular cancer − Cancer of the testicle; 15 to 35 yrs old testicular torsion − Twisting of the spermatic cord causing decreased blood flow to the testis Varicocele − Enlarged veins of the spermatic cord Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26 ANIMATIONS/SPEAK AND SPELL https://evolve.elsevier.com/objects/lafleur8e_v1/mod07/me dia/07s02l0206/07s02l0206p1.html https://evolve.elsevier.com/Courses/14615_sjohnson2458_1 001#/content/463633674?view=https:%2F%2Fevolve.elsevier .com%2Fobjects%2Flafleur8e_v1%2Fmod07%2F07s02l0303.h tml Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 27 THREADED CASE STUDY Frank confides to Dr. Kane, "Whenever I have any kind of problems like the ones I'm having now, I always think it could be cancer. I know that probably doesn't make much sense, but I can't help thinking about it because my brother Sam had testicular cancer when he was younger. And I'm older now, so I figure that my chances can only increase, right?" Actually, Frank is only partially right. Dr. Kane has ruled out any obstructions or disorders of the penis or urethra. Now she turns her attention to a possible prostate disorder as the key to Frank's symptoms. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 28 VARICOCELE Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29 HYDROCELE Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 30 PROSTATE CANCER Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 31 PROSTATE CANCER Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 32 PROSTATE CANCER Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 33 Syphilis. A) Treponema pallidum, organism responsible for syphilis viewed microscopically; B) Primary syphilis, depicting a syphilitic chancre. C) Secondary syphilis, depicting rash on palms of hands. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 34 Balanitis: inflammation of the glans penis Cryptorchidism: state of hidden testes Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35 THREADED CASE STUDY However, the penis may also be affected by structural abnormalities. For example, one of the first things Frank's physician does is check for phimosis(phim/o), a structural disorder in which the prepuce, or foreskin, fits so tightly over the glans penis that it cannot retract (see illustration). This condition can obstruct the flow of urine and lead to infection, because of the accumulation of secretions under the foreskin. "Still," Frank says, "I think I would have noticed if I had that." Phimosis is treated with circumcision, the surgical removal of the prepuce. Another disorder of the glans penis is a balanocele, or protrusion of the glans penis through a rupture of the prepuce. "This, too," Dr. Kane explains, "can interfere with the flow of urine." "Well, that is something I would have noticed by now,” says Frank. “Once you hit the locker rooms in junior high, you usually figure out if you've got something a little different." Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 36 CLICKER QUESTION Which of the following means discharge from the prostate gland? a) phimosis b) hydrocele c) prostatorrhea d) Prostatitis Answer) C Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 37 SURGICAL TERMS BUILT FROM WORD PARTS balanoplasty epididymectomy orchidectomy, orchiectomy orchidopexy, orchiopexy orchidotomy, orchiotomy orchioplasty Prostatectomy Prostatocystotomy Prostatolithotomy Prostatovesiculectomy Vasectomy Vasovasostomy Vesiculectomy Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 38 VASECTOMY 1. 2. 3. 4. Incision is made into the covering of the vas Vas is exposed Segment of vas is excised Vas is replaced and skin is sutured Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 39 SURGICAL TERMS NOT BUILT FROM WORD PARTS circumcision hydrocelectomy suprapubic prostatectomy transurethral incision of the prostate gland (TUIP) Transurethral microwave thermotherapy (TUMT) Transurethral resection of the prostate gland (TURP) Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 40 SUPRAPUBIC PROSTATECTOMY LARGE INCISION SURGERY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 41 LAPAROSCOPIC PROSTATECTOMY Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 42 TRANSURETHRAL RESECTION Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 43 THREADED CASE STUDY Results of Frank's PSA assay make Dr. Kane decide it's time to test him further for possible prostate cancer. Diagnosis of prostate cancer will be confirmed by biopsy of tissue from the gland. Frank will next undergo atransrectal ultrasound (TRUS), which uses sound waves to help visualize the prostate gland, to assess suspicious areas, and to guide placement of the biopsy needle. Dr. Kane has conducted a thorough physical assessment, including the digital rectal examination, which has revealed a unilateralenlargement of the prostate gland. Lab results also show that Frank's PSA level, which normally would measure 0 to 4 mg/L, is at 6. However, mild elevations in PSA can occur with other prostate disorders, so further tests are needed. The next challenge is to check Frank's levels of prostatic acid phosphatase (PAP). An elevated level of PAP specifically pinpoints cancer of the prostate. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 44 THREADED CASE STUDY Frank is back to discuss his test results. Let's briefly review his medical history. Earlier, we learned that Frank had had a vasectomy. In this procedure, the vas deferens is surgically closed of f for the purpose of sterilization. Analyzing the semen for the presence of sperm is a way to evaluate the ef fectiveness of this procedure. It is possible to reverse a vasectomy through a procedure called vasovasostomy, which is the creation of artificial openings between the once -severed ducts. The figure on the right illustrates a vasectomy procedure. After a biopsy of Frank's prostate tissue, Dr. Kane concludes that Frank is in the early stages of prostate cancer. Together, Frank and his physician will review his treatment options. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 45 CLICKER QUESTION Which of the following is the surgical removal of the foreskin of the penis? a) vasectomy b) vesiculectomy c) circumcision d) hydrocelectomy Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 46 FRANK Frank's surgery goes well. Afterward, Dr. Kane stops by to tell Frank's wife, Louisa, that there was absolutely no spread of the cancer to other tissues, and that Frank required no blood transfusions during the procedure. A full recovery is well underway by the time Frank goes home from the hospital two days later. Had Frank's PSA levels continued to rise —or had there been evidence of metastasis —Dr. Kane would have suggested adjuvant hormone therapy to minimize recurrence. However, there has been neither metastasis nor elevated PSA levels, so Frank is sent home with only some painkillers. At home, Frank complains of some urinary incontinence, but within a couple of weeks, this resolves. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 47 FRANK Frank has now had a complete recovery from his surgery and is back at work. "This week I've been working on the windows on the 42nd floor of a finance building," he says. "It sure is funny how some people are really drawn to watching us work. Doesn't bother me, though," he says. "I like being an entertainer." "The nice thing, though," he says, "is that I can choose my own antics now...I'm not going up and down that lift all day long! Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 48 SPEAK AND SPELL https://evolve.elsevier.com/Courses/14615_sjohnson2458_1 001#/content/463633674?view=https:% 2F%2Fevolve.elsevier .com%2Fobjects%2Flafleur8e_v1%2Fmod07%2F07s04l0103.h tml Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 49 CHAPTER 7 Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Lesson 7.2 50 OBJECTIVES Define, pronounce, and spell diagnostic terms related to the male reproductive system Define, pronounce, and spell complementary terms related to the male reproductive system. Interpret the meaning of abbreviations related to the male reproductive system. Interpret, read, and comprehend medical language in simulated medical statements and documents. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 51 DIAGNOSTIC TERMS NOT BUILT FROM WORD PARTS Diagnostic imaging transrectal ultrasound (TRUS) Laboratory prostate-specific antigen (PSA) semen analysis Other digital rectal examination (DRE) Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 52 COMPLEMENTARY TERMS BUILT FROM WORD PARTS andropathy aspermia oligospermia spermatolysis Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 53 COMPLEMENTARY TERMS NOT BUILT FROM WORD PARTS acquired immunodeficiency syndrome (AIDS) artificial insemination azoospermia chlamydia coitus condom ejaculation genital herpes gonads gonorrhea Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 54 COMPLEMENTARY TERMS NOT BUILT FROM WORD PARTS (CONT’D) heterosexual homosexual human immunodeficiency virus (HIV) human papillomavirus infertility orgasm puberty sexually transmitted disease (STD) sterilization syphilis trichomoniasis Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 55 LIST OF MALE AND FEMALE SEXUALLY TRANSMITTED DISEASES acquired immunodeficiency syndrome human immunodeficiency virus infections syphilis genital herpes venereal warts (human papilloma virus) gonorrhea chlamydia trichomoniasis cytomegalovirus infections Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 56 ABBREVIATIONS AIDS BPH DRE ED HIV HPV PSA RP STD TRUS TUIP TUMT TURP Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 57 CLICKER QUESTION Which of the following is an STD? a) orgasm b) digital rectal exam c) coitus d) chlamydia Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 58 INTERACT WITH MEDICAL RECORDS CHIEF COMPLAINT: Severe lower abdominal pain and the inability to void for the past 12 hours. PRESENT ILLNESS: Andrew Nguyen is a 75-year-old Asian-American man who came into the emergency department at 3 am stating that he was in great p ain and could not urinate. He had not been seen by a physician for several years but claimed to be in good health except for “a little high blood pressure. ” The patient reports urinary frequency, nocturia x2, hesitancy, intermittency, and diminished force and caliber of the urinary stream. He also has post-void dribbling and the sensation of not having completely emptied the bladder. Earlier today, he had hematuria at the end of urination. MEDICATION ALLERGIES: None CURRENT MEDICATIONS: Benadryl 25 mg. at bedtime. PHYSICAL EXAM: Temperature 98.6ºF. Blood pressure 140/90. Pulse 98. Respirations 24. Palpation of the abdomen shows a suprapubic mass Approximately three fingerbreadths below the umbilicus, dull to percussion, and slightly tender. IMPRESSION: Urinary bladder distention caused by urinary outlet obstruction, probably from benign prostatic hyperplasia. PLAN: Indwelling Foley catheter for relief of urinary obstruction. Urology consult. Copyright © 2012, 2009, 2005, 2002, 1998, 1994, 1989, 1985 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 59