Internal genital examination

Male genital examinations include prostate examination, seminal vesicle examination, testicular examination, and the like. If the testicle is too small (less than 12 ml) or too soft, it means that the testicular dysplasia is unilateral. If the unilateral side is too small, it may be fertile. If there are small people on both sides, there may be no sperm in the semen. The same is true for the absence of testes (cryptorchidism) in the scrotum. Whether the epididymis has induration often means that there is inflammation or tuberculosis in the epididymis. The round mass is probably a semen cyst that can hinder the smooth flow of the epididymis. The epididymis is full and no sperm in the semen may be obstructive azoospermia. The presence or absence of varicocele is also an important test. Basic Information Specialist classification: male examination inspection classification: other inspection Applicable gender: whether the male is fasting: fasting Tips: Keep the testicles clean and clean before checking. Normal value 1. Normal adult male testicular tissue consists of refined tubules and interstitial. (1) The spermatic tubule contains spermatogenic cells (spermatogonial cells, spermatocytes, sperm cells, sperm, etc.) and supporting cells (Sertoli cells), which are present in the spermatogenesis process. Short, often difficult to see. The support cell is large in volume, and its cell body extends from the basement membrane to the small lumen surface, and has the functions of secretion, nutrition, phagocytosis, support of spermatogenic cells and release of sperm, which constitute a blood testis barrier. (2) The outer membrane of the conjunctiva is a thin and neat boundary membrane, also known as the lamina propria, which is divided into three layers. From the inside to the outside, there are no cell layer (basement membrane), myoblast layer, lymphatic endothelial cells and The fibroblast layer is a component of the blood testis barrier and has functions such as contraction, substance exchange, and phagocytosis. (3) The interstitial interstitial is loose connective tissue, which contains L~eydig cells, macrophages, blood vessels, lymphatic vessels, and fibrous tissues. 2, the size of the normal testicles are born to infants and children before the age of 12, the testes are in a relatively static developmental period, usually 1 to 4 ml. After the age of 12, entering the "publishing period of youth", the testicle volume increased rapidly. By the age of 18, 60 to 70% of men have reached more than 16.5 ml. The testicular volume in adulthood is 16-25 ml, with an average of 19.8 ml, which is slightly smaller than Caucasians and blacks. After the age of 60, men enter the stage of aging, and the testicular volume gradually shrinks. After the age of 70, the testicular product has shrunk to less than 16 ml. 3, normal prostate like chestnut size, indicating regular, no induration and flexible areas. The PSA content in the serum of normal people at the time of blood PSA examination is 4 nanograms per milliliter. Clinical significance Abnormal results: 1, testicular biopsy (1) The seminiferous epithelial-shedting type of fine-tuned tubules expand, and most or all of the lumens are filled with exfoliated spermatogenic cells, and the lumen disappears, often accompanied by changes in the membrane and small blood vessels of different degrees. (2) spermatogenesis block or maturation disorder The spermatogenic process is often blocked in the spermatocyte or sperm cell stage, often accompanied by spermatogenic cells, membrane and blood vessel changes, which is a differentiation abnormality of the spermatogenic process. (3) The spermatogenic cells and spermatozoa of all levels of spermatogenic function are uniformly reduced, and a large number of vacuoles are formed in the supporting cells, and the lumen is dilated. It can be seen that the immature spermatogenic cells, the membrane and the blood vessels that have shed early are not significantly changed. (4) The transparent degenerative fine tubules are widely hyaline degeneration, atrophy, and stenosis of the lumen. In severe cases, "phantom tubules" are often accompanied by extensive fibrosis and vascular transparency. This is a manifestation of autoimmune response, which may be caused by non-specific inflammation, viral mumps with orchitis, drug effects, or may be the cause of unknown causes or other pathological damage. (5) Only support the cell syndrome, spermatogenic cells lack or disappear, only support cells, the small tubule diameter is small, the boundary membrane and interstitial lesions are serious, can be divided into 1 primary (innate Sexuality is caused by the undeveloped or unreduced germ cells in the yolk sac of the embryonic stage, and the testicular size and sexual characteristics are abnormal. 2 acquired (secondary) is the late result of various testicular lesions. (6) There are two or more types of mixed tissue changes, which are often difficult to distinguish between primary and secondary, which are characterized by epithelial shedding of spermatogenic cells, maturation disorders, and hyaline degeneration. In addition, there are testicular hypoplasia or developmental obstruction, such as the immature testis of Klinefelter syndrome, often manifested as small testicular, secondary sexual dysplasia, testicular lesions are consistent, may have chromosomal abnormalities, easy to diagnose. (7) The relationship between histological classification and prognosis of testicular biopsy. The spermatogenic epithelial shedding, the best prognosis, the lowering of spermatogenic function, the basis of treatment, transparency, only support cell syndrome, spermatogenic disorder, Klinefelter's sign, etc. The basis of treatment, poor prognosis. 2, testicular self-examination such as testicular abnormal peas or pigeon eggs size, no painful masses suggest that may develop testicular cancer. 3. When prostate cancer grows in the capsule, CT is difficult to diagnose, and it is only possible to diagnose when the invading capsule infiltrates into the surrounding adipose tissue. The performance of the prostate is irregular and the density is uneven. The anterior rectal wall and bladder wall can be infiltrated and the seminal vesicles disappear. CT can also detect lymph node metastasis and pelvic metastases. CT is helpful for the staging of prostate cancer. People who need to be examined: middle-aged and old men often have difficulty urinating. Sometimes they feel that urinary tract can not be emptied. Because the bladder can not be emptied, frequent urination occurs, especially the number of nocturia increases, urinating effort, urine output is obviously reduced, and urinary flow is not smooth. Patients and patients with azoospermia, testicular cancer, hydrocele or oblique sputum. Precautions Taboo before inspection: 1. Pay attention to the cleanliness and cleanliness of the testicles. 2, pay attention to the clean and clean hands when self-examination. Requirements for inspection: 1. Any local tension will cause the scrotum to contract, affecting the examination, and the scrotum skin is relaxed. It is easier to check, so doctors should try to relax as much as possible. 2, generally do not advocate wearing gloves when self-examination, because it is not accurate after wearing gloves. Inspection process First, the method of testicular biopsy: Incision biopsy After disinfection of the scrotal skin, local anesthesia, fixed testicles by hand, tighten the surface of the scrotum skin, select the site with less blood vessels, make an incision of about 1 ~ 2cm, the incision vertically through the skin, the intima and the sheath. The testicular white film is made into a "∧"-shaped incision, about 0.5cm long, gently squeeze the testicles to expose the testicular parenchyma, take a little testicular tissue as a specimen, and send the pathology for pathological examination. Strict disinfection during surgery, careful operation, generally does not cause infection, hematoma or pain. In a small number of patients, the sperm count decreases in the short term after taking testicular tissue, and it takes about 4 months to gradually recover. Cut the skin and testicles, take out the seminiferous tubules in the testicles, so that the extraction is very complete, can accurately reflect the spermatogenic function of the testis, without the error of inspection, the result is reliable. However, this method of examination is traumatic, and it is necessary to make the skin, the incision of the testicular tunica, and suture removal after surgery, which brings more pain and inconvenience to the patient. Although this method of examination is accurate, it is difficult to carry out clinically because of the pain and the patient's fear of surgery. Puncture method Using a needle and needle for puncture, after routine disinfection of the skin and anesthesia, puncture the needle through the scrotal skin puncture into the testicle, withdraw the needle core, aspirate the needle tube to obtain a little testicular tissue, and then pull out the puncture needle, if the tissue is extracted once If it is too small, it can be pumped several times in different parts. After the end, the puncture site is wrapped, the testicular tissue is sent for examination, the puncture site is wrapped, and the testicular tissue is sent for examination. Compared with the incision method, this method has less damage and less pain, and does not require suturing. Its deficiency is that needle aspiration cytology can only obtain a small number of tissue cells, and can not see the overall structure of the tissue, so it can not accurately reflect the testicular spermatogenesis. There are errors of false positives and false negatives. The results of the tests are not reliable and are easily misdiagnosed. Testicular biopsy puncture After disinfecting the skin with 1 ‰ 新洁尔, the spermatic nerve block anesthesia was performed with 2% or 1% procaine, 10 ml per side to reduce the discomfort during testicular fixation and extrusion. After fixing the testicles, disinfect the puncture site with iodine, infiltrate the anesthesia and deep anesthesia with avascular zone, and then use the vas deferens to remove the avascular zone into the skin and intima, and enlarge the piercing hole to about 0.7cm, deep into the testicular sheath. On the surface of the membrane, the tip of the peeling forceps is used to puncture the wall layer of the testis and the visceral layer (testis white membrane) to a depth of 0.5 cm, and then separated into 0.5-0.7 cm small mouth with a spreader, and the finger of the testicle is slightly squeezed. Testicles, so that the testicular tissue protrudes from the small mouth, quickly remove the stripping forceps in the testicles, use the ophthalmic surgery to cut the small test pieces of the testicles, and leave a biopsy. Rapid testicular biopsy This method is a new method after Director Yuan Yuqing further improved on the above traditional methods. Its operation has no trauma to the incision method, but the testicular tissue taken out is complete and can accurately reflect the spermatogenic function of the testicle. The specific operation is to use a special instrument to remove the intact testicular tissue without cutting the testicles. This has the advantages of small damage to the puncture method and the accuracy of the incision method. And to avoid the shortcomings of the above methods, this operation is fast (complete surgery within a few seconds, is one-hundredth of the time of routine testicular biopsy operation), less pain, no bleeding during surgery, no suture and suture removal, postoperative recovery Fast, get the completeness of the organization and fully comply with the medical examination requirements. Surgical procedure for rapid biopsy: 1. Prepare the skin in a regular operating area and disinfect it. 2. Fix the testicles. The doctor should select one side of the testicle as needed, apply the left middle finger and the ring finger, and fix the testicle firmly with the thumb. The epididymis end of the testicle should be under the hand, exposing the testicle to the thumb and index finger. Fix the testicles examined by hand to tighten the surface of the scrotum skin. 3. Local anesthesia. Choose a relatively avascular zone, local anesthesia. 4, surgery. After successful anesthesia, the special testicular biopsy inserting step is used to quickly remove the seminiferous tubules in the testis, and then the specimen is placed in the fixative solution, and the site of the operation is pressed to stop bleeding, and the amount of bleeding is very small, or even no bleeding. No suture, postoperative dressing. 5, postoperative treatment. The oral anti-inflammatory drug was applied for 3 days, the tape was removed on the 3rd, and no incision was left after the operation. No obvious sequelae were found. 6, specimen observation. Analyze in combination with the patient's condition. Second, testicular self-examination: Hold the testicles on one side with both hands, touch the thumb and move the other fingers to check for a lump or touch, and the appearance is different. When self-testing the testicles, first pay attention to the size of the testicles. The adult testicle volume should be above 8 ml, and the Chinese average testicular size is 12 ml. If the testicles of an adult are less than 8 ml, there may be a testicular atrophy. When the boy is 10 years old, the testicular volume should generally reach 4 ml. Less than 4 ml should be considered abnormal. Next, check the testicles with a touch. The normal state of the testicles should be smooth, full of texture, no tenderness, and clear boundary with the epididymis. If the testicle is found to increase in the short term and there is no tenderness, it may be testicular cancer; if the testicle has pain under the touch, it indicates inflammation of the testicle; if the scrotum is enlarged and the testis and epididymis are not touched, it may be a sheath. Membrane effusion, that is, fluid accumulation in the scrotum; if the epididymis is painful or swollen, it indicates that the epididymis has lesions. In addition, if the scrotum and testicles have a sense of bulging or falling pain, they will be aggravated during long-term standing and long-distance walking; if the symptoms will be alleviated or disappeared when lying down, it may be varicocele. Typical varicocele can see twisted and dilated veins under the skin of the scrotum; or when touched by hand, it can feel a cluster of vasophores that expand. Primary varicocele can be reduced or disappeared after lying down. If the symptoms are still not improved in the supine state, there may be compression of the tumor and other lesions. Once the above symptoms appear, it is best to go to the hospital for treatment as soon as possible. Third, rectal examination 1. Patients take more knee chest or lithotomy position. If the patient's condition is severe or weak, the lateral position can also be taken. 2. The physician wears gloves or finger cots and applies Vaseline or liquid paraffin to the end. 3. When taking the chest position, support the left shoulder or hip of the patient with the left hand, and gently massage the anus at the mouth with the right hand. Detection of early prostate lesions allows the patient to adapt to avoid sudden anal sphincter tension. Then slowly insert the finger into the anus. When the fingertip enters the anterior wall of the rectum about 5cm away from the anus, the prostate can be touched. Pay attention to the shape and change of the prostate. 4. When massaging the prostate, use the distal end of the finger to massage inward and forward, about 4-5 times on each side, then move the hand to the upper part of the gland and squeeze it downwards, so that the prostatic fluid can be from the urethra. Discharge, leave the specimen for inspection. There are many items for internal genital examination. Only a few of them are listed here. You can view the examinations of internal genital examination in detail. Not suitable for the crowd No taboos. Adverse reactions and risks No complications.