3.1 mens health - urology Flashcards
what is phimosis? what is the best treatment?
when the prepuce (foreskin) cannot be fully retracted in adulthood
normal in childhood till you reach about 17
best treatment = circumcision
what complications can occour as a result of phimosis?
- poor hygiene = more STDS
- pain on intercourse, splitting/bleeding
- balanitis (inflamed glans)
- posthitis (inflamed foreskin/prepuce)
- paraphimosis
what is paraphimosis and what are the commonest causes?
the painful constriction of the glans penis by the retracted prepuce (foreskin) proximal to the corona
needs reduction immediately as can lead to gangrene/necrosis of glans penis
causes:
- phimosis
- catheterisation (esp elderly)
- penile cancer
what type of cancer Is penile cancer?
a squamous cell carcinoma
what are the risk factors for penile cancer?
- HPV 16 and 18
- phimosis - poor hygiene and smegma
what are the causes for adult circumcision?
recurrent balanitis
phimosis
recurrent paraphimosis
penile cancer
what differential diagnoses can you get for acute scrotal pain?
- testicular torsion
- epididymitis (UTI/STI/Mumps)
- trauma
- uteric calculi
what history do you typically get with testicular torsion?
- usually younger patient (under 30)
- sudden onset
- unilateral pain
- nauseated/vomit
on examination
- tender testis
- lies high in scortum with horizontal lie
what is the typical history for epididymo-orchitis?
Age
- 20-40/50 = STI (esp chlamydia)
- 40/50+ = UTI (esp. e.coli
- gradual onset
- usually unilateral
often recent history of UTI, unprotected intercourse, catheter mumps
what would you see on examination for epididymo-orchitis?
- may be pyrexial, can be septic
- scrotum erythematous
- testis enlargement, tender
- fluctuant areas may represent abscess
- may reactivate hydrocele
what is a necrotic area of scrotal skin called?
fourniers gangrene (big in diabetes)
what examinations would you do for epididymo orchitis?
- blood (FBC,U&E, culture if septic)
- urine
- radiology (scrotal USS for abscess)
what treatment would you take for epididymo orchitis
abcess
fourniers gangrene
epididymo orchitis - antibiotics
abscess - surgical drainage and antibiotics
fourniers gangrene - emergency debridement and antibiotics
what is the typical history with a testicular tumour?
- painless
- teratoma/seminoma in men below 45 (risk - history of undescended testis)
- older men (could be lymphoma)
what is the history of hydrocele in adults?
- slow/sudden onset
- uni/bilateral swelling
what is urinary retention?
inability to pass urine
what can cause urinary retention?
- BPH in transitional zone
- Phimosis/ urethral stricture
- constipation
- UTI
- Drugs e.g anticholinergics
- following surgery
- neurological
what treatment strategies are used for urinary retention?
Acute
- painful
- relieve with catheter
chronic
- painless/less painful
- self catheterisation is learnt
- may have kidney insult
acute on chronic
- long term catheter/surgical intervention
what are the possible causes of lower urinary tract symptoms?
- irritative
- overactive bladder
- low compliance of bladder e.g scarred
- polyuria
What zone of the prostate can be palpitated in DRE?
the peripheral zone
most prostate cancers start here
what zone of the prostate increases in size in BPH?
transitional zone, gets bigger with age
what could be some physical obstructions to bladder outflow?
phimosis
urethral strictures (spraying of urine. the more distal the stricture, the more likely spraying)
BPH
what tests would you do if someone presented to you with lower urinary tract symptoms?
DRE
palpable bladder?
dipstick - UTI/blood
consider PSA
why is PSA unreliable?
can’t measure after
- ejaculation
- till a few days post DRE
- till after infection if they are ill
all these things will raise it. Also, PSA raises with age anyway as you get BPH as you age.
how can a patient manage BPH (LUTs) (primary care)?
lifestyle
- reduce caffeine intake
- avoid fizzy drinks
- don’t drink more than 2.5 L a day
treatment
- alpha blockers relax smooth muscle in prostate and bladder neck = rapid symptom relief
- 5 alpha reductase inhibitors shrink prostate by androgen deprivation. slower symptom relief than alpha blocker and slow progression, but reduces risk of retention.
what are some LUTs?
Lower urinary tract symptoms (LUTS) include voiding or obstructive symptoms such as hesitancy, poor and/or intermittent stream, straining, prolonged micturition, feeling of incomplete bladder emptying, dribbling, etc, and storage or irritative symptoms such as frequency, urgency, urge incontinence, and nocturia.
what can be done to treat BPH LUTs in secondary care?
surgical resection of prostate done transurethrally
what are the side effects of 5 alpha reductase inhibitors?
low BP
erectile dysfunction
