3.1 mens health - urology

Question 1

what is phimosis? what is the best treatment?

Answer 1

when the prepuce (foreskin) cannot be fully retracted in adulthood

normal in childhood till you reach about 17

best treatment = circumcision

Question 2

what complications can occour as a result of phimosis?

Answer 2

• poor hygiene = more STDS
• pain on intercourse, splitting/bleeding
• balanitis (inflamed glans)
• posthitis (inflamed foreskin/prepuce)
• paraphimosis

Question 3

what is paraphimosis and what are the commonest causes?

Answer 3

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

Question 4

what type of cancer Is penile cancer?

Answer 4

a squamous cell carcinoma

Question 5

what are the risk factors for penile cancer?

Answer 5

• HPV 16 and 18

- phimosis - poor hygiene and smegma

Question 6

what are the causes for adult circumcision?

Answer 6

recurrent balanitis
phimosis
recurrent paraphimosis
penile cancer

Question 7

what differential diagnoses can you get for acute scrotal pain?

Answer 7

• testicular torsion
• epididymitis (UTI/STI/Mumps)
• trauma
• uteric calculi

Question 8

what history do you typically get with testicular torsion?

Answer 8

• usually younger patient (under 30)
• sudden onset
• unilateral pain
• nauseated/vomit

on examination

• tender testis
• lies high in scortum with horizontal lie

Question 9

what is the typical history for epididymo-orchitis?

Answer 9

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

Question 10

what would you see on examination for epididymo-orchitis?

Answer 10

• may be pyrexial, can be septic
• scrotum erythematous
• testis enlargement, tender
• fluctuant areas may represent abscess
• may reactivate hydrocele

Question 11

what is a necrotic area of scrotal skin called?

Answer 11

fourniers gangrene (big in diabetes)

Question 12

what examinations would you do for epididymo orchitis?

Answer 12

• blood (FBC,U&E, culture if septic)
• urine
• radiology (scrotal USS for abscess)

Question 13

what treatment would you take for epididymo orchitis
abcess
fourniers gangrene

Answer 13

epididymo orchitis - antibiotics

abscess - surgical drainage and antibiotics

fourniers gangrene - emergency debridement and antibiotics

Question 14

what is the typical history with a testicular tumour?

Answer 14

• painless
• teratoma/seminoma in men below 45 (risk - history of undescended testis)
• older men (could be lymphoma)

Question 15

what is the history of hydrocele in adults?

Answer 15

• slow/sudden onset

- uni/bilateral swelling

Question 16

what is urinary retention?

Answer 16

inability to pass urine

Question 17

what can cause urinary retention?

Answer 17

• BPH in transitional zone
• Phimosis/ urethral stricture
• constipation
• UTI
• Drugs e.g anticholinergics
• following surgery
• neurological

Question 18

what treatment strategies are used for urinary retention?

Answer 18

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

Question 19

what are the possible causes of lower urinary tract symptoms?

Answer 19

• irritative
• overactive bladder
• low compliance of bladder e.g scarred
• polyuria

Question 20

What zone of the prostate can be palpitated in DRE?

Answer 20

the peripheral zone

most prostate cancers start here

Question 21

what zone of the prostate increases in size in BPH?

Answer 21

transitional zone, gets bigger with age

Question 22

what could be some physical obstructions to bladder outflow?

Answer 22

phimosis
urethral strictures (spraying of urine. the more distal the stricture, the more likely spraying)
BPH

Question 23

what tests would you do if someone presented to you with lower urinary tract symptoms?

Answer 23

DRE
palpable bladder?
dipstick - UTI/blood
consider PSA

Question 24

why is PSA unreliable?

Answer 24

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.

Question 25

how can a patient manage BPH (LUTs) (primary care)?

Answer 25

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.

Question 26

what are some LUTs?

Answer 26

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.

Question 27

what can be done to treat BPH LUTs in secondary care?

Answer 27

surgical resection of prostate done transurethrally

Question 28

what are the side effects of 5 alpha reductase inhibitors?

Answer 28

low BP

erectile dysfunction