4 Men's Health Urology Flashcards
Define phimosis.
What is the incidence of phimosis in the adult population?
Foreskin (prepuce) cannot be fully retracted in adult
Incidence= 1% in adult non-circumcised population
At what ages is phimosis physiological?
State some of the consequences/complications of phimosis. (8)
-
Balanitis Xerotica Obliterans (BXO)
- = male version of Lichen sclerosus is a skin condition that causes itchy white patches on the genitals or other parts of the body
-
Paraphimosis
- Manage to retract foreskin but can’t get it back again
What is paraphimosis?
Give the 3 commonest causes of it.
Painful constriction of glans penis by the retracted prepuce proximal to the corona
Causes:
- Phimosis
- Catheterisation (esp in elderly)
- Penile cancer
What is the best treatment for phimosis?
Circumcision s
What is the best treatment for paraphimosis?
- Needs reduction
- This is usually achieved manually
- Occasionally dorsal slit may be necessary- to relieve oedema
- Done under local anaestetic
How prevalent is penile cancer? What are the risk factors?What is the prognosis like?
(Squamous cell carcinoma)
Prevalence: 350 new cases/yr in UK
Risk factors: Phimosis- hygiene, HPV 16 &18
If untreated most die within 2 yrs (important not to miss)
What are the key indications for circumcision? (think paediatric and adult)
Balanitis xerotica obliterans= chronic, inflammatory condition- white patches on genitals
Give some causes of acute scrotal pain.
- Testicular torsion
- Epididymitis, Orchitis
- UTIs
- STIs
- Mumps (bilateral)
- Torsion of hydratid of morgagni (remnant of mullerian duct)
- Trauma
- Ureteric calculi (rarely)
What history might you expect for a case of testicular torsion?
- Younger patient <30yrs
- Sudden onset
- Unilateral pain
- Nausea/vomiting (often NO LUTS)
State 2 examination findings for testicular torsion.
- Testis= very tender
- Testis= lying high in scrotum with horizontal lie
What needs to be done if you suspect testicular torsion in a patient?
Patient needs emergency scrotal exploration- ideally within 6 hrs
DO NOT waste time getting investigations eg ultrasound
What history might you expect for a patient who has epididymo-orchitis?
What examination findings are there likely to be with epidydymo-orchitis?
Fournier’s gangrene- high mortality- high spread rate- can spread to abdomen
What investigations can be done into epididymo-orchitis?
How is epididymo-orchitis treated? (how would it be treated if an abscess develops/fournier’s gangrene develops?)
A patient presents with a scrotal lump. What key questions should we be asking (history/examination)?
History:
- Is it painful?
- How quickly has it appeared?
Give some differential diagnoses for each of the following:
- Painless, non tender scrotal lumps
- Painless/aching at end of day, non tender lumps
- Painful, tender
- Painless, non tender scrotal lumps
- Testicular tumour
- Epididymal cyst
- Hydrocele
- Reducible inguino-scrotal hernia
- Painless/aching at end of day, non tender lumps
- Varicocele
- Painful, tender
- Epididymitis
- Epididymo-orchitis
- Strangulated inguino-scrotal hernia
What history might you expect for a patient with a testicular tumour? What are you likely to find on examination?
- Usually painless
- Men <45yrs- germ cell tumour (seminoma/teratoma)
- Older men- lymphoma?
Examination:
Body of testis= abnormal, can ‘get above’ lump
How does a hydrocele present?
- Onset
- Swelling?
- Examination?
Hydrocele:
- Slow/sudden onset
- Uni/bilateral scrotal swelling
- Examination:
- Testis not palpable separately
- Can ‘get above’ swelling
- Swelling transilluminates
Is an epididymal cyst usually painful? What is it like on examination?
How does a varicocele present? (History and examination)
History:
- Dull ache- at end of day
- Left more than right affected
- Reduced fertility
Examination:
- Bag of worms above testic
- NOT tender
- Palpable abdominal/renal mass
How are each of the following treated:
- Testicular tumour
- Epididymal cyst
- Adult hydrocele
- Varicocele
- Inguino-scrotal hernia
- Testicular tumour
- Inguinal orchidectomy
- Epididymal cyst
- Excise if large, reassure
- Adult hydrocele
- Reassure
- Surgical removal if large/symptomatic
- Varicocele
- Radiological embolisation if:
- Symptomatic
- Infertility risk (growth of testis affected is present in adolescence
- Radiological embolisation if:
- Inguino-scrotal hernia
Give some causes of urinary retention in males.
- Meatal stenosis/phimosis/urethral stricture
- Prostatic enlargement
- BPH
- Cancer
- Constipation
- UTI
- Drugs (anticholinergics)
- Over distension (too many fluids eg alcohol)
- Following surgery (anaesthetic)
- Neurological
How can urinary retention be treated? (think acute, chronic, acute on chronic)
Catheterise
- Acute:
- Trial without catheter after addressing exacerbating factor
- Chronic:
- Learn to self catheterise
- Acute on chronic:
- Long term catheter or surgical intervention
What is the diagnosis for an older man with nocturnal enuresis until proven otherwise?
Chronic retention with overflow incontinence until proven otherwise
What types of lower urinary tract symptoms could a male patient present with?
- Voiding (suggestive of bladder outflow obstruction)
- Hesitancy
- Poor flow
- Post micturition dribbling
- Storage
- Frequency
- Urgency
- Nocturia
Give some causes of storage lower urinary tract symptoms.
eg
Frequency
Urgency
Nocturia
Give some causes of voiding lower urinary tract symptoms in men.
(Spraying of urine suggests stricture)
How is an assessment of LUTS made in primary care?
How is BPH managed in primary care? (3)
- Lifestyle
- Reduce caffeine
- Avoid fizzy drinks
- Alpha blockers
- Relax smooth muscle
- 5alpha-Reductase Inhibitors (5ARIs)1.
How is BPH managed in secondary care? (2)
- Flow rate measured before considering surgery
- Surgical - TURP
