bladder and urethra; male reproduction Flashcards
What are potential treatments for urge incontinence?
antimuscarinics- oxybutynin, tolerodine, solifenacin
What is overflow incontinence? What are the causes?
bladder outlet obstruction, impaired detrusor contractility, neurogenic bladder leads to continuous leakage of urine due to incomplete bladder emptying
What testing should be performed for overlow incontinence?
automated bladder scanner or catheterized postvoid residual to see if there is full bladder after voiding
What is the treatment for overflow incontinence?
decompress bladder with foley catheter, treat underlying obstruction surgically, treat detrusor underactivity with sacral nerve stimulation, intermittent self-catheterization
Which is more common: bacterial or non-bacterial prostatitis?
non-bacterial; note that prostatitis is a risk factor for prostate cancer
What is the treatment for prostatits?
TMP-SMX for 4-6 wks; treat for STIs in sexually active males
What are the treatments for BPH?
terazosin, tamsulosin (alpha 1 blockers); finasteride (5 alpha reductase inhibitor; surgery possible if refractory to medical therapy
What is the appropriate work-up for BPH?
DRE and UA. If blood in urine the patient must be evaluated for bladder cancer; if hard nodule on DRE, pt should be evaluated for prostate cancer.
Anatomically, where does prostate cancer typically develop?
peripheral zone
What treatments are available for prostate cancer?
- radical retropubic, perineal, laparascopic, or robotic prostatectomy, with retropubic used for more extensive tumors
- In early tumors, ok to use radiation therapy or brachytherapy instead
- follow-up with PSA to monitor recurrence and mets
- Antiandrogen therapy may be useful in metastatic disease or high grade disease
What are the common complications of radical prostatectomy?
-incontinence and impotence
What is the clinical presentation and what are the causes of epididymitis?
inflammation of the epididymis due to STIs, urinary reflux, or prostatitis
-epididymal pain relieved by SUPPORTING THE SCROTUM, dysuria, scrotal redness, and induration
What is the clinical presentation for testicular torsion? What is the “next steps”
- painful swollen testes, may have N/V/fever, superiorly displaced testes
- Next step: get ultrasound, then proceed to emergent surgical reduction (though OK to try manual detorsion first)
What should you look for on exam of a man presenting with infertility?
varicocele, undescended testes, penile defect
What are the main causes of impotence?
vascular, neurogenic or hormonal. look for changes in pulses/perfusion, anal wink reflex and parasthesias, and testicular atrophy or gynecomastia
