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Men's Health Module > BPH, Urethra & Penis Disorders, Scrotal Mass, Torsion > Flashcards

BPH, Urethra & Penis Disorders, Scrotal Mass, Torsion Flashcards

1
Q

Function of the prostate

A
  • gland that makes fluid for ejaculation

- produces PSA protein

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2
Q

Why are glands hard to treat with antibiotic?

A

No blood flow

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3
Q

Lab to screen for prostate cancer

A

PSA

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4
Q

Causes of elevated PSA

A

enlarged prostate, infection, prostate cancer

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5
Q

Function of ejaculatory duct

A

carries sperm from testes

fluid from seminal vesicles and fluid from prostate

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6
Q

testes mainly composed of what 2 things

A

sperm and testosterone

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7
Q

vasectomy destroys what structure

A

vas deferens

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8
Q

Most common benign tumor in men

A

BPH

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9
Q

Elevated risk of BPH begins at what age?

A

40

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10
Q

Location of BPH

A

around urethra - transition zone of prostate

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11
Q

Why do rectal exam for prostate cancer?

A

cancer most commonly occurs in peripheral zone of prostate on rectal/posterior side

*may miss BPH

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12
Q

2 categories of BPH symptoms and how they are caused

A

obstructive - mechanical (BOO) or dynamic (adrenergic tone)

irritative - detrusor muscle hypertrophy and hyperplasia

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13
Q

irritative symptoms of BPH

A
  • Increased frequency
  • Urgency and difficulty postponing urination
  • Discomfort when urinating
  • Nocturia
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14
Q

obstructive symptoms of BPH

A 
Hesitation
Straining when urinating
Weak or intermittent stream
Sense that bladder hasn't emptied completely
Dribbling
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15
Q

DDX of voiding complaints in males

A

Urethral stricture/bladder neck contracture
Urinary tract infection
Carcinoma of the bladder (hematuria resistant to abx gets urology referral)
Neurologic disease
Diabetes mellitus

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16
Q

suspected BPH lab work-up

A

serum creatinine

look for infection and hematuria

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17
Q

imaging of kids with UTI

A

< 2 yrs old
any boy
any GU anomalies
any child with recurrent (>3/yr)

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18
Q

Man with hematuria needs what imaging?

A

CT urogram

Refer to urology

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19
Q

Man with elevated creatinine needs what imaging?

A

renal/bladder US

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20
Q

How to manage BPH with IPSS score 0-7 (mild sx’s)?

A

watchful waiting

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21
Q

How to manage BPH with IPSS score +7 (mod to severe sx’s)?

A

Nonselective α-Blockers
- Terazozin (Hytrin)

Selective α1a-receptor blockers
- Tamsulosin (Flomax)

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22
Q

MOA of alpha blockers in BPH

A

relaxation of prostate smooth muscle (rich in adrenergic nerve supply)

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23
Q

MOA of 5α-reductase inhibitor in BPH

A

Blocks conversion of testosterone to dihydrotestosterone (DHT)

treats prostate epithelium

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24
Q

5α-reductase inhibitor rare side effects

A

ED, decreased libido, gynecomastia

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25
Q

Examples of 5α-reductase inhibitor

A

Dutasteride (Avodart)

Finasteride (Proscar, Propecia)

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26
Q

1st line therapy for BPH in man with moderate to severe symptoms

A

alpha blocker

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27
Q

Cons of 5-alpha-reductase inhibitors

A

need 6 month therapy to see maximum benefit

only helpful in very large prostate (> 40 cm3)

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28
Q

When should 5a-reductase inhibitor be added to alpha blocker in BPH therapy?

A

Very large palpated prostates

Hemorrhagic prostates

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29
Q

What plant has been claimed to treat BPH, but has no research to support?

A

Palmetto berry

30
Q

Absolute surgical indications of BPH

A

Urinary retention refractory to medical management

Recurrent urinary tract infection

Recurrent gross hematuria

Renal insufficiency

31
Q

Eval of hemorrhagic prostates

A
  • Image upper tracts

- Have urology r/o bladder cancer with cystoscopy

32
Q

Gold standard surgery for BPH

A

Transurethral resection of the prostate (TURP)

33
Q

Hypospadias

A

Failure of urethral folds to close at tip of penis

Occurs in 1 in every 300 male children

34
Q

When to refer hypospadias?

A

bothers patient

complaints of diminished stream

35
Q

urethral stricture and meatal stenosis symptoms

A

Decrease in urinary stream
Spraying or double stream
Postvoiding dribbling.

36
Q

2 risk factors of urethral stricture

A

trauma and infection

37
Q

meatal stenosis

A

scarring of urethral opening at external meatus

38
Q

phimosis and paraphimosis

A

problems with foreskin

tight over tip is phimosis or tight farther down past glans is paraphimosis

39
Q

Treatment of paraphimosis

A

Usually treated by firmly squeezing glans for 5 minutes to reduce the tissue edema; then skin drawn forward over the glans

Antibiotics

40
Q

Signs of Peyronie’s Disease

A

Curvature of penis and painful erection

No pain when penis is in non-erect state

41
Q

Pathophysiology of Peyronie’s Disease

A

fibrous plaque involving tunica albuginea

~Dupuytren’s contracture

42
Q

Peyronie’s Disease treatment and management

A
  • Observation; spontaneous remission occurs in about 50%
  • Vit E may be tried but generally don’t work
  • Refer if unable to perform intercourse
43
Q

What is Priapism?

A

prolonged erection

44
Q

Main concern of priapism?

A

impotence

45
Q

2 types of priapism?

A

ischemic: obstruction of venous drainage; painful; emergency!

non-ischemic: too much blood flow to penis; not painful; no treatment

46
Q

Drug that causes ischemic priapism

A

Trazodone

47
Q

Treatment of priapism in sickle cell patient

A

treat sickle cell and priapism will go away

massive blood transfusions, exchange transfusions, or both

48
Q

Causes of ischemic priapism

A

30-50% idiopathic

Meds for ED
Psychotropic drugs - Trazodone!
Sickle cell disease

49
Q

Causes of non-ischemic priapism

A

Trauma
Pelvic arteriovenous malformations (AVMs)
Acute spinal cord injury

50
Q

Treatment of ischemic priapism

A

MEDICAL EMERGENCY

Narcotic analgesia
Initial tx with Terbutaline (adrenergic agonist)
Corporal irrigations
Surgical shunt

51
Q

collection of peritoneal fluid between layers of tunica vaginalis

A

hydrocele

52
Q

Always get _____ to eval scrotal mass.

A

U/S

53
Q

Hydrocele may be reaction as a result of what?

A

testicular cancer, torsion, epididymitis

54
Q

Transillumination of hydrocele differentiates scrotal mass from _______.

A

varicocele

55
Q

What differentiates a complex hydrocele from a simple one?

A

septations on US

56
Q

Treatment of hydrocele

A

NO ASPIRATION

simple - observe
complex - refer for surgery

57
Q

What is epididymis cyst and spermatocele?

A

Painless fluid accumulation on sup/post to testes

clear fluid -> epididymis cyst
clear fluid + dead sperm -> spermatocele

58
Q

Treatment of epididymis cyst and spermatocele?

A

No treatment unless bothersome

59
Q

Male comes in with no sx’s but unable to have children. On palpation of scrotum feels like “bag of worms”

A

varicocele

60
Q

In what position should patient be in to eval for varicocele?

A

Both supine and upright

Perform Valsalva maneuver while standing to accentuate dilation

61
Q

Right testicular vein drains into ________ and left testicular into ________.

A

vena cava

renal vein

62
Q

Get _____ for all right sided varicoceles.

A

CT scan

63
Q

“bellclapper deformity”

A

testicular torsion in which testis rotates freely within tunica vaginalis

64
Q

Risk factors for testicular torsion

A

trauma
increased testicular volume associated w/ puberty
testicular tumor
history of cryptorchidism

65
Q

What PE most sensitive to testicular torsion?

A

absence of cremaster reflex

66
Q

Testicular torsion occurs most commonly in what age group?

A

men younger than 25

67
Q

Testicular pain with “blue dot sign” and 2-3 mm nodule

A

torsion of appendix testis

68
Q

How soon should testicular torsion be treated to salvage testicle?

A

< 6 hrs from sx onset

69
Q

Testicular torsion treatment

A

Immediate surgical exploration and testicular salvage or orchiectomy

Manual detorsion is quick and non-invasive (rotate away from midline, 25% success rate)

70
Q

DDX painful testicular swelling

A 
Epididymitis
Orchitis/Mumps
Testicular torsion
Torsion of Appendix testes
Incarcerated Inguinal Hernia
71
Q

DDX painless testicular swelling

A 
Hydrocele
Varicocele
Unincarcerated Inguinal Hernia
Nephrotic Syndrome
Testicular Tumors
Fragile-X syndrome
Klinefelter Syndrome

Men's Health Module (10 decks)

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