Genitourinary #2 Flashcards
Etiologies of acute prostatitis
- > 35 years: E. Coli
- < 35 years: Chlamydia and Gonorrhea
MCC of CHRONIC prostatitis is
E. Coli
Symptoms of prostatitis
- Irritative voiding symptoms
- Obstructive symptoms: hesitancy, incomplete emptying
- Fever, chills, perineal pain, lower back pain
- Recurrent UTIs, intermittent dysfunction
Describe the prostate in prostatitis
- Boggy prostate
- Exquisitely tender boggy (acute)
- Nontender and boggy (chronic)
Diagnostics for prostatitis
- UA and urine culture
- Avoid prostatic massage in acute because it may cause bacteremia
Treatment for prostatitis
- > 35 years: Fluoroquinolones or Bactrim
- < 35 years: Ceftriaxone + Doxy or Azithromycin
Although the causes of epididymitis are the same as prostatitis, what are the symptoms?
- Localized testicular pain and swelling
- Gradual onset
- Groin, flank, or abdominal pain
- Positive Prehn Sign: relief of pain with scrotal elevation
- Positive (normal) Cremasteric reflex: elevation of testicle after stroke inner thigh
What is the best initial test for epididymitis and what do you see?
Scrotal US: enlarged epididymis, increased testicular blood flow
Treatment for epididymitis
- Scrotal elevation, cool compresses, NSAIDs
- < 35 years: Ceftriaxone + Doxy or Azithromycin
- > 35 years: Fluoroquinolones (Cipro, Oflox, Levo)
What are some common causes of Priapism?
- Idiopathic (MC)
- Sickle Cell Disease
- Trazodone, Alpha Blockers, Antipsychotics
- Cocaine, Marijuana, Alcohol
- Trauma
What is a diagnostic that can be done for priapism?
- Cavernosal blood gas
- Can also do doppler US
Management of low flow (ischemic) priapism
- Phenylephrine (intracavernosal injection)
- Needle aspiration
- Shunt surgery if not responsive to injection or needle aspiration
What happens in testicular torsion?
Spermatic cord twists and cuts off testicular blood supply
Symptoms of testicular torsion
- Abrupt onset of scrotal, inguinal, or lower abdominal pain
- N/v
- Negative Prehn
- Negative Cremasteric
Diagnostics for testicular torsion
- Clinical diagnosis
- Emergency surgical exploration (definitive)
- Testicular Doppler US
- Radionuclide scan (most sensitive but never used)
Management of testicular torsion
-Urgent detorsion and orchiopexy within 6 hours of pain onset
testicular cancer occurs in what age group normally
15-35
Risk Factors for Testicular Cancer
- Cryptorchidism
- Klinefelter Syndrome
- Hypospadias
- Caucasian
MC type of testicular cancer
Germinal cell tumors
Nonseminomas are associated with what characteristics?
- Increased serum alpha-fetoprotein and beta-HCG
- Resistance to radiation
Seminomas are associated with what characteristics?
- 4 S’s
- -Simple (lacks tumor markers)
- -Sensitive (to radiation)
- -Slower growing
- -Stepwise spread
Symptoms of testicular cancer
- Testicular mass MC (painless)
- Dull pain or testicular heaviness
- Firm, hard, fixed mass that does not transilluminate
Initial diagnostic of choice for testicular cancer
Scrotal US
What tumor markers are present in nonseminomas
-Increased alpha-fetoprotein and beta-HCG
Treatment for testicular cancer
- Stage 1: radical orchiectomy with retroperitoneal lymph node dissection
- High grade seminoma: Chemo followed by orchiectomy and radiation
A hydrocele is
Serous fluid collection within the layers of the tunica vaginalis of the scrotum
Symptoms of a hydrocele
- Painless scrotal swelling
- Dull ache or heavy sensation
- Translucency (transilluminates)
- Swelling worse with Valsalva
Initial test of choice for hydrocele
-Testicular US
Treatment for hydrocele
Watchful waiting and resolves within first 12 months of life
A spermatocele is
an epididymal cyst that contains sperm
What is on physical exam of a patient with a spermatocele
-Round, soft mass in head of epididymis superior, posterior and separate from the testicle freely movable mass that transilluminates
What is the MC surgically correctable cause of male infertility
Varicocele
Physical exam finding of a patient with varicocele
- Bag of worms feel superior to testicle
- Dilation worsens when patients upright or with Valsalva
Initial test of choice for Varicocele
US
Sudden onset of left-sided varicocele in an older man may be possibly due to
Renal cell carcinoma
Right-sided varicocele may be due to
Retroperitoneal or abdominal malignancy
Symptoms of a urethral stricture
Chronic obstructive voiding symptoms (weak urinary stream, recurrent UTIs)
MC type of bladder cancer
Urothelial (Transitional cell) Carcinoma
Risk Factors for bladder cancer
- Smoking (MC)
- Occupational exposures to dyes, leather, rubber
- Caucasian
- Males
- Cyclophosphamide
- Long term indwelling catheter use
Symptoms of bladder cancer
- Painless gross hematuria
- Dysuria, urgency, frequency
Gold standard diagnostic for bladder cancer
-Cystoscopy with biopsy
Treatment for bladder cancer
- Localized: Transurethral resection of tumor (electrocautery)
- Invasive: radical cystectomy, chemo, radiation
If the bladder cancer is recurrent and electrocautery is unsuccessful, what vaccine should be given?
Intravesicular BCG
Symptoms of BPH
- Irritative symptoms: increased frequency, urgency, nocturia
- Obstructive symptoms: hesitancy, incomplete emptying
Diagnostics for BPH
- DRE: uniformly enlarged, firm, nontender rubbery prostate
- PSA: Normal < 4
- UA: to look for hematuria
- Urine cytology
Medical treatment for BPH
- Alpha blockers (Tamsulosin, Terazosin)
- 5-alpha-reductase inhibitors (Finasteride)
Surgical management for BPH
-TURP: removes excess prostate tissue; may cause sexual dysfunction, urinary incontinence
MOA for Alpha-1 blockers
-Smooth muscle relaxation of prostate and bladder neck, leading to decreased urethral resistance, obstruction relief, and increased urinary outflow
Adverse effects of alpha-1 blockers
-Dizziness and orthostatic hypotension
MOA of 5-alpha reductase inhibitors
-Androgen inhibitor: suppresses prostate growth, reduces bladder outlet obstruction (size reduction and decreases need for surgery)
