Genitourinary and Reproductive

Question 1

Balantitis

Answer 1

Inflammation of the glans penis
Usually associated with foreskin inflammation (posthitis)
Accumulation under the foreskin (smegma), causing irritation of the glans
Phimosis, inadequate cleansing under the foreskin, skin disorders, and infections
Most commonly in men with poorly controlled diabetes mellitus and candidiasis
Treatment: Antimicrobial agents to treat infection; circumcision to prevent recurrences and to be considered after the inflammation has subsided

Question 2

Penile Cancer

Answer 2

Rare
Mostly squamous cell carcinomas
Risk factors: Human papillomavirus (HPV), smoking, psoriasis treated with a combination involving the drug psoralen and ultraviolet (UV) light
Often diagnosed in men older than 55 years of age
Thick white plaque (leukoplakia), typically involving the meatus
Penile carcinoma: Higher incidence in uncircumcised men
Treatment: Surgery, radiation, chemotherapy

Question 3

Priapism

Answer 3

Impaired blood flow to the corpora cavernosa
Failure of detumescence (or penile relaxation)…prolonged, painful erection
A urologic emergency
Can cause ischemia, fibrosis, impotence if persistent
Causes
Associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors or infections, or penile trauma in 40% of cases
Also associated with cocaine use

Question 4

Inguinal Hernia

Answer 4

Inguinal canal fails to close after testicular descent
Parietal peritoneum & intestine protrude through abdominal cavity
Portion of small bowel may become “strangulated” or “incarcerated” & and may obstruct vascular flow.

Question 5

Phimosis

Answer 5

tight foreskin from edema & erythema that may lead to scarring. Tight foreskin may interfere w/ cleaning…risk for balanitis/balanoprosthitis

Symptoms: Edema, erythema, and tenderness of the prepuce and purulent discharge
Treatment: Circumcision

Question 6

Paraphimosis

Answer 6

Foreskin is retracted and cannot be moved forward (reduced) to cover the glans.
Causes edema of the glans.
Treatment: Surgery.
Severe paraphimosis: Medical emergency.

Question 7

Varicocele

Answer 7

Inflammation and dilation of the veins in the spermatic cord
“Bag of worms”
Cause: Inadequate or absent valves in the spermatic veins
Treatment: Ligation of the spermatic vein or occlusion of the vein by percutaneous methods, such as balloon catheter and sclerosing fluids
Scrotal support: If disorder is mild and fertility is not an issue

Question 8

Hydrocele

Answer 8

Scrotal swelling caused by the collection of fluid in the tunica vaginalis
Imbalance between fluid secretion and reabsorption

Treatment
Usually not required unless disorder causes considerable physical discomfort or undesirable cosmetic appearance
For uncomplicated hydrocele: Aspiration of the fluid and injection of a sclerosing agent into the scrotal sac
Goals: To remove the hydrocele and to prevent recurrence by sclerosing or excising the tunica vaginalis

Question 9

Testicular Torsion

Answer 9

Twisting of testis and spermatic cord, resulting in ischemia
Rotation of a testis
Rotation, causing twisting of the blood vessels in the spermatic cord
Painful and swollen testis
May be spontaneous or follow physical exertion or trauma
Medical emergency

Treatment: If torsion cannot be reduced manually, then surgery must be performed within 6 hours after the onset of symptoms to preserve normal testicular function.

Question 10

Testicular Torsion S/S

Answer 10

Absent cremasteric reflex
N/V
Tachycardia
Pain radiating to inguinal area (usually sudden)
Redness & swelling
Testicle high in the scrotum

Question 11

Orchitis

Answer 11

Infection of testes. 
Causes:
GU tract, lymphatics, or bloodstream infections
Epididymitis
Result from complication of mumps

S/S:
Sudden onset after 3-4 days of mumps
Fever
Pain & swelling of involved testicle
Sequelae of mumps orchitis: STERILITY!

Question 12

Epididymitis

Answer 12

Is an inflammation of the epididymitis .
Is common in sexually active young men.
Pathogenic microorganism reaches the epididymitis by ascending the vas deferens from an already infected bladder or urethra.
Main symptoms: Pain and the Prehn sign
Treatment: Antibiotics, analgesics, ice, and scrotal elevation.

Question 13

Testicular Cancer

Answer 13

Is among the most curable of cancers.
Is common in men between 15 and 35 years of age.
Usually arise from germ cells
Risk factors
High androgen levels, genetic predisposition
History of cryptorchidism, trauma, or infection
Causes painless testicular enlargement.
Treatment: Is based on the type of tumor, stage of the disease, general health, and age.
Surgery
Radiation and chemotherapy, singly or in combination

Question 14

Prostatitis

Answer 14

Inflammation of the prostate

Acute bacterial infection: Ascending infection of the urinary tract
Symptoms: Signs of infection
Treatment: Antibiotics, analgesics, antipyretics, bedrest, adequate hydration; Foley catheter contraindicated

Chronic bacterial infection: Recurrent urinary tract symptoms and persistence of pathogenic bacteria
Treatment: Surgery

Question 15

BPH

Answer 15

Non-malignant, age-related enlargement of the prostate gland
Prostate enlargement compresses urethra
Causes alterations in urination
Weak stream
Urgency
Dysuria 
Post-void dribbling

Question 16

Risk Factors for BPH

Answer 16

Aging (thus, rare in males <40 years old)
Family Hx
African American
No evidence of increased or decreased risk with smoking, alcohol, or any dietary factors
Possible worsening of symptoms with abdominal obesity

Question 17

S/S for BPH

Answer 17

Gross hematuria

Obstructive symptoms:
Decrease force or caliber of stream
Hesitancy
Post-void dribbling
Sensation of incomplete bladder emptying
Overflow incontinence
Inability to voluntarily stop stream
Urinary retention

Irritative symptoms:
Frequency
Nocturia
Urgency
Urge incontinence

Question 18

Diagnosis for BPH

Answer 18

PSA= screening tool
Digital rectal exam (DRE)
Transrectal or abdominal ultrasound
Cystoscopy
Biopsy

Question 19

Cancer of the Prostate

Answer 19

Most commonly diagnosed nonskin cancer in men in the United States

Considered to be the second most frequently diagnosed cancer and the sixth leading cause of death worldwide

Asymptomatic until its advanced stages

98% of prostate cancers are acinar adenocarcinomas located in the peripheral zones of the prostate
Most common male cancer in the U.S. 
Metastasis 
Lungs
Bone (lower back pain often 1st sign)

Question 20

Cancer of the Prostate Risk Factors

Answer 20

Genetic predisposition (risk of prostatic cancer increases if a malignancy has occurred in a 1st-degree relative)
African American 
Endogenous hormonal influences
Environmental influences
Dietary fat & meat consumption
Sexually transmitted diseases
Age over 50 years

Question 21

Cancer of the Prostate S/S

Answer 21

May be asymptomatic early or late in disease course
Induration of prostate on digital rectal exam
Hard prostate, nodular & fixed
Bladder outlet symptoms
Acute urinary retention
Hematuria (rare)

Question 22

Disgnosis for Prostate Cancer

Answer 22

Biopsy, fine needle aspiration 
Screening begins at age 50 (45 for AA or those w/ a family hx):
DRE
PSA
Transrectal U/S

Question 23

Treatment for Prostate Cancer

Answer 23

Consider age factor & co-morbidities
Consider tumor grade & stage
Androgen deprivation by surgical castration (orchiectomy) or medical castration
Prostatectomy 
Radiation