Genitourinary Conditions A Flashcards
Nephrolithiasis - Description
formation of kidney stones (renal calculi) in urinary tract
Nephrolithiasis - Risk Factors (General) (5)
1) male
2) 20-40 years old
3) obesity
4) dehydration
5) precipitant drugs (e.g. diuretics, antacids, Na+/Ca2+ containing drugs, vitamin C/D)
Nephrolithiasis - Types (5)
1) calcium oxalate (64%)
2) calcium phosphate (16%)
3) uric acid (10-20%)
4) cysteine (1%)
5) struvite (1-5%)
Nephrolithiasis - Risk Factors (Calcium) (4)
1) hyperparathyroidism
2) hypercalcaemia
3) high dietary calcium
4) high dietary oxalate (e.g. chocolate, spinach)
Nephrolithiasis - Risk Factors (Uric Acid) (2)
1) hyperuricaemia (±gout)
2) ileostomy
Nephrolithiasis - Risk Factors (Cysteine) (1)
1) genetic (cystinuria)
Nephrolithiasis - Risk Factors (Struvite) (1)
1) urea splitting bacteria (e.g. Klebsiella, Proteus, Pseudomonas)
Nephrolithiasis - Symptoms (6)
1) sudden onset severe writhing colicky loin to groin pain (can’t lie still)
2) testicular/labial pain
3) nausea
4) vomiting
5) stranguria (burning dysuria in frequent small volumes despite urgency) (i.e. inc. dysuria, oliguria, urgency)
6) haematuria
Nephrolithiasis - Complications (3)
1) recurrent renal calculi
2) recurrent urinary tract infection
3) pyelonephritis
Nephrolithiasis - Investigations (3/2)
initial
1) kidney, ureter, bladder x-ray (KUBXR) (80%)
2) urine dipstick (haematuria)
3) U+E (cause)
consider
1) non-contrast CT kidney, ureter, bladder* (NCC-KUB) (99%) (18 months radiation dose)
2) abdominal ultrasound (rare acutely)
Nephrolithiasis - Management (4/7/3)
conservative
1) leave to pass naturally (<5mm)
2) hydration
3) weight loss
4) low dietary sodium, calcium
medical
1) analgesia (NSAIDs, aspirin —> diclofenac)
2) antiemetic
3) antibiotics (if infected)
4) αB (e.g. tamulosin) (>5mm)
5) thiazide diuretic (calcium recurrence)
6) sodium bicarbonate (uric acid recurrence)
7) cysteine chelator (cysteine recurrence)
surgery
1) extracorpeal shockwave lithotripsy (>10mm or refractory)
2) uretoscopy + YAG laser lithotripsy (>10mm or refractory)
3) percutaneous nephrolithotomy (>15mm or complex)
Acute Kidney Injury - Description
acute increased serum urea and creatinine and decreased urine output due to acute kidney function decline
Acute Kidney Injury - Risk Factors (10)
1) >75 years old
2) male
3) shock (cardiogenic, hypovolaemic, septic)
4) malignancy
5) diabetes mellitus
6) cardiovascular disease
7) chronic liver disease
8) chronic kidney disease (esp. >stage 3a)
9) past acute kidney failure
10) nephrotoxic drugs (e.g. NSAID, ACEi, gentamicin)
Acute Kidney Injury - Causes (Pre-Renal) (5)
1) decreased cardiac output (cardiogenic shock)
2) decreased blood volume (haemorrhage, burns, diarrhoea, vomiting, diuretics)
3) systemic vasodilation (septic shock)
4) renal vasoconstriction (NSAID, ACEi, ARB, hepatorenal syndrome)
5) ischaemia (renal artery stenosis)
Acute Kidney Injury - Causes (Intra-Renal) (4)
1) acute glomerulonephritis (nephrotoxic drugs, infection, SLE)
2) acute interstitial nephritis (nephrotoxic drugs, infection)
3) acute tubular necrosis (nephrotoxic drugs, myeloma)
4) vascular (vasculitis, thrombus)
Acute Kidney Injury - Causes (Post-Renal) (2)
1) internal obstruction (renal calculi, urinary tract tumour, stricture)
2) external compression (benign prostatic hyperplasia, pelvic tumour)
Acute Kidney Injury - Symptoms (6)
1) oliguria —> anuria
2) nausea
3) vomiting
4) dizziness
5) orthopnoea
6) paroxysmal nocturnal dyspnoea
Acute Kidney Injury - Signs (6)
1) hypertension
2) hypotension
3) postural hypotension
4) tachycardia
5) peripheral oedema
6) high JVP
Acute Kidney Injury - Complications (6)
1) hyperphosphataemia
2) hyperkalaemia —> arrhythmia
3) uraemia
4) metabolic acidosis
5) chronic kidney disease
6) pulmonary oedema
Acute Kidney Injury - Investigations (6/0)
initial
1) U+E (high urea, high creatinine, high K+, metabolic acidosis)
2) LFT (hepatorenal syndrome)
3) blood/urine MS+C (infection)
4) urine dipstick (haematuria+proteinuria—>glomerular, leucocytes+nitrates—>infection)
5) kidney ultrasound (CKD—>small kidneys, obstruction)
6) ECG (hyperkalaemia)
Acute Kidney Injury - Management (0/7/2)
medical
1) treat underlying cause
2) stop nephrotoxic drugs (NSAID, ACEi, gentamicin)
3) loop diuretic (hypervolaemia)
4) IV fluids (hypovolaemia)
5) vassopressor (e.g. catecholamines) (hypotensive)
6) calcium gluconate or insulin (hyperkalaemia)
7) sodium bicarbonate (metabolic acidosis)
surgery
1) urinary catheter (obstruction)
2) renal replacement therapy (esp. haemofiltration) (refractory)
Chronic Kidney Disease - Description
GFR<60ml/min/1.73m2 for >3 months due to chronic progressive kidney function decline
Chronic Kidney Disease - Causes (6)
1) diabetes mellitus
2) hypertension
3) acute kidney injury
4) polycystic kidney disease
5) glomerular nephritic/nephrotic syndrome
6) autoimmune (e.g. SLE, RA)
Chronic Kidney Disease - Risk Factors (7)
1) >50 years old
2) male
3) family history
4) Afro-Caribbean or Hispanic
5) obesity
6) smoking
7) nephrotoxic drugs (e.g. NSAIDs, ACEi, gentamicin)
Chronic Kidney Disease - Stages (6)
1) GFR≥90
2) 60≤GFR<90
3a) 45≤GFR<60
3b) 30≤GFR<45
4) 15≤GFR<30
5) GFR<15 (end-stage kidney failure)
Chronic Kidney Disease - Pathophysiology (Diabetes Mellitus) (8)
1) high blood glucose
2) increased reactive oxygen species, proinflammatory cytokines, growth factors
3) glomerulosclerosis of nephrons
4) irreversible nephron failure
5) glomerular hyperfiltration in remnant nephrons
6) initial GFR increase in remnant nephrons
7) eventual glomerulosclerosis of remnant nephrons
8) irreversible nephron failure
Chronic Kidney Disease - Pathophysiology (Hypertension) (12)
1) increased blood pressure
2) blood vessel lumen narrowing due to wall thickening
3) decreased kidney blood flow
4) decreased GFR
5) increased renin secretion
6) further increased blood pressure
7) glomerulosclerosis of nephrons
8) irreversible nephron failure
9) glomerular hyperfiltration in remnant nephrons
10) initial GFR increase in remnant nephrons
11) eventual glomerulosclerosis in remnant nephrons
12) irreversible nephron failure
Chronic Kidney Disease - Symptoms (4)
1) asymptomatic
2) polyuria/oliguria/anuria
3) fatigue (anaemia)
4) dyspnoea (pulmonary oedema)
Chronic Kidney Disease - Symptoms (Uraemia) (8)
1) malaise
2) nausea
3) vomiting
4) anorexia
5) weight loss
6) pruritus (itchy skin)
7) amenorrhoea
8) erectile dysfunction
Chronic Kidney Disease - Signs (4)
1) periorbital oedema
2) peripheral oedema
3) ecchymosis/purpura/petechia (uraemia)
4) Kussmaul’s breathing (deep laboured breathing) (metabolic acidosis)
Chronic Kidney Disease - Complications (7)
1) compensatory hypertension
2) anaemia
3) uraemia —> encephalopathy/pericarditis/coagulopathies
4) hyperkalaemia —> arrhythmia
5) hypocalcaemia/hyperphosphataemia —> secondary parahyperthyroidism —> renal oestodystrophy —> osteomalacia/osteoporosis
6) metabolic acidosis
7) pulmonary oedema
Chronic Kidney Disease - Investigations (8/1)
initial 1) FBC (normocytic anaemia) 2) U+E (high urea, high creatinine, high K+, metabolic acidosis) 3) serum Ca2+ (low) 4) serum PO43- (high) 5) serum PTH (high) 6) eGFR (<60ml/min/1.73m2) 7) urine dipstick (haemtauria, proteinuria) 8) kidney ultrasound (small) consider 1) kidney biopsy (underlying cause)
Chronic Kidney Disease - Management (4/2/1)
conservative 1) glucose control 2) weight loss 3) smoking cessation 4) renal replacement therapy education medical 1) treat underlying cause 2) stop nephrotoxic drugs (e.g. NSAIDs, gentamicin) surgery 1) renal replacement therapy (peritoneal dialysis, haemodialysis, haemodiafiltration, haemofiltration, kidney transplant)
Chronic Kidney Disease - Management (Complications) (10)
hypertension 1) ACEi or ARB (or CCB) 2) βB or thiazide diuretic (adjunct) cardiovascular disease 3) aspirin 4) statin anaemia 5) EPO stimulating agent 6) ferrous sulphate secondary hyperparathyroidism 7) phosphate binder 8) ergocalciferol metabolic acidosis 9) sodium bicarbonate oedema 10) loop diuretic (e.g. furosemide)
Kidney Cancer - Description (Renal Cell Carcinoma)
malignant proliferation of PCT epithelium
Kidney Cancer - Risk Factors (Renal Cell Carcinoma) (10)
1) >50 years old
2) male
3) family history (4x)
4) Czech
5) Von Hippel Landau syndrome (50%)
6) smoking (20%)
7) obesity
8) hypertension
9) chronic kidney disease (15%)
10) polycystic kidney disease
Kidney Cancer - Types (4)
1) renal cell carcinoma (85%)
2) transitional cell carcinoma (10%)
3) sarcoma
4) Wilms’ tumour
Kidney Cancer - Symptoms (Renal Cell Carcinoma) (7)
1) asymptomatic (50% incidental diagnosis)
2) flank/loin pain
3) haematuria
systemic
4) fever
5) malaise
6) anorexia
7) weight loss
Kidney Cancer - Signs (Renal Cell Carcinoma) (1)
1) abdominal mass
Kidney Cancer - Complications (Renal Cell Carcinoma) (6)
1) anaemia
2) polycythaemia
3) hypertension
4) hypercalcaemia
5) SIADH
6) varicocele
Kidney Cancer - Investigations (Renal Cell Carcinoma) (6/1)
initial 1) FBC (anaemia or polycythaemia) 2) LFT (abnormal) 3) high CRP + ESR 4) urine dipstick (haematuria, proteinuria) 5) kidney ultrasound (exclude simple cysts) 6) abdomen, pelvis enhanced contrast CT* consider 1) kidney biopsy (confirmation)
Kidney Cancer - Management (Renal Cell Carcinoma) (0/4/2)
medical
1) local ablation (radiofrequency or cryo-) (non-surgical candidate)
2) chemotherapy (IL-2, TNF-α) (stage 3-4)
3) angiogenesis inhibitor (e.g. sunitinib) (refractory stage 3-4)
4) mTOR inhibitor (e.g. temsirolmus) (refractory stage 3-4)
surgery
1) radical nephrectomy* (unilateral)
2) partial nephrectomy (bilateral)
Bladder Cancer - Description (Transitional Cell Carcinoma)
malignant proliferation of transitional epithelium
Bladder Cancer - Risk Factors (6)
1) >40 years old
2) male
3) family history
4) schistomiasis (squamous cell carcinoma)
5) smoking
6) occupation (petroleum, rubber)
Bladder Cancer - Types (4)
1) transitional cell carcinoma (90%)
2) squamous cell carcinoma (5%)
3) adenocarcinoma
4) sarcoma
Bladder Cancer - Metastasis (Transitional Cell Carcinoma) (3)
1) local —> pelvic structures
2) lymphatic —> iliac node, para-aortic node
3) haematogenous —> liver, lungs
Bladder Cancer - Symptoms (Transitional Cell Carcinoma) (2)
1) painless haematuria (dysuria rare)
2) urge incontinence
Bladder Cancer - Complications (Transitional Cell Carcinoma) (3)
1) recurrent urinary tract infection
2) hydronephrosis
3) metastasis (e.g. lungs)
Bladder Cancer - Investigations (Transitional Cell Carcinoma) (1/3)
initial 1) urine dipstick (haematuria) consider 1) cystoscopy + tissue biopsy* 2) urine cytology 3) CT/MRI urogram (stage)
Bladder Cancer - Management (3/2)
medical
1) post-op chemotherapy (T1-T3)
2) radiotherapy (T2-T3) (non-surgical candidate)
3) palliative chemotherapy + radiotherapy (T4)
surgery
1) transurethral resection (T1)
2) radical cystectomy* (T2-T3)
Testicular Cancer - Description
malignant proliferation of testicular germ cells
Testicular Cancer - Risk Factors (6)
1) 20-35 years old
2) family history
3) Caucasian
4) undescended testis
5) infant hernia
6) infertility
Testicular Cancer - Types (3)
1) seminoma (55%)
2) non-seminomatous germ cell tumour (33%)
3) mixed germ cell tumour (teratoma) (12%)
Testicular Cancer - Symptoms (4)
1) testicular pain
2) abdominal pain
3) back pain (para-aortic node metastasis)
4) dyspnoea (lung metastasis)
Testicular Cancer - Signs (2)
1) testicular mass
2) abdominal mass
Testicular Cancer - Complications (3)
1) hydrocele
2) infertility
3) metastasis (e.g. lung)
Testicular Cancer - Investigations (3/2)
initial 1) testicle colour Doppler ultrasound 2) serum α-fetoprotein (positive) 3) serum β-human chorionic gonadotrophin (positive) consider 1) testicular biopsy (confirmation) 2) abdomen, pelvis CT (staging)
Testicular Cancer - Management (2/2/1)
conservative 1) sperm storage 2) regular self-examination medical 1) chemotherapy (metastasis above diaphragm) 2) radiotherapy (metastasis below diaphragm) surgery 1) radical orchidectomy*
Prostate Cancer - Description
malignant proliferation of prostate glandular epithelium
Prostate Cancer - Risk Factors (6)
1) >50 years old (increases with age, 80% of >80 years old)
2) family history (2-3x)
3) Afro-Caribbean (high testosterone)
4) BRCA-2 (5-7x)
5) HOXB-13
6) fatty diet
Prostate Cancer - Types (4)
1) acinar adenocarcinoma (90%)
2) ductal adenocarcinoma (9%)
3) transitional cell carcinoma
4) squamous cell carcinoma
Prostate Cancer - Metastasis (3)
1) local —> pelvic structure
2) lymphatic —> iliac node, para-aortic node
3) haematogenous —> bone*, brain, liver, lungs
Prostate Cancer - Symptoms (6)
1) asymptomatic lower urinary tract symptoms 2) nocturia 3) frequency 4) hesitancy 5) haematuria 6) dysuria
Prostate Cancer - Symptoms (Metastasis) (4)
1) anorexia
2) weight loss
3) fatigue
4) bone pain
Prostate Cancer - Signs (2)
1) hard irregular prostate (digital rectal examination)
2) palpable lymph nodes (metastasis)
Prostate Cancer - Complications (1)
1) metastasis (esp. bone)
Prostate Cancer - Investigations (1/2)
initial
1) serum PSA (>4μg/L, 16μg/L if metastatic)
consider
1) transrectal ultrasound guided prostate biopsy*
2) abdomen, pelvis MRI (staging
Prostate Cancer - Management (1/3/1)
conservative
1) surveillance (>70 years old + low risk)
medical
1) androgen deprivation therapy (LHRH agonists, androgen receptor blockers) (delays progression)
2) bisphosphonates (bone metastasis—>hypercalcaemia)
3) radiotherapy (external beam or brachytherapy) (>70 years old or non-surgical candidate)
surgery
1) radical prostatectomy* (<70 years old)
Benign Prostatic Hyperplasia - Description
benign nodular or diffuse proliferation of prostate glandular epithelium and stromal cell
Benign Prostatic Hyperplasia - Risk Factors (4)
1) >50 years old (increases with age)
2) family history
3) Afro-Caribbean (high testosterone)
4) smoking
Benign Prostatic Hyperplasia - Pathophysiology (3)
1) benign nodular or diffuse proliferation of prostate glandular epithelium and stromal cells
2) prostate enlarges
3) prostate narrows urethra (compression or obstruction)
Benign Prostatic Hyperplasia - Symptoms (10)
storage lower urinary tract symptoms 1) nocturia 2) frequency 3) urgency 4) incontinence voiding lower urinary tract symptoms 5) hesitancy 6) haematuria 7) dysuria (infection) 8) poor intermittent stream 9) straining 10) after dribble (post-micturition or terminal)
Benign Prostatic Hyperplasia - Signs (2)
1) smooth enlarged prostate (digital rectal examination)
2) palpable bladder
Benign Prostatic Hyperplasia - Complications (3)
1) bladder calculi
2) urinary tract infections
3) urinary retention
Benign Prostatic Hyperplasia - Investigations (3/3)
initial
1) serum PSA (high)
2) urine dipstick (pyruria)
3) International Prostate Symptoms Score (7Qs, 0-35)
consider
1) abdomen, pelvis ultrasound (mass, stone, hydronephrosis)
2) transrectal ultrasound (mass, stone, hydronephrosis)
3) cystoscopy (mass, stone, stricture)
Benign Prostatic Hyperplasia - Management (3/2/2)
conservative
1) avoid coffee, alcohol
2) relax when voiding
3) void twice in a row
medical
1) α1B (e.g. tamulosin) (voiding symptoms)
2) 5α reductase inhibitor (e.g. finasteride)
surgery
1) transurethral incision of prostate (TIRP)
2) transurethral resection of prostate* (TURP)
Pyelonephritis - Description
inflammation of kidney and upper ureter, urinary tract infection
Pyelonephritis - Causes (5)
KEEPS
1) Klebsiella
2) Enterocci
3) Escherichia coli*
4) Proteus
5) Staphylococci
Pyelonephritis - Risk Factors (10)
1) <35 years old
2) female
3) sex
4) pregnancy
5) menopause
6) urinary tract obstruction (e.g. renal calculi)
7) catheter
8) diabetes mellitus
9) immunocompromised (e.g. HIV, chemo, steroids)
10) congenital abnormalities
Pyelonephritis - Pathophysiology (3)
1) bowel flora Escherichia coli
2) females have a shorter urethra which is closer to anus
3) ascending transurethral transmission of bacteria to urinary tract
Pyelonephritis - Symptoms (9)
1) loin pain
2) costovertebral back pain
3) fever
cystitis/urethritis associated
4) frequency
5) urgency
6) dysuria
systemic
7) malaise
8) nausea
9) vomiting
Pyelonephritis - Signs (4)
1) loin tenderness
2) costovertebral back tenderness
3) pyuria
4) fell smelling urine
Pyelonephritis - Complications (4)
1) acute kidney injury
2) renal abscess
3) recurrent urinary tract infection
4) sepsis
Pyelonephritis - Investigations (4/0)
initial
1) urine dipstick (nitrites, leucocytes, proteins)
2) midstream urine MS+C* (>10^5 colony forming units)
3) FBC (leucocytosis)
4) high CRP + ESR
Pyelonephritis - Management (3/3/0)
conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (ciprofloxacillin or co-amoxiclav) 3) IV antibiotics (gentamicin or co-amoxiclav)
Cystitis - Description
inflammation of bladder, urinary tract infection
Cystitis - Causes (5)
KEEPS
1) Klebsiella
2) Enterococci
3) Escherichia coli*
4) Proteus
5) Staphylococci
Cystitis - Risk Factors (10)
1) >60 years old
2) female
3) sex
4) pregnancy
5) menopause
6) urinary tract obstruction (e.g. renal calculi)
7) catheter
8) diabetes mellitus
9) immunocompromised (e.g. HIV, chemo, steroids)
10) congenital abnormalities
Cystitis - Pathophysiology (3)
1) bowel flora Escherichia coli
2) females have shorter urethra which is closer to anus
3) ascending transurethral transmission of bacteria
Cystitis - Symptoms (6)
1) suprapubic pain
2) fever
3) frequency
4) urgency
5) dysuria
6) haematuria
Cystitis - Signs (2)
1) pyuria
2) foul smelling urine
Cystitis - Complications (2)
1) pyelonephritis
2) recurrent urinary tract infection
Cystitis - Investigations (4/0)
initial
1) urine dipstick (nitrites, leucocytes, proteins)
2) mid-stream urine MS+C* (>10^5 colony forming units)
3) FBC (leucocytosis)
4) high CRP + ESR
Cystitis - Management (3/3/0)
conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (trimethoprim or cefalexin) 3) IV antibiotics (ciprofloxacin or co-amoxiclav) (severe)
Prostatitis - Description
inflammation of prostate, urinary tract infection
Prostatitis - Causes (5)
1) Escherichia coli (80%)
2) Enterococci
3) Pseudomonas
4) Chlamydia
5) Streptococci faecaelis
Prostatitis - Risk Factors (7)
1) 35-50 year olds
2) male
3) sexually transmitted infection
4) urinary tract infection
5) benign prostatic hyperplasia
6) post biopsy
7) catheter
Prostatitis - Symptoms (13)
1) perianal pain
2) fever (inc. rigors)
3) malaise
storage lower urinary tract symptoms
4) nocturia
5) frequency
6) urgency
7) incontinence
voiding lower urinary tract symptoms
8) hesitancy
9) poor intermittent stream
10) straining
11) dysuria
12) haematuria
13) after dribble (post micturition or terminal)
Prostatitis - Signs (1)
1) hot soft tender prostate (digital rectal examination)
Prostatitis - Complications (3)
1) urinary retention
2) sepsis
3) recurrent urinary tract infection
Prostatitis - Investigations (5/2)
initial 1) serum PSA (high) 2) urine dipstick (nitrites, leucocytes, proteins) 3) mid-stream urine MS+C* (>10^5 colony forming units) 4) FBC (leucocytosis) 5) high CRP + ESR consider 1) STI screening 2) transurethral ultrasound
Prostatitis - Management (0/2/0)
medical
1) analgesia (NSAID)
2) PO antibiotics (ciprofloxacin)
Urethritis - Description
inflammation of urethra (sexually transmitted infection or trauma)
Urethritis - Causes (7)
sexually transmitted infection 1) Chlamydia trachomatis* 2) Neisseria gonorrhoea 3) Ureaplasma urealyticum 4) Mycoplasma genitalum trauma 5) catheter 6) urethral stricture 7) urinary calculi
Urethritis - Risk Factors (4)
1) 15-24 years old
2) female
3) homosexual male
4) unprotected sex
Urethritis - Symptoms (5)
1) asymptomatic (10% gonorrhoea, 50% chlamydia)
2) dysuria
3) urethral pain
4) urethral discharge
5) urethral itching
Urethritis - Investigations (3/0)
initial
1) nucleic acid amplification test (swab - female, first void volume - male)
2) urethral discharge MS+C (PMN leucocytes)
3) urine dipstick (exclude UTI)
Urethritis - Management (3/3/0)
conservative 1) patient education 2) partner notification 3) contact tracking medical 1) analgesia 2) PO azithromycin (chlamydia) 3) PO azithromycin + IM ceftriaxone (gonorrhoea)
Erectile Dysfunction - Description
inability to achieve or maintain an erection
Erectile Dysfunction - Causes (Organic) (6)
1) vascular (e.g. atherosclerosis) (40%)
2) diabetes mellitus (30%)
3) iatrogenic (15%)
4) trauma (e.g. radical prostatectomy)
5) neurogenic
6) endocrine
Erectile Dysfunction - Causes (Psychogenic) (5)
1) age related libido decline
2) partner related
3) fear of failure
4) depression
5) major life stress (e.g. death of partner)
Erectile Dysfunction - Risk Factors (12)
1) ischaemic heart disease
2) peripheral vascular disease
3) hypertension
4) hypogonadism
5) diabetes mellitus
6) smoking
7) alcohol
8) neurological disease
9) psychosexual/relationship problems
10) antihypertensive
11) antidepressant
12) antiandrogenic
Erectile Dysfunction - Symptoms (1)
1) premature ejaculation
Erectile Dysfunction - Signs (6)
1) penile plaques
2) penile deformities
3) penile angulation
4) small testes (hypogonadism)
5) abnormal hair pattern
6) gynecomastia
Erectile Dysfunction - Investigations (5/2)
initial 1) Internal Index of Erectile Dysfunction questionnaire 2) fasting blood glucose (>11mM) 3) fasting lipid profile 4) BP 5) HR consider 1) 9:00am testosterone (low - hypogonadism) 2) PRL/FSH/TSH (if testosterone low)
Erectile Dysfunction - Management (2/4/1)
conservative 1) psychosexual therapy 2) risk factor modification medical 1) treat underlying cause (1st) 2) phosphodiesterase-5-inhibitors (2nd) (sildenafil, Viagra) 3) intracarvenous prostaglandin injections (3rd) 4) vacuum erection device (4th) surgeryi 1) penile prosthesis (5th)
