GP - Men Flashcards
Who is benign prostatic hyperplasia more common in?
Black > White > Asian
What are the clinical features of BPH?
- Voiding (obstructive) = weak flow/straining/hesitancy/terminal dribbling/incomplete emptying
- Storage (irritative) = urgency/frequency/urgency incontinence/nocturia
- Post-micturition dribbling
- Complications (UTI/retention/obstructive uropathy)
What are the investigations for BPH?
- Dipstick urine
- U&Es
- PSA
- Urinary frequency-volume chart (min. 3 days)
What scoring system is used for prostatism?
International prostate symptom score (IPSS) = tool for classifying the severity of LUTS and assessing their impact on QoL
0-7 = mildly symptomatic
8-19 = moderately symptomatic
20-35 = severely symptomatic
What is the management for BPH?
- Moderate to severe = alpha-1 antagonists e.g. tamsulosin/alfuzosin
- 5 alpha-reductase inhibitors e.g. finasteride (sx may not improve for 6 months)
- Combination therapy of above
- Storage/voiding sx and alpha blocker not helping = antimuscarinic e.g. tolterodine/darifenacin
- Surgery = transurethral resection of prostate (TURP - a.k.a transurethral prostatectomy)
What is the most common cause of acute bacterial prostatitis and what are the risk factors?
- Gram-negative bacteria e.g. E. Coli
- Recent UTI
- Urogenital instrumentation
- Intermittent bladder catheterisation
- Recent prostate biopsy
What are the clinical features of acute bacterial prostatitis?
- Referred pain to perineum/penis/rectum/back
- Obstructive voiding symptoms
- Fever/rigors
- DRE = tender/boggy prostate gland
What is the management for acute bacterial prostatitis?
14 day course of quinolone e.g. ciprofloxacin
What are the risk factors for prostate cancer?
- Increasing age
- Obesity
- Afro-Caribbean ethnicity
- Fhx
What is the most common type of prostate cancer?
95% = adenocarcinoma
What are the clinical features of prostate cancer?
- Asx
- Bladder outlet obstruction = hesitancy/urinary retention
- Haematuria/haematospermia
- Back/perineal/testicular pain
- Metastasis = bone pain
- DRE = asymmetrical/hard/nodular enlargement with loss of median sulcus
What are the investigations for prostate cancer?
- Prostate specific antigen (PSA) testing
- Multiparametric MRI
- Transrectal ultrasound-guided (TRUS) biopsy
What is the grading system for prostate cancer?
- Gleason grading system
- 2 = best prognosis
- 10 = worst prognosis
When may PSA levels be raised?
- BPH
- Prostatitis/UTI
- Ejaculation
- Vigorous exercise
- Urinary retention
- Instrumentation of urinary tract
What si the management for prostate cancer?
Localised:
- Monitoring
- Surgery = radical prostatectomy
- Radiotherapy
Localised advanced:
- Hormonal therapy
- Surgery = radical prostatectomy
- Radiotherapy
Metastatic:
- Hormonal therapy = synthetic GnRH agonists e.g. Goserelin
- Hormonal therapy = non-steroidal anti-androgen e.g. bicalutamide
- Hormonal therapy = steroidal anti-androgen e.g. cyproterone acetate
- Hormonal therapy = androgen synthesis inhibitor e.g. abiraterone
- Surgery = bilateral orchidectomy
- Chemotherapy
What is the management for UTIs in men?
Abx = nitrofurantoin or trimethoprim for 7 days
What can cause impotence?
- Thiazide diuretics
- Excess prolactin (prolactinoma)
- Finasteride (5 alpha-reductase inhibitor)
- Lambert Eaton syndrome
- Degenerative cervical myelopathy
What are risk factors for impotence?
- Increasing age
- CVD
- Obesity
- Diabetes
- Dyslipidaemia
- Metabolic syndrome
- HTN
- Smoking
- Alcohol use
- Drugs = SSRIs/beta blockers
What is the management for impotence?
- PDE-5 inhibitors e.g. sildenafil (Viagra)
- Vacuum erection devices (for those who can’t/won’t take PDE-5 inhibitor)
What are the types of testicular cancer?
Germ cell tumours (95%):
- Seminomas
- Non-seminomas = embryonal/yolk sac/teratoma/choriocarcinoma
Non-germ cell tumours:
- Leydig cell tumours
- Sarcomas
What is the peak incidence for testicular cancer?
20-30
- Teratomas = 25
- Seminomas = 35
What are the risk factors for testicular cancer?
- Infertility
- Cryptorchidism
- Fhx
- Klinefelter’s syndrome
- Mumps orchitis
What are the clinical features of testicular cancer?
- Painless lump
- Pain
- Hydrocele
- Gynaecomastia (increased oestrogen:androgen ratio)
What are the investigations for testicular cancer?
- USS (first line)
- Elevated hCG = seminomas
- Elevated AFP and/or beta-hCG = non-seminomas
- Elevated LDH = germ cell tumours
What is the management for testicular cancer?
- Orchidectomy
- Chemotherapy and radiotherapy
What are the clinical features of epididymal cysts and what is the investigation?
- Scrotal swelling
- Separate from body of testicle
- Found posterior to testicle
- USS
What conditions are associated with epididymal cysts?
- PKD
- CF
- Von Hippel-Lindau syndrome
What is a hydrocele and what are the types?
Accumulation of fluid within tunica vaginalis
- Communicating = patency of processus vaginalis which allows peritoneal fluid to drain down into the scrotum
- Non-communicating = excessive fluid production within tunica vaginalis
What are the clinical features of hydroceles and what are the investigations?
- Soft, non-tender swelling of hemi-scrotum
- Usually anterior to and below testicle
- Swelling confined to scrotum - can ‘get above’ mass on examination
- Transilluminates with pen torch
- USS
What is the management for hydroceles?
- May resolve spontaneously by age 1-2 years
- Conservative approach
What is a varicocele?
Abnormal enlargement of testicular veins
What are the clinical features of varicoceles and what is the investigation?
- More common on left side
- Feel like ‘bag of worms’
- Subfertility
- USS with Doppler studies
What is the management for varicoceles?
- Conservative
- Surgery (if pain)
What are causes of retrograde ejaculation?
Anything that damages the internal urethral sphincter or the nerves controlling it
- Bladder neck surgery
- Transurethral resection of prostate
- Congenital abnormality
- Diabetic autonomic neuropathy
