GU Flashcards

Question

For whom is active surveillance recommended?

Answer 1

* active surveillance [AS] has been supported in men * Over the age of 65 * low grade and stage disease * low and stable serum prostate specific antigen (PSA) levels. * However, AS has been associated with illness uncertainty * Used by about 10% of eligible patients

Answer 2

May occur in 2/3 of patients treated with radical prostatectomy or radiation.

Answer 3

* Penile Self-exams * Testicular self-exams * men \> 50 years and men with family history of prostate cancer should check prostate specific antigen (PSA) for screening for prostate cancer {PSA can be elevated with inflammation also}

Answer 4

* Benign prostate hyperplasia (BPH) enlargement of prostate secondary to change in sex hormones which causes urethral obstruction so decreased urine outflow & increased potential for urinary tract infection * This is very common in men \> 70 years * Bacterial prostatitis * Nonbacterial prostatitis

Answer 5

* As the gland enlarges, there is a resistance to urine flow * Bladder muscle hypertrophies * Emptying becomes incomplete * Increase in residual urine * Increase in chance of infection * Sometimes bladder diverticula * Acute urinary retention * Painless hematuria * Weak stream * Straining * Hesitancy * Nocturia * urgency

Answer 6

(IPSS) * Incomplete emptying * Frequency * Nocturia * Straining * Weak system * Hesitancy * Interrupted stream * AUA SCORE \> 8 WARRANTS THERAPY for BPH/LUTS

Answer 7

•Goroll, page 918 AUA symptom index. Use this screening tool to have patient complete self assessment * Obtain a urine, check for blood and or infection * Would need to see urologist for post void amount. May not need to do In primary care setting, ?? Cost of specialist •Imaging, but then again, cost?

Answer 8

* Diuretics * Anticholinergics * Tricyclic antidepressants * Watch over the counter meds * Avoid stimulants before bed

Answer 9

* alpha-1-adrenergic antagonists to relax prostate and bladder muscle contractility - Tamsulosin (Flomax) ; [terazosin](http://www.uptodateonline.com/online/content/topic.do?topicKey=drug_l_z/255124&drug=true) (Hytrin) * Hypotensive effects * 5-alpha-reductase inhibitors to reduce size of prostate gland Finasteride (Proscar); [dutasteride](http://www.uptodateonline.com/online/content/topic.do?topicKey=drug_a_k/158652&drug=true) (Avodart) * Erectile dysfunction

Answer 10

infection, STI, torsion

Answer 11

* Sudden pain * No cremasteric reflex * Scrotum not swollen * Get ultrasound * Surgical emergency!! * Have only a few hours (after 12 hrs. Patient will most likely loose testical

Answer 12

* Acute prostatitis – inflammation and infection requires antibiotics * Gm negative, e coli, proteus, klebsiella, pseudomonas, enterococci * Chlamydia * HIV, watch for fungal: aspergillus

Answer 13

Acute Onset * Fever * perineal pain * dysuria * decreased urine flow Patient looks ill, be careful not to examine prostate aggressively , this could increase risk for bacteremia

Answer 14

start on oral antibiotic treatment x minimum 3-4 weeks * Cipro * Bactrim * Levaquin * Doxyclycline * Amoxicillin

Answer 15

* hot sitz baths: 2-3x/days * bedrest * tylenol * stool softeners

Answer 16

* Difficult to treat * May need referral * Prostatic fluids become more alkaline * Need long term 8-12 weeks * Doxyclycline * Cipro * Sulfa ds * Alpha blocker * May need admission to hospital, esp if high fever and ?abscess

Answer 17

* No etoh * Coffee * Tea * Keep bladder flat * No anticholinerics * Watch sedatives, ssri

Answer 18

squamous cell with fast metastasis due to the abundance of lymph glands, may be more potential for noncircumcised

Answer 19

no known etiology however there is a correlation with undescended testicles and testicular cancer later in life, good PX if diagnosed early

Answer 20

yes testicular cancer is one of most treatable /curable

Answer 21

No screening low incidence, high cure rate

Answer 22

* sexual desires diminish with age * Sex after 40 should be illegal * sexual intercourse is a young, healthy person’s activity for the purpose of procreation * Sex in long-term care facilities is against the rules

Answer 23

* Can you tell me how you express your sexuality? * What concerns do you have about fulfilling your continuing sexual needs? * In what ways has your sexual relationship with your partner changed as you have aged? * What interventions or information can I provide to help you to fulfill your sexuality? * What questions do you have about your continuing sexual needs and function? * Do you use protection against pregnancy? * Have you had any sexual contact with a partner who may have a sexually transmitted disease?

Answer 24

* P obtaining permission from the client to initiate sexual discussion * LI providing the limited information needed to function sexually * SS giving specific suggestions for the individual to proceed with sexual relations * IT providing intensive therapy surrounding the issues of sexuality for that client

Answer 25

* Herpes Type 1 & 2 – Acyclovir, Famciclovir, Valacyclovir (first episode, recurrence, and suppression regimines) * HPV – podophyllin, alvara * HIV – already discussed in earlier class * Hepatitis A, B, C, D, E (study in GI class)

Answer 26

Candida albicans – candidiasis - Diflucan

Answer 27

Trichomonas vaginalis – trichomoniasis Metronidazole (flagyl) Be aware of no ETOH when taking

Answer 28

* Bacterial vaginosis - metronidazole * Neisseria gonorrhorae – gonorrhea –Ceftriaxone, ciprofloxacin, levofloxacin * Treponema pallidium – syphillis - penicillin * Chlamydia trachomates\* – chlamydia – azithromycin or doxcycline or ceftriaxone

Answer 29

* seems to have a limited impact on sexual functioning due to the fact that only a minimal amount of testosterone is needed for the purposes of sex. * The loss of testosterone is not pathological and does not result in sexual dysfunction. * labeled viropause, andropause and male menopause generally begins between the ages of 46 and 52

Answer 30

* As a result of normal aging changes older men require more direct stimulation of the penis to experience a somewhat weaker erection * orgasms are fewer and weaker in older men, the force * amount of ejaculation is reduced * the refractory period after ejaculation is significantly increased * The persistent inability to attain and maintain an erection adequate for sexual activity * The Massachusetts male aging study of 1085 older men indicated that age was an independent risk factor for decreased sexual function in men

Answer 31

* Rosen (2006) main predictors of sexual dysfunction are: * Age * cardiovascular diseases * Diabetes * depression * other diseases such as strokes, Parkinson’s disease (PD) and Benign Prostatic Hypertrophy (BPH) also interfere with sexual function

Answer 32

1) _antihypertensives_ including: ACE inhibitors, Alpha Blockers, Beta Blockers, Calcium Channel Blockers, Clonidine, Methyldopa and Thiazide Diuretics 2) _antidepressants_ including SSRIs, Tricyclic Antidepressants, MAOIs 3_) cholesterol lowering medications_ including statins and fibrates 4) other medications such as _antipyschotics_ (Phenothiazines & Risperdone) _seizure__medications_ (Carbamazepine) and _H2 Blockers_ (Cimetidine)

Answer 33

* planning for more time during sexual activities, * being sensitive to changes in one another’s bodies, * the use of aids to increase stimulation and lubrication, * the exploration of foreplay * Masturbation * sensual touch * different sexual positions * education about these common changes associated with sex and aging

Answer 34

* Oral Erectile agents assists with erections by increasing blood flow to penis, be aware of interaction with nitrates * Sildenafil Citrate (Viagra®) 100 mg: found to be well-tolerated * Vardenafil HCL(Levitra) 20 mg * Tadalafil HCL (Cialis)– 20 mg * Cavernosal injection therapy * Balloon implants

Answer 35

* Teach what’s down there and how to use it. * Introduce to resources * Use as an opportunity to promote health * Diabetes * smoking

Answer 36

* medications * artificial water-based lubricants (K-Y silky) * alternative methods of intimacy * treat pathological conditions when possible

Answer 37

11-15% (up from 10% five years ago) ## Footnote Safe sex rules apply to older adults too Lillian and the condoms

Answer 38

* Common injury in male and female cyclists * Underreported * Long distance races * Perineal numbness * Related to saddle pressure

Answer 39

* Compression of pudendal nerve that innervates genital and perineal regions * Frequently causes impotence after cycling

Answer 40

Low Testosterone Levels linked with higher risk for depression ## Footnote Their study, which appears in the March issue of the Archives of General Psychiatry, shows that older men with abnormally low free testosterone levels, or hypogonadism, were on average 271% more likely to display clinically significant signs of depression than men with higher testosterone levels.

Answer 41

* failure of the testis to produce physiological levels of testosterone and normal number of spermatozoa

Answer 42

38.7% \> 45 yrs have

Answer 43

* Primary and secondary, we are addressing secondary * Causes? Chemo, radiation, ETOH abuse, some meds

Answer 44

* Inspect: testes, upper and lower musculature, beard, gynecomastia * Palpate: scrotum and testes for masses, breasts for masses * Labs: free testosterone ( 8 am), avoid labs if acute illness

Answer 45

* Check PSA first! * Refer if primary hypogonadism * Patch, gel, cream, injection * evaluate q6 months

Answer 46

* Geriatrics: not in favor of hormone treatment, benefits unproven * HIV, short term ok

Answer 47

decrease in testosterone and sperm production primary cause is natural decline in rate of production starting in 3rd decade of life

Answer 48

Low testosterone 2/2 insufficient stimulation of Leydig cells Result of hypothalamic and pituitary DOs or lesions - hyperprolacinemia, Kallman syndrome

Answer 49

causes release of glucocorticoids which can suppress testosterone levels

Answer 50

* Suramin (Germanin) * Ketoconazole (Nizoral) * Glucocorticoids * Alkylating agents * Chronic opioids

Answer 51

* decreased vigor and libido * depression * fatigue * difficulty concentrating * hot flashes * decreased muscle mass * insulin resistance * increased body fat * hair loss * breast discomfort/gynecomastia * sleep disturbance * ED * decline in mental function * loss of bone mineral density * moodiness/irritability * metabolic syndrome * atherosclerosis * no change in deepening voice

Answer 52

relieve sx and restore testosterone levels to mid-to-nl range (400 ng/dL - 600 ng/dL)

Answer 53

Q7-10 days for stable therapeutic levels

Answer 54

* stimulate growth of prostate and breast ca * worsen sx BPH * liver toxicity/tumor * gynecomastia * erythrocytosis * testicular atrophy/infertility * skin dzes * cause/exacerbate OSA

Answer 55

* liver toxicity/tumor * metastatic prostate ca * undiagnosed prostate nodule / induration * unexplained elevation of PSA (\>3ng/mL): *Jerri says may if not going up* * erythrocytosis (hematocrit \>50%) * Severe BPH (IPSS \>19) * Unstable CHF (Class III or IV) * Untreated OSA

Answer 56

* circadian rhythms * episodic secretions * measurement variations * illness

Answer 57

* CBC * CMP * TSH * LH * FSH * Total and Free testosterone * PSA (all abnormals referred to urologist who can clear for tx) * Prolactin * Estradiol * DRE

Answer 58

MRI to r/o pituitary adenoma or dz

Answer 59

Every 90 days!!! CBC, total & free testosterone, LH, FSH, estradiol, PSA

Answer 60

* Improved QoL * Testosterone: 400 - 600 ng/dL * Free Testosterone: 15 - 20 ng/dL