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UWS Q9 > GU Survey Exam 3 > Flashcards

GU Survey Exam 3 Flashcards

1
Q

What are the 2 functions of the testes?

A
  1. produce sperm

2. secrete hormones (testosterone)

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2
Q

What is in the scrotum?

A

testicles

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3
Q

What is the function of the scrotum?

A
  • contains the testi at a lower temperature to allow for optimal sperm production
  • prone to injuries
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4
Q 
Testicular or Scrotal mass?
firm solid and 
1. painless
2. do not transilluminate
3. usually malignant
A

testicular mass

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5
Q

Testicular or Scrotal mass?

  1. painful
  2. transilluminate
  3. usually benign
A

scrotal mass

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6
Q

Are testicular masses usuaslly painful?

A

no, painless

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7
Q

Will testicular masses transilluminate?

A

no, do not transilluminate

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8
Q

are testicular masses usually benign or malignant?

A

usually malignant

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9
Q

are scrotal masses and those in the epididymiss or spermatic cord usually painful?

A

yes painful

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10
Q

Will scrotal masses and those in the epididymiss or spermatic cord transilluminate?

A

yes

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11
Q

are scrotal masses and those in the epididymiss or spermatic cord usually malignant or benign?

A

benign

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12
Q

what tissue/part of the penis is the erectile tissue?

A

corpora cavernosa

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13
Q

What tissue/part of the penis contains the urethra?

A

corpus spongiosum

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14
Q

what layer of tissue surrounds the erectile tissue?

A

tunica albuginea

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15
Q

define circumcision

A

surgical removal of the foreskin of the penis

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16
Q

is the american academy of pediatrics in support of circumcision?

A

Yes, as a result of emerging evidence that found links between circumcision and decreased risk of urinary tract infection, rare penile cancer, HPV, HIV and other STIs, the AAP is in more support of the procedure

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17
Q

Does the AAP recommend routine circumcision for all newborn males?

A

no, “What remains unchanged is that the AAP still holds that the
health benefits are not great enough to recommend routine
circumcision for all newborn males,”

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18
Q

what are 3 non medical reasons PRO circumcision?

A
  1. religious/faith
  2. aesthetics
  3. hygiene
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19
Q

what are 2 possible medical advantage of circumcision?

A
  1. less UTI, STI/HIV

2. less risk of penile cancer

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20
Q

What are 5 cons/surgical risks to infant of circumcision?

A
  1. hemorrhage
  2. infection
  3. pain/trauma
  4. diminshed sensation
  5. > mother/child bonding
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21
Q

where are the seminal vesicles located?

A

out-pocketing of vas deferens: extend from base of bladder

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22
Q

what does the seminal vesicles and vas deferens form?

A

ejaculatory duct

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23
Q

what is the order of sequency from the seminal vesicles?

A
  1. extend from base of bladder, out pocketing of vas deferens –> forms ejaculatory duct –> thru prostate –> to urethra
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24
Q

what is secreted from the seminal vesicles?

A

70% of fluid components of semen = energy/fluidity for sperm

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25
Q

secretions from where supply 70% of fluid for semen and provide the energy for sperm?

A

seminal vesicles

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26
Q

HPO axis for tesis?

A

hypothalamus > GnRH > pituitary > LH and FSH

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27
Q

what does LH in the testis stimulate?

A

leydig cells to produce testosterone

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28
Q

what cells produce testosterone?

A

leydig cells/interstitial cells

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29
Q

testosterone + FSH =>

A

spermatogenesis

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30
Q

how many sperm does a male produce each day?

A

70-100 million each day!

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31
Q

length of time for production of spermatogenesis in the testes?

A

approx 70 days

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32
Q

length of time for maturation of sperm in the epididymis?

A

= 2 weeks

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33
Q

what 3 components occurs as part of the maturation of sperm in the epididymis?

A

acquisition of

  1. motility
  2. capacity to bind to an ovum
  3. capacity to penetrate the zona pellucida
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34
Q

after what age should FOBT x3 be used as lab work up for preventative health?

A

after age 50

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35
Q

what is the peak age for tumors for penile conditions?

A

60 YO

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36
Q

what parts to the penis are tumors likely to involve (2)?

A

prepuce or glans

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37
Q

dx?

painless, enlarging wart-like growth

A

HPV, conyloma acuminata

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38
Q

dx?

hyperkeratotic, scaly, white patches of penile epithelium, yes for biopsy?

A

leukoplakia

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39
Q

is a biopsy necessary if you suspect leukoplakia?

A

yes

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40
Q 
dx?
an intraepidermal (pre)cancerous indurated erythematous plaque, ulcerated center, development of pinkish or brownish papules covered with a thickened horny layer
A

Bowen’s dz

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41
Q

is a biopsy necessary for bowen’s dz?

A

yes

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42
Q

what are 2 skin cancers of the penis?

A

squamous cell carcinoma, SCC
and
melanoma

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43
Q

what is balanitis

A

inflammation of glans

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44
Q

Causes of balanitis? (8)

A 
1. Uncircumcised w/ poor hygiene
or over hygiene
2. Diabetes
3. Chemical irritants
4. CHF, cirrhosis, nephrosis
5. Drug allergies
6. Obesity
7. Infections: candida, HPV,
anaerobes, treponema,
gardnerella, tichomonas
8. Penile cancer
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45
Q

what is phimosis?

A

In ability to retract the distal foreskin.
-at birth the foreskin is adherent to the glans penis. These adhesions usually spontaneously separate and allow the foreskin to become retractible.

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46
Q

what is paraphimosis?

A

Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus. Paraphimosis is a disease of uncircumcised or partially circumcised males.

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47
Q

where is the urethral opening with hypospadius

A

urethral opening on the ventral surface

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48
Q

which side is the ventral surface of the penis?

A

under

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49
Q

which is more common hypospadius or epispadius?

A

hypospadius

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50
Q

what is it called when the urethral opening is on the dorsal surface of the penis?

A

epispadius

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51
Q

which side is the dorsal surface of the penis?

A

upper

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52
Q

What are 3 causes of hypospadius and epispadius?

A
  1. exposure to PG hormone, finesteride
  2. lack of T in utero
  3. inherited
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53
Q

what is hypo and epispadius often associated with? (2)

A
  1. inguinal hernias

2. cryptorchidism

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54
Q

what is priapism?

A

non-erotic sustained painful erection with acute onset

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55
Q

why does the glans remain soft with priapism?

A

glans remains soft because involves the corpora cavernosa but not the spongiosum

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56
Q

Etiology of priapism?

A
  • unknown in most cases
  • possible associated w/ leukemia, metastatic carcinoma, local trauma, sickle cell dz, spinal cord trauma, circulatory distrubances, medications like viagra
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57
Q

tx for priapism? (5)

A
  1. spontaneously resolve in few hours
  2. ice water
  3. enema
  4. pharmaceutical intervention
  5. drainage is rare cases
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58
Q

dx?

plaques/strands of dense fibrous tissue surrounding the corpus cavernosum –> deformity and painful erection, impotence

A

peyronie’s dz

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59
Q

what are the s/sx of peyronie’s dz?

A
  1. hardened tissue
  2. pain during erection
  3. curvature with erection
  4. distortion (indentation, shortening)
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60
Q

most common age for peyronie’s dz?

A

45-60 YO

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61
Q

etiology/risk factors for peyronie’s dz? (5)

A
  1. unknown
  2. trauma (surgery, injury)
  3. HLA-B7 (SLE. Scleroderma)
  4. 30% of ppl will develop fibrotic tissue in other areas like dupuytrens contracture
  5. diabetics
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62
Q

how do you dx peyronie’s dz?

A

exam and vasoactive injection to cause erection

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63
Q

tx for peyronie’s dz? (3)

A
  1. watch and wait 1-2 years, often resolves
  2. non surgical tx within 6 mnths of dx: ca+ channel blockers, collagenase, cortisone
  3. surgery
    - severe/persistent
    - can cause partial loss of erectile function, penis length, urethral damage, infection, sensation loss
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64
Q

penile cancer incidence?

A

1/100k USA

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65
Q

what percentage of malignancies in men is d/t penile cancer?

A

0.2%

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66
Q

how much higher is cervical cancer incidence than penile cancer?

A

10x higher

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67
Q

how much higher is prostate cancer incidence than penile cancer?

A

100x

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68
Q

how much higher is fatal heart attack incidence than penile cancer?

A

200x

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69
Q

what are 3 sx of penile cancer?

A
  1. penile growths or sores
  2. abnormal penile d/c
  3. bleeding
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70
Q

what area is the most common site for penile cancer?

A

glans and foreskin

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71
Q

Risk factors for penile cancer? 4)

A
  1. intact/non-circumcised male (high risk factor, low incidence)
  2. HPV infection (only certain strains, low risk factor)
  3. smoking
  4. age: majority >50 YO (40% <40 YO)
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72
Q

chance for penile cancer in uncircumcised vs circumcise?

A

un- 1/600

circumcised- 1/1500

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73
Q

what are the 3 main tx for penile cancer?

A
  1. surgery: excision, laser, circumcision, partial to complete penectomy, nodal dissection
  2. radiation
  3. chemotherapy: topical, oral/IV
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74
Q

What are some examples of surgical procedures for treatment of penile cancer?

A
  1. excision
  2. laser
  3. circumcision
  4. partial to complete penectomy
  5. nodal dissection
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75
Q

what is the most common reason for visit to a urologist?

A

scotal masses

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76
Q

define a scrotal mass?

A

painless or painful lump or swelling

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77
Q

can scrotal masses be solid or cystic?

A

yes

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78
Q

can you develop a scrotal mass at any age?

A

yes

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79
Q

how are scrotal masses evaluated?

A

via US

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80
Q

how do most men discover scrotal masses?

A

most men discover scrotal masses themselves

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81
Q

Describe a testicular exam

A
  1. stand in front of mirror
  2. examine each testicle with both hands
  3. gently roll the testicle between the thumbs and fingers
  4. if palpable lump, refer for US and/or a urologist
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82
Q

what are 5 causes of scrotal masses?

A
  1. cysts
  2. infection
  3. inflammation
  4. hernia
  5. tumors
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83
Q

what is cryptorchidism?

A

undescended testicles

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84
Q

what is a 30% risk with preterm infants?

A

undescended testicles

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85
Q

what are 3 risks associated with crytorchidism ?

A
  1. testicular cancer
  2. infertility
  3. torsion
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86
Q

what are the two location for the testicle for cryptorchidism?

A
  1. abdominal testicle

2. pubo-scrotal testicle

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87
Q

what are the two location for ectopia undescended testicle?

A
  1. femoral

2. perineal

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88
Q

ddx?

worse with lifting the testicle

A

testicular torsion

ddx epididmyitis- pain lessens

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89
Q

describe the sx of testicular torsion?

A
  1. sudden severe pain, swelling, erythema

2. lower ab pain, N/V

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90
Q 
dx?
 1. sudden severe pain,
swelling, erythema
2. lower abdominal pain,
N/V
3. worse with lifting the
testicle
A

testicular torsion

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91
Q

Is testicular torsion considered a medical emergency?

A

yes

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92
Q

within how many hours should surgery for testicular torsion occur?

A

6-8 hrs to prevent atrophy, 80% good prognosis

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93
Q

after how many hours is preservation of the testicle doubtful in relationship to testicular torsion?

A

24 hrs

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94
Q

what type of surgery is advised if delayed beyond 48 hr?

A

orchiectomy

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95
Q

does pain get worse or better with lifting of testicle with epididymitis?

A

pain lessens

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96
Q

what is a hydrocele?

A

collection of fluid in the sheath (tunica) that holds the testicle

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97
Q

Cause of hydrocele?

A

excess fluid production or decreased fluid absorption

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98
Q

is a hydrocele painful?

A

often painless

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99
Q

will hydrocele be transilluminated?

A

yes

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100
Q

describe a hydrocele?

A

often painless, swollen, soft, unilateral or bilateral, that will transilluminate

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101
Q

what is the ddx for hydrocele?

A

varicocele

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102
Q

younger or older men more likely to have hydrocele?

A

older

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103
Q

can hydrocele develop rapidly?

A

yes

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104
Q

causes of hydrocele?

A
  1. trauma
  2. radiation therapy
  3. inflammation
  4. congenital
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105
Q

“bag of worms”

A

varicocele

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106
Q

what causes a varicocele?

A

blood backs up in the veins leading from the testicles d/t valve dysfunction

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107
Q

varicocele painful or painless?

A

painless

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108
Q

which side is more likely to have a varicocele?

A

more common on the left side

109
Q

which vein does left spermatic vein empty into?

A

left renal vein

110
Q

Which vein does the right spermatic vein empty into?

A

inferior vena cava

111
Q

sx/s of varicocele?

A

may feel heavy, better with lying down, achy, testicular atrophy, infertility, visibly enlarged vein, will not transilluminate

112
Q

will a varicocele be transilluminated?

A

nope

113
Q

typical age for varicocele?

A

15-25 YO

114
Q

why is varicocele associated with 40% infertile men?

A

increased testicular temperature

115
Q

what are 4 big risk factors for varicocele?

A
  1. pelvic floor stress (constipation, heavy lifting)
  2. vascular damage
  3. hereditary
  4. tumor
116
Q

2 dx evaluation procedures for varicocele?

A

US and venogram (dye/xray)

117
Q

tx for varicocele?

A
  1. scrotal support (atheletic supporter, tighter underwear)
  2. surgical ligation “varicocelectomy”
  3. embolization
  4. laparscopy
118
Q

what is a varicocelectomy

A

surgical ligation for a varicocele

119
Q

what % of varicocele reoccur?

A

5-20% reoccur

120
Q

what % of those with varicocele develop a hydrocele?

A

2-5%

121
Q

what is an inguinal hernia?

A

protrusion of abdominal contents, usually the small bowel, thru a weak point of the abdominal wall, where the vas deferens passes

122
Q

sx/s of inguinal hernia?

A
  1. bulge in the groin area that may extend into the scrotum

2. painful or uncomfortable

123
Q

tx for inguinal hernia

A

surgical repair

124
Q

define epididymitis

A

infection in the tubular coil, epididymis

125
Q

what is the function of the epididymis?

A

collects sperm from the testes

126
Q

where is pain with epididymitis?

A

produces pain in the top and rear of the scrotum

127
Q

what organisms are often associated with epididymitis?

A

often a complication of gonorrhea/chlamydia

- may be enterobacteriacae or pseudomonas (w/prostatitis)

128
Q

s/sx of epididymitis?

A
  • pain is generally severe and insidious

- fever and swelling are common

129
Q

tx (2) for epididymitis?

A
  1. antibiotics

2. STI screen

130
Q

what is inflammation of the testes called?

A

orchitis

131
Q

what is the causative agent of orchitis?

A

often d/t bacterial infection or mumps virus

132
Q

can spermatogenisis be affected by mumps?

A

spermatogensis is irreversible damaged in 30% of mumps cases

133
Q

if the patient has orchitis, what might they are have or be experiencing?

A

prostatitis or epididymitis

134
Q

s/sx of orchitis?

A
  1. pain and swelling

2. heaviness

135
Q

can orchitis cause permanent damage to testicles?

A

yes

136
Q

orchitis can cause permanent damage to testicles resulting in what 3 things?

A
  1. diminished size
  2. inadequate hormone production
  3. infertility
137
Q

what are 6 scrotal mass ddx?

A
  1. epididymitis
  2. hydrocele
  3. varicocele
  4. hernia
  5. orchitis
  6. cancer
138
Q

is testicular cancer highly treatable when detected and treated early?

A

YES, 95%

139
Q

what is the most common cancer in men 15-34 YO?

A

testicular cancer

140
Q

what is the common age for testicular cancer?

A

15-34 YO

141
Q

what are 5 main testicular cancer risk factors?

A
  1. cryptorchidism
  2. genetic (klinefelter’s and chromosome 12 abnormality)
  3. caucasion (4-5x)
  4. family hx
  5. HIV
142
Q

how much higher risk of testicular cancer does a male have if his crytorchidism is untreated?

A

3-17x higher risk

143
Q

what are two genetic abnormality that are risk factors for testicular cancer?

A

klinefelters and chromosome 12 abnormality

144
Q

is there an increased risk of testicular cancer with injury or vasectomy

A

no increased risk

145
Q

sx/s of testicular cancer?

A
  1. unilateral enlargement or change in the way it feels
  2. painless lump or swelling or collection of fluid (recommend monthly self-screening)
  3. dull ache in back, groin or lower abdomen
  4. gynecomastia &/or mastalgia
  5. discomfort/pain or feeling in heaviness
146
Q

can a male experience gynecomastic or mastalgia with testicular cancer?

A

yes

147
Q

might there be no symptoms with testicular cancer?

A

yes

148
Q

what is secondary testicular cancer?

A

cancer metastasizes from primary (i.e. hodgkins)

149
Q

T/F: testicular lymphoma is more common than testicular cancer in men over 50

A

T

150
Q

what are 4 cancers that can metastasize to testicles

A
  1. hodgkins
  2. prostate
  3. lung
  4. skin
151
Q

Where is stage 1 testicular cancer?

A

confined to testicles

152
Q

where is stage II testicular cancer?

A

mets to nodes

153
Q

where is stage III testicular cancer?

A

mets above diaphragm or to visceral organs

154
Q

5 yr survival rate for stage I testicular cancer?

A

98%

155
Q

5 yr survival rate for stage II testicular cancer?

A

97%

156
Q

5 yr survival rate for stage III testicular cancer?

A

72%

157
Q

what are some sx that may be noted especially during a testicular self exam?

A
  1. lump on testicle
  2. slight enlargement of one of the testes
  3. heavy sensation in testicles or groin
  4. dull ache in lower abdomen or groin
158
Q

what are 3 PE findings to dx testicular cancer?

A
  1. firm, non-tender testicular mass that does not transilluminate”
  2. fluid collection
  3. regional lymphadenopathy
159
Q

will testicular cancer transilluminate?

A

nope

160
Q

what is the first imaging step in Dxing testicular cancer?

A
  1. US
  2. CXR
  3. abd CT
161
Q

are there any blood screening tests for testicular cancer?

A

nope

162
Q

what are some blood tests to monitor the response to treatment?

A
  1. AFP: alpha-fetoprotein
  2. beta HCG
  3. LHD: lactic dehydrogenase
163
Q

what test might a MD perform in diagnosing testicular cancer if other tests are inconclusive?

A

biopsy

164
Q

what are 5 main testicular cancer tx?

A
  1. radical inguinal orchiectomy
  2. retroperitoneal lymph node dissection with metastatic dz
  3. testicular prosthesis available
  4. radiation- adjunct tx to orchiectomy
  5. chemotherapy
165
Q

what might a man do prior to testicular cancer treatment in terms of family planning?

A

sperm banking before tx

166
Q

what is the 2nd leading cause of urinary tract problems in males?

A

prostate related

167
Q

sxs of prostate related complaints?

A
  1. pain
  2. discomfort
  3. sexual problems
168
Q

define prostatitis?

A

inflammation of the prostate

169
Q

what % of all visits regarding GU concern in young to middle aged men is related to prostatitis?

A

25%

170
Q

is prostatitis contagious?

A

not contagious, not STI unless d/t NG/CT

171
Q

what are 6 main sx of prostatitis?

A
  1. tender/swollen prostate
  2. fever/chills (in acute)
  3. dysurina, nocturia, urgency, hesitancy, frequency, hematuria
  4. pelvic/abdominal pain
  5. LBP, joint/mm pain
  6. painful ejaculation
172
Q

7 risk factors for prostatitis?

A
  1. medical procedure- catheterization
  2. unprotected vaginal &/or rectal intercourse
  3. abnormal urinarytract
  4. enlarged prostate (BPH)
  5. diabetes
  6. immunocompromised
173
Q

dx?

  • sudden onset
  • chills
  • fever
  • LBP
  • body aches
  • dysuria/freq/urgency/nocturia
  • perineal pain
A

acute bacterial prostatitis

174
Q

cause of acute bacterial prostatitis?

A

overgrowth of bacteria normally found in prostatic fluid (E. coli) or STI

175
Q

tx for acute bacterial prostatitis?

A

ER referral, tx with antibiotics

176
Q

PE findings of acute bacterial prostatitis?

A

tender, swollen, indurated prostate*

  • purulent prostatic secretions if obtained
  • often accompanied by bacteriuria
177
Q

what is the pathogenesis of chronic prostatitis?

A

variable causes

  • CT
  • ureaplasma urealyticum
178
Q

what are the sx of chronic prostatitis?

A
  1. suprapubic pain
  2. LBP
  3. dysuria
  4. nocturia
  5. intermittent
  6. waxing/waning
  7. bacterial chronic- often assoc w/ recurrent UTIs
179
Q

what might longstanding prostatitis be associated with?

A

underlying prostate defect= harbors persistent bacteria (BPH, anatomical variant)

180
Q

what type of chronic prostatitis is more common?

A

non bacterial

181
Q

sx of chronic non bacterial prostatitis?

A

similar to CBP w/o fever

182
Q

what are some theories of pathogenesis of chronic non-bacterial prostatitis?

A
  1. infectious agents undetected by standard lab tests
  2. heavy lifting causing urine retention
  3. physical acitivity may irritate/inflame prostate
  4. pelvic mm spasm may lead to increased prostate pressure
  5. structural abnormalities; urethral narrowing = pressure
183
Q

how is the dx for chronic non bacterial prostatitis made?

A

made by excluding other causes

184
Q

4 diagnostic prostatitis lab procedures

A
  1. prostatic stripping and culture discharge (expressed prostatic secretion- EPS)
  2. WBCs in EPS, (assoc w/ non bacterial prostatitis, urethritis, prostatic stones, recent ejaculation)
  3. pH of prostatic fluids rises when infection is present 6.5 to > 8.0
  4. PSA levels often elevated (collect pre-DRE)
185
Q

is WBCs in expressed prostatic secretions associated with bacterial prostatitis?

A

nope

186
Q

when should PSA level be collected?

A

collect pre-DRE, repeated testing 6 weeks after resolution of prostatitis

187
Q

when performing a DRE in prostatits what are you checking for?

A
  1. size
  2. symmetry
  3. consistency
  4. lumps/nodules
  5. discomfort/pain
188
Q

what is the classic presentation (3) for DRE in prostatitis?

A
  1. sx patient
  2. enlarged, soft/boggy gland
  3. mod-severe tender on palpation
189
Q

what may you palpate during a DRE in prostatitis?

A

prostatic stones

190
Q

can prostatic stones cause recurrent infections?

A

YES

191
Q

ddx acute prostatitis with lab work?

A

WBCs and bacteria in urine/prostate fluid w/ acute onset and systemic sxs

192
Q

ddx chronic bacterial prostatitis with lab work?

A

WBCs and bacteria in urine/prostate fluid w/ insidious onset

193
Q

ddx chronic non-bacterial prostatitis with lab work?

A

may see WBC in urine or prostate fluid

- no evidence of infection

194
Q

tx of acute prostatitis?

A

Antibiotics 7-10d, repeat if symptoms do not resolve

195
Q

tx of chronic prostatitis?

A
  • Antibiotics 4-12 wks 60% will clear up
  • NSAIDs to palliate symptoms
  • Sitz baths may provide symptomatic improvement
196
Q

tx for non infectious prostatitis?

A
  • reduce inflammation: NSAIDs, natural COX2 inhibitors

- relax tissue, decrease congestion

197
Q

what % of american men have sx of prostadynia?

A

11%

198
Q

what % of men dx’d as chronic prostatitis have no evidence of bacterial infection or inflammatory cells in the prostatic fluid

A

95%

199
Q

another name for prostadynia?

A

chronic pelvic pain syndrome (CPPS)

200
Q

sx of prostadynia?

A

 Pain in pelvis or perineum, can extend to penis, testes, rectum
 May cause voiding or sexual dysfunction

201
Q

define prostadynia

A

prostatitis sx w/o inflammation or bacterial infection

202
Q

what is the cause of prostadynia?

A

Cause = unknown; pain may be due to muscle spasms or

musculoskeletal conditions, like nerve entrapment

203
Q

what might be helpful in decreasing sx and is routing rx’d for prostadynia?

A

Finesteride

204
Q

3 causes for pudendal nerve entrapment?

A
  1. impact trauma
  2. surgery
  3. congenital malformation
205
Q

sx of pudendal nerve entrapment?

A
  1. pain in penis, scrotum, or anorectal area
  2. prostatitis-like pain and voiding/sexual dysfunction are the hallmark of PNE
  3. aggravated by sitting, relieved by standing, lying
206
Q

what is the hallmark of pudendal nerve entrapment

A

prostatitis-like pain &
voiding/sexual
dysfunction

207
Q

where is the pudendal nerve predisposed to entrapment?

A

at level of ischial

spine and within pudendal canal:

208
Q

what are some mechanisms of injury for pudendal nerve (4)?

A
  1. At ischial spine, nerve can be compressed between
    sacrotuberous and sacrospinous ligaments.
  2. Nerve may be ensheathed by ligamentous expansions
    that form a perineural compartment.
  3. At pudendal canal, nerve can be compressed by falciform
    process of the sacrotuberous ligament
  4. If thickened, duplication of obturator fascia may act as an
    entrapment site
209
Q

is imaging helpful in Pudendal NE?

A

not necessarily

210
Q

what should you r/o with pudendal NE?

A

R/O causes of prostatitis (urology referral)

211
Q

what type of surgery may help with pudendal NE?

A

decompression surgery

212
Q

which ethnicity has increased incidence of BPH?

A

african americans

213
Q

is BPH precancerous?

A

nope!

214
Q

what percentage of men over 80 have BPH?

A

90%

215
Q

Etiology of BPH?

A

uknown, condition of aging

216
Q

What is the hormonal influence of BPH?

A
  1. combo of decreased testosterone and increased estrogen

2. increased sensitivity to DHT in the prostate

217
Q

Where does hyperplasia in BPH typically occur?

A

Hyperplasia nearly always occurs in transitional zone beginning around prostatic urethra & extending peripherally

218
Q

what % of males with BPH have sx?

A

20%

219
Q

what are sx of BPH? (5)

A
  1. difficulty initiating urine stream (hesitancy)
  2. interruption of steam
  3. frequency
  4. urgency
  5. nocturia
220
Q

what are the rectal exam findings of of BPH?

A

non-tender, soft, boggy

221
Q

what are the rectal exam findings of cancer?

A

rock-hard

222
Q

what are the rectal exam findings of prostatitis?

A

painful

223
Q

What are 3 complications of BPH?

A
  1. decreased QOL, ADLs
  2. increased risk of UTI and acute urinary rentention, but ER referral (d/t residual urine)
  3. complete obstructuion requires surgery
224
Q

does complete obstruction d/t prostate require surgery?

A

YES

225
Q

does BPH increase the risk of developing prostate carcinoma?

A

NOPE

226
Q

what are two Hx/PE procedures for BPH?

A
  1. DRE

2. AUA sx index questionnaire

227
Q

4 things PSA is elevated in?

A
  1. BPH
  2. prostate cancer
  3. recent ejaculation/DRE (~2 days)
  4. prostatitis
228
Q

is PSA elevated in BPH?

A

yes

229
Q

what are DRE screening for?

A

colorectal cancer and prostate cancer

230
Q

what is the normal consistency of the prostate?

A

normal= rubbery, walnut size, 4 cm, symmetrical and absent of any nodules or polyps

231
Q

what is the recommended starting age for DRE?

A

50 YO, earlier with sx or risk factors

232
Q

what should the rectal wall feel like in a DRE?

A

smooth without abnormalities or unusual lumps, swelling or tenderness

233
Q

where are PSA produced?

A

by cells of prostate capsule and periurethral gland

234
Q

what is a normal PSA level?

A

0-4.0 ng/mL

235
Q

does PSA normally increase with age?

A

YES

236
Q

when should you refer in regards to PSA and DRE?

A
  1. PSA 4-10 ng/mL w/ abnormal DRE
  2. PSA >10
    regardless of DRE
  3. palpable nodule on DRE, regardless of PSA
  4. pts w/ UTI, prostatitis or recent biopsy should have PSA test deferred to avoid a potential unnecessary biopsy
237
Q

should patients with recent UTI, prostatitis, or recent biopsy have a PSA test?

A

no, PSA test deferred to avoid a

potentially unnecessary biopsy.

238
Q

what is the typical conventional tx for BPH?

A

watchful waiting and regular follow up

239
Q

what are 2 medications used to tx BPH?

A
  1. 5-alpha-reductase inhibitors: finasteride (proscar)

2. alpha blockers

240
Q

how does 5 alpha reductase inhibitors work for BPH?

A

finasteride inhibits peripheral conversion of testosterone to DHT, block growth effect of DHT

  • clinical trials show its effective in reducing size and sx
  • assoc w/ lower risk of acute urinary retention and need for sx common with placebo 4y trial in 3040 men with mod-severe BPH sx and enlarged prostate
241
Q

do alpha blockers change prostate size?

A

no, relaxes smooth mm, do not decrease prostate size

242
Q

what are 3 surgical tx for BPH?

A
  1. TURP- transurethral resection of the prostate (core out middle part of prostate to open lumen
  2. laser/thermoablation
  3. prostatectomy
243
Q

what are 2 goals of complementary care for BPH?

A
  1. reduce hyperplasia by inhibiting conversation of T to DHT

2. prevent estrogen from binding to estrogen r/c

244
Q

what is saw palmetto used to tx

A

BPH

245
Q

according to research is saw palmetto good for tx of BPH?

A

research is mixed “may be beneficial”

246
Q

side effects of saw palmetto?

A

HA, nausea, dizziness

247
Q

how might saw palmetto tx BPH?

A

may improve urine flow and decrease sx while avoiding negative SE of conventional tx

248
Q

Will saw palmetto effect PSA?

A

nope, does not affect PSA like medications

249
Q

what are 6 supplements for tx of BPH?

A
  1. amino acids
  2. beta-sitosterol
  3. zinc picolinate
  4. pygeum
  5. nettles (urtica diocia)
  6. saw palmetto
250
Q

what % of men over age of 40 have sexual dysfunction?

A

> 50%

251
Q

what are 3 common ways male sexual dysfunction presents?

A
  1. decreased libido
  2. ejaculatory disturbances
  3. erectile dysfunction
252
Q

what is the most common presentation of sexual dysfunction?

A

erectile dysfunction

253
Q

4 physical causes of male sexual dysfunciton?

A
  1. drugs
  2. blood flow abnormalities
  3. nerve abnormalities
  4. hormonal abnormalities
254
Q

how might hormonal abnormalities contribute to male sexual dysfunction?

A

andropause

  1. tesosterone levels decline
    - about 2-3%/y b/w 40-70, SHBG increases as well
255
Q

what are 4 psychological causes of male sexual dyfunction?

A
  1. depression
  2. stress
  3. performance anxiety
  4. misinformation about sexuality
256
Q

What is ADAM?

A

androgen decline in aging men

257
Q

sx of ADAM (5)

A
  1. mood dysfunction
  2. sexual dysfunction (libido loss, erectile dysfunction)
  3. osteoporosis
  4. mm atrophy
  5. cognitive changes
258
Q

What are some lab tests to run with ADAM?

A

free and total testosterone (diurinal variation)

and LH, PRL

259
Q

5 factors that may compound testosterone?

A
  1. stres: physical and psychologica;
  2. obesity
  3. diabetes
  4. pituitary tumor
  5. drugs: cimetidine, digoxin, spironolactone
260
Q

What should you R/O for ADAM?

A
  1. hypothyroid
  2. depression
  3. anemia
  4. prolactinoma
261
Q

what is the most common type of cancer in MEN in the US?

A

prostate cancer

262
Q

what is the second leading cause of cancer death in men?

A

prostate cancer

263
Q

incidence of prostate cancer?

A

1/6 will get prostate cancer

264
Q

cause of prostate cancer?

A

cause is uknown, genetic, hormonal and environmental factors may play a role

265
Q

what can prostate cancer growth be inhibited by?

A
  1. orchiectomy or use of estrogen therapy

2. decrease/eliminate testosterone which feeds prostate cancer cell growth

266
Q

6 major risk factors for prostatic cancer?

A
  1. age > 50
  2. race or ethnicity, African american
  3. family hx, testing should begin at age 40 if so
  4. diet: high fat,, sedentary lifestyle & obesity
  5. vasectomy
  6. smoking
267
Q

annual DRE and PSA screening guideline?

A

baseline screening at 50 for those w/o risk factors

268
Q

annual DRE and PSA screening guideline for AA and men w/ 1st degree relative?

A

at 40 YO for baseline screening

UWS Q9 (3 decks)

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