ICA5 - Urological Conditions In Men's Health

Question 1

Conditions affecting the foreskin (prepuce)

Phimosis
Sequelae of Phimosis x8
Paraphimosis

Answer 1

1. ) Phimosis - inability to retract the foreskin in adulthood
   - it is ‘normal’ up to adolescence
   - treatment is often circumcision
2. ) Sequelae of Phimosis
   - urinary retention, poor hygiene, ↑STDs, dyspareunia
   - inflammation: balanitis (glans), posthitis (foreskin)
   - paraphimosis and penile cancer
3. ) Paraphimosis - painful constriction of the glands by the retracted foreskin proximal to the corona
   - causes: phimosis, catheterisation, penile cancer
   - treatment is reduction, often manual or circumcision

Question 2

Key indications for a circumcision

Paediatric x2
Adulthood x4

Answer 2

1. ) Paediatric - recurrent balanitis/UTIs
   - also religious reasons
2. ) Adulthood
   - phimosis and recurrent paraphimosis and balanitis
   - penile cancer

Question 3

5 causes of acute scrotal pain

Answer 3

1. ) Testicular Torsion
   - younger patient (<30), sudden onset
   - unilateral pain +/- nausea/vomiting, no LUTS
   - testis is very tender and lying high in scrotum
2. ) Torsion of hydatid of Morgagni
   - small embryological remnant at the upper pole of testis
3. ) Epididymitis/Orchitis/Epididymo-orchitis
   - inflammation of the epididymis and testicles
4. ) Trauma
5. ) Ureteric Calculi - very rare

Question 4

Features of epididymo-orchitis

History x3
Examination x4
Treatmetn x3

Answer 4

1. ) History
   - age: 20-45 (STI esp Chlamydia), 45+ (UTI esp E.coli)
   - gradual onset and often unilateral
   - causes: STIs, UTIs, mumps, catheterisation
2. ) Examination
   - red scrotum, enlarged and tender testis/epididymis
   - may be pyrexial and can also be septic
   - may have reactive hydrocoele or abscesses
   - Fournier’s Gangrene: necrotic area of scrotal skin (rare)
3. ) Treatment - antibiotics
   - drainage of abscess, debridement of gangrene

Question 5

5 causes of painless scrotal lumps (and their treatments)

Testicular Tumour
Epididymal Cyst
Hydrocoele
Varicocoele 
Reducible Inguino-Scrotal Hernia

Answer 5

1. ) Testicular Tumour
   - younger men: germ cell tumour (seminoma/teratoma)
   - history of cryptorchidism (undescended testis)
   - older men: lymphoma
   - treatment: inguinal orchidectomy
2. ) Epididymal Cyst - benign growth on top of the testis
   - separate from the testis and transilluminates
   - treatment: excise if large
3. ) Hydrocoele
   - slow or sudden onset w/ uni/bilateral scrotal swelling
   - transilluminates and testis not palpable separately
   - treatment: surgical removal if large/symptomatic
4. ) Varicocoele - enlargement of testicular veins
   - not tender but may ache at the end of the day
   - left testies more affected than the right testis
   - may be associated w/ reduced fertility (esp if bilateral)
   - treatment: radiological embolisation if symptomatic
5. ) Reducible Inguino-Scrotal Hernia
   - treatment: surgery

Question 6

2 causes of painful scrotal lumps

Answer 6

1.) Epididymo-orchitis

2. ) Strangulated Inguino-Scrotal Hernia
   - treatment: surgery

Question 7

Features of male lower urinary tract symptoms (LUTS)

Voiding Symptoms
Causes of Voiding Symptoms
Storage Symptoms
Causes of Storage Symptoms

Answer 7

1. ) Voiding Symptoms
   - hesitancy, poor flow, post micturition dribbling
2. ) Causes of Voiding Symptoms
   - bladder outflow obstruction or reduced contractility
   - physical: phimosis, stricture, BPH, prostate cancer
   - neurological: (↓coordination between bladder and urinary sphincter, UMN lesion)
   - LMN lesion causes reduced contractility
3. ) Storage Symptoms
   - frequency, urgency, nocturia
4. ) Causes of Storage Symptoms
   - irritative: bladder infection/inflammation/stone/cancer
   - overactive bladder: idopathic or neuropathic (e.g. MS)
   - ↓bladder compliance: e.g. post-TB, schistosomiasis
   - polyuria: diabetes, venous stasis, sleep apnoea

Question 8

Management of LUTS and BPH

Lifestyle
Alpha Blockers
5-alpha-Reductase Inhibitors (5ARIs)
Transurethral Resection of Prostate (TURP)

Answer 8

1. ) Lifestyle - intake
   - ↓caffeine, avoid fizzy drinks, <2.5L per day
2. ) Alpha Blockers - e.g. Tamsulosin
   - relax SMCs within the prostate and the bladder neck
   - provides rapid symptom relief
3. ) 5-alpha-Reductase Inhibitors (5ARIs) - e.g. finasteride
   - shrink the prostate via androgen deprivation
   - slows progression and reduces risk of retention
4. ) Transurethral Resection of Prostate (TURP)
   - surgical intervention for BPH
   - used if failed lifestyle and medical management

Question 9

Causes of urinary retention

Urological x6
Non-Urological x5

Answer 9

1. ) Urological
   - BPH, prostate cancer, UTIs
   - urethral stricture/phimosis/meatal stenosis
2. ) Non-Urological
   - post surgery: anesthetic/mobility related
   - drugs: anti-depressants, anti-cholinergics
   - neurological, over-distension, constipation