Lecture 11 - Men's Health

Question 1

Transilluminates

Answer 1

hydrocele

Question 2

Hydrocele

Answer 2

reassure parents
will probably go away on its own within a year
monitor

transilluminates

Question 3

Varicocele

Answer 3

always wonder “why did this form?”

a cenous varicosity within the pampiniform plexus occurs more often on the left than the right
does NOT illuminate

“Bag of worms”

Question 4

Bag of worms

Answer 4

varicocele

Question 5

What is the most common type of kidney stone?

Answer 5

calcium oxalate or calcium phosphate (75-85%)
radioopaque

second most common is struvite (10-15%)(calcium/ammonium/magnesium salt)

Question 6

When are kidney stones most common?

Answer 6

3rd to 4th decade of life
M > W

may recur in 30-50% of patients within 5 years

Question 7

What are the signs and sxs of urolithiasis?

Answer 7

CVAT (not as sensitive as pyelonephritis) 
tachycardia
tachypnea
restlessness
hematuria (85%)

Question 8

Do we need to get imagining on every pt with kidney stones?

Answer 8

no —probably the very first time we’d get a non contrast abdomen and pelvis

but these commonly recur so we don’t want to do this every single time —look at their hx of kidney stones and how they passed

stone must me 5mm or smaller to pass on its own

Question 9

What is the treatment of kidney stones?

Answer 9

hydration (IV only if PO isn’t tolerate)

Pain control (TORADOL IV/IM, high dose ibuprofen)

Question 10

When do pts with kidney stones get admitted to the hospital?

Answer 10

only if they are infected

even if the stone is too big they still go home (on pain meds) and follow up SOON with urologist

Question 11

Phimosis

Answer 11

inability to retract the foreskin

congenital
acquired (usually d/t chronic balanitis)

not an emergency
treat underlying infection if there is one (commonly fungal)

Question 12

Paraphimosis

Answer 12

entrapment of the foreskin behind the glans

commonly iatrogenic when doing foley catheters

tx: squeeze to displace edema, then you should be able to move the foreskin –if that doesnt work –> urology consult!

Question 13

Who gets testicular torsion?

Answer 13

urologic EMERGENCY

12-18 years old

Question 14

Testicular torsion

Answer 14

urologic EMERGENCY

testis twists on its spermatic cord

sudden onset of severe unilateral pain and swelling, N/V

urgent US with doppler! —if this takes too long you need to just try and untwist it yourself before the US (manual detorsion)

Question 15

Urethritis

Answer 15

discharge
painful urination
typically following sexual intercourse –> you need to ask if it was a male or female partner

THIS IS REPORTABLE – so encourage pt to tell their partner –or else the department of health has to

don’t focus on blame –both men and women can be asymptomatic for a long time before presenting with STI

most commonly gonorrhea and chlamydia (if >35yo probably E.coli)

Question 16

Epidiymitis

Answer 16

> 35 e. coli
<35 chlamydia and gonorrhea

heaviness unilaterally
fever, chills
unilateral enlarged and swollen epidiymis

we tx based on assumption from hx (age) and PE

if they don’t get better then we do studies

Question 17

What is the treatment for epiddiymitis for a man >35 yo?

Answer 17

ciprofloxacin 50mg bid for 10-14 days

Question 18

Orchitis

Answer 18

if bacterial, caused by ascending infection from urinary tract
can be viral from mumps

dx: urinalysis shows pyuria and bacteriuria

tx:
tx like epididymitis
if mumps: tx with ice and pain meds

Question 19

Prostatitis

Answer 19

urinary frequency, urgency, dysuria, fever, rigors, and low back pain or perineal pain

pain or bleeding with ejaculation may be present

dx:
pyuria on UA
prostate swollen on exam

tx:
fluoroquinolone or bactrim for 6 weeks

Question 20

What is the treatment for prostatitis?

Answer 20

fluoroquinolone or bactrim for 6 weeks

Question 21

Priapism

Answer 21

erection lasting >4hours

bimodal distribution: 5-10 years and 20-50 years of age

ischemic vs non ischemic

ischemic(MC): pills; more acute
non ischemic: trauma like biking; more slowly

tx: urology needle aspirate

Question 22

Scrotal pain

Answer 22

is this epididymitis? is this orchitis? is this Fourniers gangrene? Is this torsion? Is this CA?

have a chaperone (document in your chart who it was and that they were present when you were doing the exam)
do the exam!

Question 23

Fournier’s gangrene

Answer 23

surgical emergency

dead tissue on scrotum and/or perineum

don’t miss this
do a full head to toe
this pt might come in with AMS, don’t let this get missed –> high risk (~100%) of mortality

Question 24

Why do we see BPH in the ER?

Answer 24

acute urinary retention

tx: try twice with foley catheter –if that fails then you need to get urology down to help

Question 25

In regards to mens health, what are truly emergent?

Answer 25

testicular torsion
unreducible paraphimosis
Fournier’s gangrene
Priapism