lecture 24 - mens health Flashcards
what is balanitis - condition affecting penis?
pain and inflammation (swelling and irritation) of the glans. completely red or patchy
what is phimosis - condition affecting penis ?
a condition where the foreskin remains unusually tight and cannot be drawn back, leading to pain, urianation difficulties and caressed risk infection
what is testicular torsion - condition affecting testicles ?
a medical emergency due to the rotation and twisting of the testicle, causing pain and inflammation and eventually cutting off the blood supply.
What is epididymitis?
pain and inflammation f the epididymis which is back of the testicles. most feted caused by a bacterial infection such as chlamydia or gonorrhoea and treated with antibiotics and measures to relive discomfort. testicle may also become inflamed.
what are benign causes of testicular lumps or swelling ?
varicoceles - soft lumps that develop gradually above the testicle on the left side of the scrotum
hydroceles - swelling in the scrotum caused by a build-up of fluid
epidydimal cysts - a small, smooth fluid-filled swelling that slowly develops in the epididymis
inguinal hernias - when fatty tissue or part of the bowel pokes through the groin at the top of the inner thigh
testicualr cancer
What is Peyronie’s disease?
causes scar tissue, or a hard lump, to form inside the penis. The cause is not really known, though trauma (such as hitting or bending) of the penis may be involved.
can improve without treatment in 6 to 15 months. In most cases, the hardened scar tissue can make the penis less flexible, cause pain and force the penis to bend or arc during erection. Can cause impotence and make sexual intercourse difficult or even impossible.
What is priapism
persistent erection that lasts at least 4 hours
usually painful, and may not be related to sexual stimulation or activity. Left untreated, it can cause lasting damage to the penis
What is haematospermia?
Visible blood in the ejaculate, commonly due to infection or recent urological procedures.
what is a normal erection ?
to achieve adequate peniel tumescence for successful penetrative intercourse, blood flow within the corpus cavernous needs to increase
how is an erectile dysfunction defined?
Persistent inability to attain and maintain an erection for satisfactory sexual performance.
what are common causes of erectile dysfunction ?
vascular, neuronal, hormonal, and metabolic factors, mediated by endothelial and smooth muscle dysfunction
what is the role of dopamine in sexual function ?
dopamine enhances sexual motivation and performance. dopamine in other parts of the brain controls genital reflexes, sexual configurations, and specifically libido. the dopamine hypothesis of psychosis is a model that attributes symptoms of schizophrenia to a disturbed and overactive active dopamine signalling
what is prolactin ?
prolactin secretion in the pituitary is normally suppressed by dopamine. it plays a key role in maintaining a healthy libido. hyperprolactinamyia often deceases sex drive because prolactin can decrease levels of sex hormones like testerstreon in men and women
explain serotonin dn sexual behaviour
it is thought that dismissed activity of serotonin pathways can cause depression
prolonging the effects of serotonin is thought to be a major action of several classes of pharmacological antidepressants
serotonin generally inhibits sexual activity. sexual behaviour is impaired by many serotonin agonists.
what are diseases that can cause sexual dysfunction ?
high blood pressure - this decreased blood flow can interfere with erections, ejacualtions, and sexual desire while in women achieving orgasm and vaginal dryness are common, diabetes, mental disorders. hormonal imbalance, chronic disease eg renal or lier failure
what are ways in which medicines can impact sexual dysfunction ?
desire disorders: the lack of sexual desire or interest in sex
arousal disorders: the inability to become physically aroused during sexual activity, including problems achieving and maintaining an erection
orgasm disorders: the delay or absence of orgasm
pain disorders: pain during intercourse
what are main drug classes causing sexual dysfunction ?
Anti-psychotics
Anti-depressants
Anti-hypertensives
Anti-epileptics
Recreational/substances of abuse
Others
what are ‘other’ drugs causing sexual dysfunction
Anti-parkinsonian drugs: L-dopa may cause hypersexuality as a side effect in some cases.
Benzodiazepines act as hypnotics and cause drowsiness, thus reducing desire. In certain doses they can be disinhibiting and may increase libido.
Antacids – cimetidine and ranitidine affect histamine - may play a role in human penile erection. The erection-promoting action of histamine is probably due to H2 receptor activation, although another histamine receptor, possibly H3, also seems to be involved.
How do PDE5 inhibitors (e.g., Sildenafil) work in treating ED?
They inhibit PDE5 in the cavernous smooth muscle and prevent the breakdown of cGMP to GMP. nitric oxide mediated smooth muscle relaxation is therefore facilitated in both corpus cavernous and cavernosal arteries
what are storage, voiding and post-micturation symptoms of lower urinary tract symptoms ?
storage symptoms include urgency, daytime urinary frequency, nocturne, urinary incontinence, and feeling the need to urinate again just after passing urine.
Voiding symptoms include hesitancy, weak or intermittent urinary stream sometimes causing splitting or spraying, straining, intermittency, incomplete emptying, and terminal dribbling
Post-micturition symptoms include post-micturition dribble and the sensation of incomplete emptying
what are common conditions related to LUTS in men
Benign prostatic hyperplasia (BPH) — a condition in which a biopsy of the prostate shows histologic signs of hyperplastic changes (abnormalities at the cellular level). Only 25–50% of men with BPH have LUTS and often the predominant problem is voiding symptoms
Benign prostatic enlargement — describes enlargement of the prostate gland by BPH. Only about 50% of men with BPH develop benign prostatic enlargement
Bladder outlet obstruction — the generic term for obstruction during voiding. It is diagnosed when urodynamic voiding studies show increased detrusor (bladder wall muscle) pressure and reduced urine flow rate
what are lower Urinary Tract Symptoms ?
Overactive bladder — a syndrome (symptom complex) of storage symptoms, including urinary urgency, with or without urgency incontinence; frequency; and nocturia. Usually caused by bladder (detrusor) overactivity
Detrusor overactivity — a urodynamic observation characterized by involuntary detrusor contractions during the bladder filling phase which may be spontaneous or provoked. Detrusor overactivity occurs in approximately 65% of men presenting with overactive bladder symptoms and 50% of men with bladder outlet obstruction
what are the potential causes of LUTS
causes of overactive bladder symptoms:
- benign prostatic hyperplasia and benign prostatic enlargement
- neurological conditions eg diabetes, stroke
- lower urinary tract infection, sexually transmitted infections and prostatitis
- blader stones
- cancer of the bladder and prostate
what are the recommended treatments for overactive bladder symptoms or LUTS storage
prudent fluid intake
lifestyle measures
temporary urine contaminant products
referral for supervised bladder training
first lien medication if symptoms persist
- oxybutynin, tolterodine, daliferacin
what are the causes of urinary voiding symptoms ?
benign prostatic hyperplasia and benign prostate enlargement are the most common causes
drugs with antimuscarinic actions include TCAs, sedating antihistamines, Antimuscarinic drugs for urinary incontinence, Disopyramide
Diabetic autonomic neuropathy & neurogenic bladder, Urethral stricture & phimosis (foreskin constriction),
Cancer of the prostate, bladder, or rectum
what are treatment option for urianry voiding ?
moderate-to-severe voiding symptoms offer an alpha blocker (alfuzosin, doxazosin, tamsulosin or terazosin)
if enlarged prostate and is considered to be at high risk of progression offer a 5-alpha reductase inhibitor (dutasteride or finasteride).
If bothersome moderate-to-severe voiding symptoms and prostatic enlargement, consider offering a combination of an alpha-blocker and a 5-alpha reductase inhibitor
