Lecture 9 - Men Urology Flashcards
What is phimosis?
When the prepuce cannot be fully retracted
What are some consequences of phimosis?
Poor hygiene (STDs)
Pain on intercourse
Balanitits (Inflamed glans)
Posthitis (inflamed foreskin)
Paraphimosis.
Urinary retention
Penile cancer
What is Paraphimosis?
The painful. Constriction of the glans penis by the retracted foreskin proximal to the corona
What are the most common causes of Paraphimosis?
Phimosis
Catheterisation (esp. elderly)
Penile cancer
What is the treatment for phimosis?
Circumcision
What is the treatment for Paraphimosis?
Needs reduction
(Manually or dorsal slitting)
What is the main type of penile cancer?
Squamous cell carcinoma
What are the risk factors for penile cancer (Squamous Cell Carcinoma)?
Phimosis
Poor hygiene
HPV 16 + 18
What is Balanitits?
Inflamed glans penis
What are some indications for circumcision for paeds?
Religious
Recurrent Balanitits + UTIs
What are some adult indications for circumcision?
Recurrent Balanitits
Phimosis
Recurrent Paraphimosis
Balanitits xerotica obliterates
Penile cancer
What are some acute emergency presentations for acute scrotal pain?
Testicular torsion
Epididymitis (caused by UTI, STI, MUMPS)
Torsion of hydatid of Morgagni
Trauma
Ureteric calculi
What is the likely history for a testicular torsion?
Usually younger patient
Sudden onset (woke from sleep)
Unilateral pain
May be nauseated
What examinations and immediaet treatment do you do for someone with a testicular torsion?
Testis tender
Lying high in scrotum with horizontal lie
Emergency scrotal exploration needed
What is the history likely to be for a patient with Epididymitis or Epididymo-or hit is
20 - 50 STI (Chlamydia) or 40-50 UTI (E.coli)
Gradual onset
Unilateral normally
Recent:
-UTI
-Unprotected intercourse
-catheter
-MUMPS history
How does epidiymo-orchitis present on exa m?
Pyrexia L can. Be septic
Scrotum erythematous
Testis/epidiymis enlarged and tender
May have abscess
May have Hydrocoele
Rarely necrotic scrotal skin = Fournier gangrene
What investigations are done for epidiymo-orchitis?
Bloods (FBC/UEs/CUltures if septic)
Urine (MSU for MC&S)
Radiology (US)
What is the treatment for Epididymo-orchitis?
Abx
What is the treatment for an abscess on the scrotum?
Surgical drainage and Abx
What is the treatment for Fournier gangrene>
Emergency debridement and Abx
What are some examples of painless (non tender) scrotal lumps?
Testis tumour
Epididymis cyst
Hydrocoele
Reducible Inguinal-scrotal hernia
What is a condition that would cause painless aching at teh end of the day?
Varicocele
What are some painful tender acute. Presentations of testicular disease?
Epididymitis
Epidiymo-orchitis
Strangualted inguino-scrotal hernia
What is the normal Hx of a testical tumour?
Normally painless
Germ cell tumours (seminomas/teratomas in men younger than 45)
Older = lymphoma
What is a big risk factor for a germ cell tumour like a seminoma/teratoma?
Hx of undescended testes
How does a testicular tumour normally feel on palpation?
Body of testis abnormal (can get above it)
What tumour markers are looked for in testicular tumours?
AFP, hCG and LDH
What is the Hx for an adult Hydrocoele?
Slow/sudden onset
Can be uni or bilateral scrotal swelling
What causes Hydrocoele?
Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis
How does Hydrocoele appear on nexam?
Testis not palpable separately
Can usually get above
Transilluminates
How does an epididymis cyst appear on exam and Hx??
Usually painless
Separate from testes
Can get above mass
Transilluminates
How does varicocele present?
Dull ache at end of day
Usually effects left testes more than right
Feels like a bag of worms abbbove testes
Not tender
What usually causes varicocele on the left side?
L test vein drains into L renal vein then in IVC, ,issue along the way leads to increase in pressure int eh scrotal veins
How is a testicular tumour treated?
Inguinal orchidectomy
How is an epididymis cyst treated?
Reassure
Excise if large
How is an adult Hydrocoele treated?
Reassure and surgical removal if large
How is varicocele treated?
Reassure
Radiological embolisation if symptomatic
Likely to cause infertility
How is an Inguinal-scrotal hernia treated?
Surgery (emergency if strangualted)
What is urinary retention?
Inability to pass urine
What are some causes of urinary retention?
BPH
Prostate cancer
Phimosis/meatal stenosis/urethral stricture
Constipation
UTI
Anticholinergic drugs
Overdistension
After surgery
Neruological
How do you treat an acute painful Urinary retention?
Catheterise ((relives pain)
If there’s less than <1000ml residual vol theres no kidney insult
How do you treat chronic painless/less painful urinary retention??
May have a kidney insult
Need to learn to self catheterise
What is the treatment for an acute on chronic urinary retention? (Painful)
Residual vol > 1000ml
Usually have kidney insult
Long term Cather or surgical intervention
What is assumed if an older man has nocturnal enuresis?
Chronic retention of urine witht overflow incontinence
What are some male Lower urinary tract symptoms?
Voiding: (bladder outflow obstructiotn)
-hesitantly
-poor flow
-post micturition dribbling
Storage:
-frequency
-urgency
-nocturnal
What aree some possible causes oof lower urinary tract symptoms?
Prostate pathology
Bladder irritation (infection, inflammation, stone, cancer)
Overactive bladder (Parkinson’s , MS)
Low compliance of bladder (scarred maybe after TB/schistosomiasis)
Polyuria (uncontrolled diabetes or venous stasis)
What are some physcial causees of bladder outflow obstruction?
Urethral:
-phimosis
-stricture
Prostate:
-benign
-malignant
-bladder neck
What are some neurological causes of voiding symtpoms?
Lllack of coordination between bladder and urinary sphincter (UMN lesion)
What type of neurone would be damaged if there’s reduced bladder contractility?
LMN lesion
What may be suggested by a patient saying there’s spraying of urine?
Urethral stricture
What receptor mediates sympathetic smooth muscle tone?
A1 receptors
What exams are done on a Pateint with male lower urinary tract symptoms?
DRE
Bladder palpable
Neuro if Hx supports
What Ix are done for a patient with male lower urinary tract symtpoms?
Dipstick for blood or UTIs
Consider PSA
How is BPH managed?
Reduce caffeine intake
Avoid fizzy drinks
Don’t drink more than 2.5L a day
Alpha blockers
5a-reductase inhbitors
What is the function of alpha blockers in treating BPH?
What is an example of an alpha blocker?
The relax the smooth muscle in the prostate and the neck of the bladder
Tamsulosin
How do 5a-reducatse inhibtors work to treat BPH?
What is an example of a 5a-REDUCTASE inhbitors?
Prevent conversion of test -> dihydrotestosterone
So shrinks the prostate by depriving it of androgens
Slows progression and reduces risk of retention
Example = finasteride
What measurement must be considered before doing prostate surgery for BPH?
Flow rate
What is the standard surgical technique for BPH leading to urinary retention?
Transurethral resection of prostate (TURP)
What are some indications for surgical intervention for BPH?
Failed lifestyle and medical management
Urinary retention neeedding intervention m
What part of the prostate is normally affect with BPH?
Transitional zone
