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Y2 - Clinical App > Lecture 9 - Men Urology > Flashcards

Lecture 9 - Men Urology Flashcards

1
Q

What is phimosis?

A

When the prepuce cannot be fully retracted

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2
Q

What are some consequences of phimosis?

A

Poor hygiene (STDs)
Pain on intercourse
Balanitits (Inflamed glans)
Posthitis (inflamed foreskin)
Paraphimosis.
Urinary retention
Penile cancer

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3
Q

What is Paraphimosis?

A

The painful. Constriction of the glans penis by the retracted foreskin proximal to the corona

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4
Q

What are the most common causes of Paraphimosis?

A

Phimosis
Catheterisation (esp. elderly)
Penile cancer

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5
Q

What is the treatment for phimosis?

A

Circumcision

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6
Q

What is the treatment for Paraphimosis?

A

Needs reduction
(Manually or dorsal slitting)

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7
Q

What is the main type of penile cancer?

A

Squamous cell carcinoma

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8
Q

What are the risk factors for penile cancer (Squamous Cell Carcinoma)?

A

Phimosis
Poor hygiene
HPV 16 + 18

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9
Q

What is Balanitits?

A

Inflamed glans penis

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10
Q

What are some indications for circumcision for paeds?

A

Religious
Recurrent Balanitits + UTIs

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11
Q

What are some adult indications for circumcision?

A

Recurrent Balanitits
Phimosis
Recurrent Paraphimosis
Balanitits xerotica obliterates
Penile cancer

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12
Q

What are some acute emergency presentations for acute scrotal pain?

A

Testicular torsion
Epididymitis (caused by UTI, STI, MUMPS)
Torsion of hydatid of Morgagni
Trauma
Ureteric calculi

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13
Q

What is the likely history for a testicular torsion?

A

Usually younger patient
Sudden onset (woke from sleep)
Unilateral pain
May be nauseated

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14
Q

What examinations and immediaet treatment do you do for someone with a testicular torsion?

A

Testis tender
Lying high in scrotum with horizontal lie

Emergency scrotal exploration needed

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15
Q

What is the history likely to be for a patient with Epididymitis or Epididymo-or hit is

A

20 - 50 STI (Chlamydia) or 40-50 UTI (E.coli)

Gradual onset
Unilateral normally

Recent:
-UTI
-Unprotected intercourse
-catheter
-MUMPS history

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16
Q

How does epidiymo-orchitis present on exa m?

A

Pyrexia L can. Be septic
Scrotum erythematous
Testis/epidiymis enlarged and tender
May have abscess
May have Hydrocoele

Rarely necrotic scrotal skin = Fournier gangrene

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17
Q

What investigations are done for epidiymo-orchitis?

A

Bloods (FBC/UEs/CUltures if septic)
Urine (MSU for MC&S)
Radiology (US)

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18
Q

What is the treatment for Epididymo-orchitis?

A

Abx

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19
Q

What is the treatment for an abscess on the scrotum?

A

Surgical drainage and Abx

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20
Q

What is the treatment for Fournier gangrene>

A

Emergency debridement and Abx

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21
Q

What are some examples of painless (non tender) scrotal lumps?

A

Testis tumour
Epididymis cyst
Hydrocoele
Reducible Inguinal-scrotal hernia

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22
Q

What is a condition that would cause painless aching at teh end of the day?

A

Varicocele

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23
Q

What are some painful tender acute. Presentations of testicular disease?

A

Epididymitis
Epidiymo-orchitis
Strangualted inguino-scrotal hernia

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24
Q

What is the normal Hx of a testical tumour?

A

Normally painless

Germ cell tumours (seminomas/teratomas in men younger than 45)
Older = lymphoma

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25
Q

What is a big risk factor for a germ cell tumour like a seminoma/teratoma?

A

Hx of undescended testes

26
Q

How does a testicular tumour normally feel on palpation?

A

Body of testis abnormal (can get above it)

27
Q

What tumour markers are looked for in testicular tumours?

A

AFP, hCG and LDH

28
Q

What is the Hx for an adult Hydrocoele?

A

Slow/sudden onset
Can be uni or bilateral scrotal swelling

29
Q

What causes Hydrocoele?

A

Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis

30
Q

How does Hydrocoele appear on nexam?

A

Testis not palpable separately
Can usually get above
Transilluminates

31
Q

How does an epididymis cyst appear on exam and Hx??

A

Usually painless

Separate from testes
Can get above mass
Transilluminates

32
Q

How does varicocele present?

A

Dull ache at end of day

Usually effects left testes more than right

Feels like a bag of worms abbbove testes
Not tender

33
Q

What usually causes varicocele on the left side?

A

L test vein drains into L renal vein then in IVC, ,issue along the way leads to increase in pressure int eh scrotal veins

34
Q

How is a testicular tumour treated?

A

Inguinal orchidectomy

35
Q

How is an epididymis cyst treated?

A

Reassure
Excise if large

36
Q

How is an adult Hydrocoele treated?

A

Reassure and surgical removal if large

37
Q

How is varicocele treated?

A

Reassure
Radiological embolisation if symptomatic
Likely to cause infertility

38
Q

How is an Inguinal-scrotal hernia treated?

A

Surgery (emergency if strangualted)

39
Q

What is urinary retention?

A

Inability to pass urine

40
Q

What are some causes of urinary retention?

A

BPH
Prostate cancer

Phimosis/meatal stenosis/urethral stricture
Constipation
UTI

Anticholinergic drugs
Overdistension
After surgery
Neruological

41
Q

How do you treat an acute painful Urinary retention?

A

Catheterise ((relives pain)

If there’s less than <1000ml residual vol theres no kidney insult

42
Q

How do you treat chronic painless/less painful urinary retention??

A

May have a kidney insult
Need to learn to self catheterise

43
Q

What is the treatment for an acute on chronic urinary retention? (Painful)

A

Residual vol > 1000ml
Usually have kidney insult

Long term Cather or surgical intervention

44
Q

What is assumed if an older man has nocturnal enuresis?

A

Chronic retention of urine witht overflow incontinence

45
Q

What are some male Lower urinary tract symptoms?

A

Voiding: (bladder outflow obstructiotn)
-hesitantly
-poor flow
-post micturition dribbling

Storage:
-frequency
-urgency
-nocturnal

46
Q

What aree some possible causes oof lower urinary tract symptoms?

A

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)

47
Q

What are some physcial causees of bladder outflow obstruction?

A

Urethral:
-phimosis
-stricture

Prostate:
-benign
-malignant
-bladder neck

48
Q

What are some neurological causes of voiding symtpoms?

A

Lllack of coordination between bladder and urinary sphincter (UMN lesion)

49
Q

What type of neurone would be damaged if there’s reduced bladder contractility?

A

LMN lesion

50
Q

What may be suggested by a patient saying there’s spraying of urine?

A

Urethral stricture

51
Q

What receptor mediates sympathetic smooth muscle tone?

A

A1 receptors

52
Q

What exams are done on a Pateint with male lower urinary tract symptoms?

A

DRE
Bladder palpable
Neuro if Hx supports

53
Q

What Ix are done for a patient with male lower urinary tract symtpoms?

A

Dipstick for blood or UTIs

Consider PSA

54
Q

How is BPH managed?

A

Reduce caffeine intake
Avoid fizzy drinks
Don’t drink more than 2.5L a day

Alpha blockers
5a-reductase inhbitors

55
Q

What is the function of alpha blockers in treating BPH?

What is an example of an alpha blocker?

A

The relax the smooth muscle in the prostate and the neck of the bladder

Tamsulosin

56
Q

How do 5a-reducatse inhibtors work to treat BPH?

What is an example of a 5a-REDUCTASE inhbitors?

A

Prevent conversion of test -> dihydrotestosterone
So shrinks the prostate by depriving it of androgens
Slows progression and reduces risk of retention

Example = finasteride

57
Q

What measurement must be considered before doing prostate surgery for BPH?

A

Flow rate

58
Q

What is the standard surgical technique for BPH leading to urinary retention?

A

Transurethral resection of prostate (TURP)

59
Q

What are some indications for surgical intervention for BPH?

A

Failed lifestyle and medical management
Urinary retention neeedding intervention m

60
Q

What part of the prostate is normally affect with BPH?

A

Transitional zone

Y2 - Clinical App (14 decks)

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