Lecture 9 - Men Urology

Question 1

What is phimosis?

Answer 1

When the prepuce cannot be fully retracted

Question 2

What are some consequences of phimosis?

Answer 2

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

Question 3

What is Paraphimosis?

Answer 3

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

Question 4

What are the most common causes of Paraphimosis?

Answer 4

Phimosis
Catheterisation (esp. elderly)
Penile cancer

Question 5

What is the treatment for phimosis?

Answer 5

Circumcision

Question 6

What is the treatment for Paraphimosis?

Answer 6

Needs reduction
(Manually or dorsal slitting)

Question 7

What is the main type of penile cancer?

Answer 7

Squamous cell carcinoma

Question 8

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

Answer 8

Phimosis
Poor hygiene
HPV 16 + 18

Question 9

What is Balanitits?

Answer 9

Inflamed glans penis

Question 10

What are some indications for circumcision for paeds?

Answer 10

Religious
Recurrent Balanitits + UTIs

Question 11

What are some adult indications for circumcision?

Answer 11

Recurrent Balanitits
Phimosis
Recurrent Paraphimosis
Balanitits xerotica obliterates
Penile cancer

Question 12

What are some acute emergency presentations for acute scrotal pain?

Answer 12

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

Question 13

What is the likely history for a testicular torsion?

Answer 13

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

Question 14

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

Answer 14

Testis tender
Lying high in scrotum with horizontal lie

Emergency scrotal exploration needed

Question 15

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

Answer 15

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

Gradual onset
Unilateral normally

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

Question 16

How does epidiymo-orchitis present on exa m?

Answer 16

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

Rarely necrotic scrotal skin = Fournier gangrene

Question 17

What investigations are done for epidiymo-orchitis?

Answer 17

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

Question 18

What is the treatment for Epididymo-orchitis?

Answer 18

Abx

Question 19

What is the treatment for an abscess on the scrotum?

Answer 19

Surgical drainage and Abx

Question 20

What is the treatment for Fournier gangrene>

Answer 20

Emergency debridement and Abx

Question 21

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

Answer 21

Testis tumour
Epididymis cyst
Hydrocoele
Reducible Inguinal-scrotal hernia

Question 22

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

Answer 22

Varicocele

Question 23

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

Answer 23

Epididymitis
Epidiymo-orchitis
Strangualted inguino-scrotal hernia

Question 24

What is the normal Hx of a testical tumour?

Answer 24

Normally painless

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

Question 25

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

Answer 25

Hx of undescended testes

Question 26

How does a testicular tumour normally feel on palpation?

Answer 26

Body of testis abnormal (can get above it)

Question 27

What tumour markers are looked for in testicular tumours?

Answer 27

AFP, hCG and LDH

Question 28

What is the Hx for an adult Hydrocoele?

Answer 28

Slow/sudden onset Can be uni or bilateral scrotal swelling

Question 29

What causes Hydrocoele?

Answer 29

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

Question 30

How does Hydrocoele appear on nexam?

Answer 30

Testis not palpable separately Can usually get above Transilluminates

Question 31

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

Answer 31

Usually painless Separate from testes Can get above mass Transilluminates

Question 32

How does varicocele present?

Answer 32

Dull ache at end of day Usually effects left testes more than right Feels like a bag of worms abbbove testes Not tender

Question 33

What usually causes varicocele on the left side?

Answer 33

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

Question 34

How is a testicular tumour treated?

Answer 34

Inguinal orchidectomy

Question 35

How is an epididymis cyst treated?

Answer 35

Reassure Excise if large

Question 36

How is an adult Hydrocoele treated?

Answer 36

Reassure and surgical removal if large

Question 37

How is varicocele treated?

Answer 37

Reassure Radiological embolisation if symptomatic Likely to cause infertility

Question 38

How is an Inguinal-scrotal hernia treated?

Answer 38

Surgery (emergency if strangualted)

Question 39

What is urinary retention?

Answer 39

Inability to pass urine

Question 40

What are some causes of urinary retention?

Answer 40

BPH Prostate cancer Phimosis/meatal stenosis/urethral stricture Constipation UTI Anticholinergic drugs Overdistension After surgery Neruological

Question 41

How do you treat an acute painful Urinary retention?

Answer 41

Catheterise ((relives pain) If there’s less than <1000ml residual vol theres no kidney insult

Question 42

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

Answer 42

May have a kidney insult Need to learn to self catheterise

Question 43

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

Answer 43

Residual vol > 1000ml Usually have kidney insult Long term Cather or surgical intervention

Question 44

What is assumed if an older man has nocturnal enuresis?

Answer 44

Chronic retention of urine witht overflow incontinence

Question 45

What are some male Lower urinary tract symptoms?

Answer 45

Voiding: (bladder outflow obstructiotn) -hesitantly -poor flow -post micturition dribbling Storage: -frequency -urgency -nocturnal

Question 46

What aree some possible causes oof lower urinary tract symptoms?

Answer 46

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)

Question 47

What are some physcial causees of bladder outflow obstruction?

Answer 47

Urethral: -phimosis -stricture Prostate: -benign -malignant -bladder neck

Question 48

What are some neurological causes of voiding symtpoms?

Answer 48

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

Question 49

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

Answer 49

LMN lesion

Question 50

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

Answer 50

Urethral stricture

Question 51

What receptor mediates sympathetic smooth muscle tone?

Answer 51

A1 receptors

Question 52

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

Answer 52

DRE Bladder palpable Neuro if Hx supports

Question 53

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

Answer 53

Dipstick for blood or UTIs Consider PSA

Question 54

How is BPH managed?

Answer 54

Reduce caffeine intake Avoid fizzy drinks Don’t drink more than 2.5L a day Alpha blockers 5a-reductase inhbitors

Question 55

What is the function of alpha blockers in treating BPH? What is an example of an alpha blocker?

Answer 55

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

Question 56

How do 5a-reducatse inhibtors work to treat BPH? What is an example of a 5a-REDUCTASE inhbitors?

Answer 56

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

Question 57

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

Answer 57

Flow rate

Question 58

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

Answer 58

Transurethral resection of prostate (TURP)

Question 59

What are some indications for surgical intervention for BPH?

Answer 59

Failed lifestyle and medical management Urinary retention neeedding intervention m

Question 60

What part of the prostate is normally affect with BPH?

Answer 60

Transitional zone