Male Conditions Flashcards
Match:
- Composed of blood, therefore does NOT transilluminate. Extremely painful. Usually due to inflammation and will need surgery if infected.
- Composed of sterile fluid, therefore transilluminate. It’s painless. Aspiration provides temporary relief.
- Composed of dead sperm cells and fluid. Bulging at the upper testis, most likely due to obstruction of the epididymal ducts. Painless and the physical exam transilluminates. Surgery indicated if enlarges.
- Bag of worms upon palpation. Presents when the patient stands upwards and disappears when they are supine. Feels full but can be either asymptomatic or painful.
a. Hematocele
b. Hydrocele
c. Spermatocele
d. Varicocele
How do you test for them?
Complications?
a. Hematocele
b. Hydrocele
c. Spermatocele
d. Varicocele
test: testicular biopsy, scrotal US, clinical
complications: infertility and infection
**Painful lump can radiate to the back, groin, abdomen
A 55 yo African American PTC with urinary complaints. He thinks he has UTI due to urinary frequency, urgency, hesitancy, dysuria, nocturia, and dribbling of urine. He is concerned about painful ejaculation and noticed blood in urine. Separately, he complains of bone pain.
What do you suspect? Next step?
Prostate cancer
- DRE: hard irregular nodule or diffuse dense induration involves one or both lobes
- PSA (prostate-specific antigen) and Gleason score: elevated
- Transrectal US & biopsy
- CT and MRI to assess metastasis
PSA and Gleason score
Prostate cancer
Why would you order CT and MRI for prostate cancer?
to assess metastasis
T1 ,T2,T3, T4
N0, N1
M0, M1
T = tumor 1 = undetectable clinically (normal DRE and TRUS) 2 = palpable, limited to prostate 3 = beyond prostate capsule 4 = penetrates nearby structures
N = Lymph 0 = no regional metastasis 1 = spread to regional lymph
M = metastasis 0 = none 1 = distant metastasis
PSA score < 10
Low risk
PSA > 20
high risk
Gleason score < 7
low risk
Gleason score 8-10
high risk
What diet increases prostate cancer risk by X2
high-fat diet & low vitamin D
A 38 yo M PTC with sudden dysuria, fever, and chills. He complains of prostate tenderness, rectal and lower back pain, and incomplete voiding of urine.
PE reveals “boggy” prostate. CBC revealed increased WBC and elevated serum PSA. Positive culture for E.coli.
What do you suspect? Tx?
Acute prostatitis EMERGENT CONDITION
- note that DRE is contraindicated
- Antibiotics - fluoroquinolone/cipro
NO prostate massage or catheterization!!
What do you do for chronic bacterial prostatitis
Antibiotics
Often AFEBRILE. Recurrent infection that presents with less severe acute prostatitis sxs.
What is chronic pelvic pain syndrome in men? How long do they report the symptoms?
What would urinalysis show? Tx?
The most common form of prostatitis; pain for 3-6 months
- presents with pelvic pain, ejaculation pain, dysuria, frequency, urgency, abdominal and low back pain, fatigue
- urinalysis NO sign for bacteria
- Treatment is difficult - antibiotics, SSRI
A 55 yo M PTC with dibbling with weak stream upon urination. He’s noticed nocturia and incomplete voiding of bladder as well.
DRE revealed enlarged prostate, smooth and rubbery with loss of median sulcus. Serum PSA came back elevated. Urinalysis was WNL. What do you suspect? Next step? Tx? complications?
BPH
Transrectal ultrasound to examine prostate size and for biopsy as needed.
Tx: alpha-adrenergic antagonist (tamsulosin) and 5-alpha reductase inhibitor (finasteride)
Lifestyle: avoid fluid intake before bed, alcohol/caffeine and follow voiding schedule
Surgery: transurethral reaction of the prostate if other tx were not effective
complications: UTI, urinary stones, hematuria.
A 32 yo African American PTC with painless testicular enlargement. He notes that there is heaviness in the scrotum, lower abdomen, and anal area. He also indicates back pain and enlarged breast tissue.
PE revealed supraclavicular and inguinal lymphadenopathy
What do you suspect? Next step? Tx?
Testicular cancer
Testicular ultrasound → hypoechoic area within yunica albuginea
CT scan to r/o metastasis
Blood test → Beta-HCG and AFP tumor markers
DO NOT perform needle aspiration
