Male disorders Flashcards
Cannot readily retract foreskin to the corona of the glans (turtle head stuck inside)
Phimosis
Tight foreskin around the head of penis. (Can’t get the turtle head back in)
Paraphimosis
inherited varicose veins of scrotum
“bag of worms”
always on left side
Varicocele
Water on testicle
Dx thru ultrasound
Illumination
Tx usually reassurance
Hydrocele
Common SE of phosphodiesterase type 5 inhibitor (i.e. viagra)
headache!
Cannot use nitrates or alpha blockers
PDE 5 inhibitors (ie viagra)
Often seen in young
Usually sudden onset
Often E. coli or Klebsiella
*can be seen in men who ride bikes
Prostatitis
acute
Chronic infection or inflammation of prostate, can be seen in men who sit for long periods
Chronic prostatitis
Testicular cancer tx
Orchiectomy
Proliferation of fibrostromal tissue of the prostate can lead to compression of the prostatic urethra, creating an obstruction of the urinary outlet leading to LUTS
benign prostatic hyperplasia (BPH)
Disease of older men (avg 60-65 yo)
Symptoms= obstruction and irritation, decreased force of urinary stream, hesitancy and straining, postvoid dribbling, sensation of incomplete emptying
Benign prostatic hyperplasia (BPH)
Increased frequency, nocturia, urgency
Recurrent UTIs
Urinary retention
Digital rectal exam reveals an enlarged prostate
*PSA may be slightly elevated
BPH
Slow growing, malignant neoplasm of the adenomatous cells of the prostate gland that can lead to urinary obstruction and metastatic disease
Prostate cancer
Disease of aging….cause is unknown
*many cases not clinically apparent. Symptoms of urinary obstruction or irritative voiding may occur if tumor has invaded into urethra, bladder neck or trigone of bladder
Prostate cancer
In advanced disease, pts may present with bone pain from metastases, possible spinal cord impingement if vertebral bodies involved
Prostate cancer
Prostate may be enlarged, nodular and asymmetric
PSA usually elevated
Biopsy confirms diagnosis of adenocarcinoma
Prostate Cancer
The Gleason grading system adds together the primary and secondary grades of the tumor, resulting in a final score of 2-10. Total score can be used for prognostic purposes, with a higher score indicating a worse prognosis
This is used for…..
Prostate cancer
Inability to retract the foreskin over the glans penis
*may be congenital or acquired
Phimosis
If congenital, identified in children and adolescents and usually is physiologic
If acquired, seen in adults and caused by poor hygiene and chronic balanitis
Phimosis
Erythema with tenderness and possible purulent discharge
Inability to retract the foreskin over the glans penis
Obstructed urinary stream, hematuria, or pain of prepuce
Phimosis
If asymptotic and congenital, leave it alone.
If symptomatic, consider circumcision
If infection also present, broad spectrum abx
Phimosis
Entrapment of foreskin behind the glans penis
- can be caused by frequent catheterization
- forcibly retracting a constricted foreskin for cleaning or catheterization can lead to
also can be caused by vigorous sexual activity
Paraphimosis
Pain, edema, tenderness and erythema of the glans and foreskin
ID of any encircling foreign bodies, such as hair, clothing rubber bands or metallic objects is important
Paraphimosis
Tx= reduced emergently
*manual reduction should be tried initially. If this fails, surgical reduction
Paraphimosis
Consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse
ED
Normal erections require intact parasympathetic and somatic nerve supply, unobstructed arterial inflow, adequate venous constriction, hormonal stimulation and psychological desire. Disorders of any of these may result in…
impotence
HTN, diabetes, hyperlipidemia and CV disease are all predictors of…
erectile dysfunction
The testis is abnormally twisted on its spermatic cord, thus compromising arterial supply and venous drainage of the testis, leading to testicular ischemia
Testicular torsion
Most common age group for testicular torsion?
Prepubertal and post pubertal young males (12-18 yo), especially with hx of cryptorchidism (late descent of testis)
Sudden onset of severe unilateral pain and scrotal swelling
Testis is painful to palpation; testicle and scrotum are edematous
NO RELIEF WITH ELEVATE OF TESTICLE (NEGATIVE PREHN SIGN)
Testicular torsion
Does testicular torsion have a positive or negative Prehn sign?
negative! (there is no relief with elevation of testicle)
Diagnosis is made clinically
*doppler ultrasonography demonstrates decreased blood flow to affected spermatic cord and testis
Testicular torsion
Tx= mild analgesics may be given once the diagnosis is made.
SURGICAL EMERGENCY!! try to get into surgery within 6 hours
Testicular torsion
Formation of venous varicosity within spermatic vein (pampiniform plexus)
-left spermatic vein has an increased incidence of varicosity because the vein is longer than the right and joins the left renal vein at right angles
Varicocele
A chronic, non tender mass that does NOT transilluminate (usually on left side)
“bag of worms” feeling, increases in size with Valsalva and decreases in size with elevation of scrotum or supine position
Varicocele
What happens to the Varicocele size with valsalva?
increases in size!
What happens to size of varicocele with elevation of scrotum or lying supine?
Decreases in size!
If diagnosis is inconclusive, doppler sonography is diagnostic method of choice
tx=surgical repair if painful or seems to be causing infertility
Varicocele
Abrupt onset of scrotal, inguinal or lower abdominal pain (usually less than 6 hours) +/- N/V
MC in boys 10-20
Testicular torsion
MC cause under 35= chlamydia
can also be caused by gonorrhea, ureaplasma, E.coli
Epididymitis
MC cause of Epididymitis in kids is…
mumps
Gradual (over a few days) onset of scrotal pain, erythema and swelling
PE shows POSITIVE PERHN’S SIGN (relief of pain with elevation of effected scrotum) and POSITIVE CREMASTERIC REFLEX
Epididymitis
Which two exam tests are positive in Epididymitis
Positive Perhn’s sign (relief with elevation of effected scrotum) and positive Cremasteric reflex
Symptomatic tx= bed rest, scrotal elevation and cool compresses; NSAIDs
also tx underlying cause
Epididymitis
PE shows: swollen, tender, retracted testicle
- negative Perhn’s test (no relief with elevation of testicle)
- absent/negative Cremasteric reflex
Testicular torsion
Which 2 test can distinguish between Epididymitis and testicular torsion?
Perhn’s test (pos in Epididymitis, neg in torsion)
Cremasteric reflex (pos in Epididymitis, neg in torsion)
“Blue dot sign”** at upper pole indicates torsion of _____ of testis
appendix
seen in testicular torsion
What is the best INITIAL*** test for testicular torsion (not gold standard)
Testicular doppler (there will be a decrease in blood flow)
What is the GOLD STANDARD** diagnostic in testicular torsion?
Radionuclide scan!!
Detorsion and orchioplexy within 6H is management for…
testicular torsion
If the testicle is not salvageable in torsion, what is done?
Orchiectomy
Cystic collection of fluid in testicle leading to a testicular mass
*MC cause of painless scrotal swelling
Hydrocele
Communicating: peritoneal fund between the parietal and visceral layers from a patent processus vaginalis
Noncommunicating: Fluid from the mesothelial lining of the tunica vaginalis (no connection to the peritoneum)
Hydrocele
Infants: congential, due to incomplete obliteration of the processus vaginalis (usually will close within first year)
Hydrocele
Adults: usually acquired, represents injured, infection or inflammatory etiology
*painless scrotal swelling!! can be transilluminated on exam
Hydrocele
Usually no tx needed. may aspirate fluid if compressive
Hydrocele
Cystic testicular mass of varicose veins
MC on left side. MC surgically correctable cause of infertility
Varicocele
“bag of worms” superior to testicle
**dilation worse when pt is upright or with valsalva (dilation increases when pt is supine or with testicular elevation)
Varicocele
Undescended testicle (MC right sided)
Increased risk in…premature infants, low birth weight
Cryptorchidism
Empty, small scrotum
can increase risk of cancer, infertility, testicular torsion and inguinal hernia
Cryptorchidism
Tx of choice for cryptorchidism as early as 6 months of age and before 1 years old
Orchiopexy
observation can be done only if less than 6 months
MC solid tumor in young men 15-40 yo
Risk factors: cryptorchidism**, frequent UTIs, renal lithiasis, uncircumcision, multiple sex partners
MC in right side
Testicular cancer
Germinal cell tumors usually malignant (Seminoma is MC. also can be Nonseminomatous)
Testicular cancer
Painless testicular nodule, solide mass or enlargement (may have hydrocele present)
*gynecomastia may be present also
Testicular cancer
Dx made with scrotal ultrasound and serum studies (alpha-fetoprotein, HCG, LDH)
Testicular cancer
with testicular cancer, HCG may cause…
gynecomastia
Seminomatous germ cell tumors
Less aggressive
Radiosensitive and lack tumor markers
Non-seminomatous germ cell tumors
Increase serum alpha-fetoprotein
increase beta-HCG
*RadioRESISTANT
Foreskin become trapped being the corona of glans and forms a tight band, constricting penile tissues
UROLOGIC EMERGENCY (must manual reduct or use pharm therapy)
Paraphimosis
Prostate gland inflammation secondary to ascending infection
MC cause= E coli, psueodomas (or gonorrhea/chlamydia if under 35)
Prostatitis
Fever, increased frequency, urgency, dysuria, poor or interrupted stream, starring to void, incomplete emptying
if chronic, may present with recurrent UTIs/intermittent dysfunction
Prostatitis
Dx made thru UA (if chronic, may be negative and prostatic massage recommended to increase bacterial yield on UA)
**avoid massage in acute cases!
Prostatitis
Tx= fluoroquinolones, Bactrim
if caused by STI, tx appropriately
Prostatitis
Prostate hyperplasia (periurethral/transitional zone) that leads to bladder outlet obstruction
*increase in dihydrotestosterone production
BPH
Frequency, urgency, nocturia, hesitancy, weak/intermittent stream, incomplete emptying, incontinence
digital rectal exam: uniformly enlarged, firm, rubbery prostate
BPH
Firm, rubbery prostate vs hard, nodular prostate
Firm, rubbery= BPH
Hard, nodular= Cancer
Tx= observation if mild (AVOID ANTIHISTAMINES AND ANTICHOLINERGICS)
Can also use… 5 alpha reductase inhibitors, alpha 1 blockers, surgery (trans urethral resection of prostate)
BPH
SLOW growing tumor!
Risk factors= age, genetics, high fat intake diet, obesity, african american
Prostate cancer
Often asymptomatic until invasion of bladder, urethral obstruction or bone involvement
*with urethral obstruction, increased urinary frequency, urgency, decreased stream, urinary retention
back/bone pain= METS
Prostate cancer
Dx: screening via DRE and PSA done if over 50 (but if african american or am hx, done when over 40)
Prostate cancer
Tx for local dz= radical prostatectomy
Tx for advance dz= External beam radiation therapy, Androgen deprivation
Prostate cancer
