Male genitourinary disease Flashcards
What is bacterial prostatitis?
Relapsing infection presents as perineal pain, recurrent epididymis-orchitis and prostatic tenderness with pus in expressed secretion
4-6 weeks of trimethoprim or ciprofloxacin
What raises PSA?
benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract
What are the age adjusted upper limits for PSA?
50-59: 3
60-69: 4
>70: 5
What’s the difference between torsion of the spermatic cord and torsion of the testicular appendage?
Appendage- cremasteric reflex is marked
Spermatic cord- absent
Unilateral, swollen, retracted testicle
What are the NICE guidelines for when PSA tests can be taken?
6 weeks of a prostate biopsy 4 weeks following a proven urinary infection 1 week of digital rectal examination 48 hours of vigorous exercise 48 hours of ejaculation
What are the features of testicular cancer?
a painless lump is the most common presenting symptom
pain may also be present in a minority of men
other possible features include hydrocele, gynaecomastia
AFP is elevated in around 60% of germ cell tumours
LDH is elevated in around 40% of germ cell tumours
seminomas: hCG may be elevated in around 20%
What is Phren’s sign?
Elevation of the testis does not ease the pain
What are epididymal cysts?
Most common cause of scrotal swellings separate from the body of the testicle found posterior to the testicle Associated with: polycystic kidney disease cystic fibrosis von Hippel-Lindau syndrome
What are hydroceles?
Accumulation of fluid within the tunica vaginalis
Develop secondary to:
epididymo-orchitis
testicular torsion
testicular tumours
Features:
soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates with a pen torch
the testis may be difficult to palpate if the hydrocele is large
What are varicoceles?
A varicocele is an abnormal enlargement of the testicular veins. They are usually asymptomatic but may be important as they are associated with infertility.
Much more common on the left side >80%
Bag of worms, subfertility
What is the hormonal therapy for metastatic prostate cancer?
Synthetic GnRH agonist e.g. Goserelin (Zoladex) Co prescribe with Anti-androgen cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes
What is first line for BPH?
medication: alpha-1 antagonists, 5 alpha-reductase inhibitors.
What are the risk factors for testicular cancer?
infertility (increases risk by a factor of 3) cryptorchidism family history Klinefelter's syndrome mumps orchitis
What are the complications of a vasectomy?
Failure rate 1 per 2000, more effective than female sterilisation
Doesn’t work immediately
Semen analysis needs to be performed twice before unprotected sex (16 and 20 weeks)
Complications: bruising, haematoma, sperm granuloma, chronic testicular pain
What are the medical indications and benefits of circumcision?
phimosis recurrent balanitis balanitis xerotica obliterans paraphimosis Reduces risk of penile cancer, UTI, HIV
