MALE GU 2 Flashcards
Lower UTI:
bladder (cystitis),
prostate (prostatitis)
Upper UTI
pyelonephritis
Urethritis
normal renal structure and function
Uncomplicated UTI:
structural/functional abnormality of the GU tract
Complicated UTI :
Risk factors for UTI
↑bacterial inoculation
i.e. sexual activity
↑binding of uropathogenic bacteria
i.e. decrease estrogen, menopause
↓urine flow
i.e. dehydration, obstruction
Frequency, dysuria, urgency, polyuria, hematuria
Suprapubic pain/ tenderness/ distension
Cystitis
Vaginal d/c: consider PID
Fever, chills, nausea, vomiting
NO DYSURIA
Pain/ tenderness: flank, CVA
Acute pyelonephritis
Dysuria only if with cystitis
Pain: perineum, rectum, scrotum, penis, bladder, lower back
Fever, malaise, nausea, vomiting
Urinary Sx
Swollen or tender prostate
Prostatitis
Infection-induced inflammation of the urethra (typically from a STI)
Majority are asymptomatic
Urethral discharge
Dysuria (in men)
Urethritis
UTI investigations
Urinalysis
Gram stain and urine culture
DNA probe/ NAAT
CBC
Imaging should be considered in a MALE patient with
Hx of kidney stones (esp. struvite - staghorn calculi
Diabetic Pt
Polycystic kidneys
TB
Plain film imaging (KUB)
May show radiopaque stones
Renal Ultrasound
to detect hydronephrosis, pyonephrosis, and perirenal abscess
Transrectal U/S
prostate abscess
CT scan
helpful for stones
Non-contrast: obstructive nephrolithiasis
F>M
Associated with psychiatric disorders (anxiety) & pain syndromes (fibromyalgia)
Clinical presentation:
Chronic bladder (suprapubic) pain with filling, relief with voiding
Urgency, frequency
Dyspareunia
Diagnosis:
Bladder pain with no other attributable cause for > 6 weeks*
Urinalysis: normal; Culture: negative
Cystoscopy: Hunner lesions or glomerulations (submucosal petechiae)
Interstitial Cystitis
Age < 35: Sexually transmitted (Chlamydia, gonorrhea)
Age > 35: Bladder outlet obstruction (E. coli)
Gradual* onset of testicular pain
Epididymal tenderness
Positive Prehn’s sign: pain relief with testicular elevation
U/S: Enlarged, thickened epididymis with increased blood flow on color Doppler;
Acute Epididymitis
Ultrasound r/o testicular torsion
Mumps (most common)
Could be bacterial
Abrupt onset of testicular pain
U/S**
Swollen testicles with hypoechoic and hypervascular areas; striated testicle
Acute Orchitis
Ddx: Testicular torsion
also called condyloma acuminata
Caused by human papillomavirus
verrucous and moist papules on the penis and perianal areas
Genital warts
A cluster of small vesicles and pustules that turn to shallow, painful, nonindurated ulcers on a red base
Associated with systemic Sx
Usually fewer lesions on reinfection
Genital Herpes
Caused by *Haemophilus ducreyi
Tender papule to pustule to nonindurated, painful ulcer with a purulent base and undermined or ragged borders.
Unilateral tender(painful) inguinal adenopathy to bubo
Chancroid
Caused by *Treponema pallidum
Occurs in stages:
Primary: chancre*- oval or round, dark red, painless erosion or ulcer with an indurated base
Nontender enlarged inguinal lymph nodes
Secondary: rash, *condyloma lata, swollen glands, systemic symptoms
Syphilis
Subfertility - bc increase temperature
Dull, scrotal pain or heaviness
Soft scrotal mass (“bag of worms
dilation of the pampiniform venous plexus and the internal spermatic vein
11% of men with RCC have this
L sided is most common
Varicocele
Varicocele investigation
U/S and Doppler
Dilation of pampiniform plexus veins
Retrograde venous flow
Tortuous, anechoic tubules adjacent to the testis
Collection of serous fluid resulting from a defect or irritation in the tunica vaginalis
Patent (peds) or non-patent (adults) procesus vaginalis
Association: indirect inguinal hernia, trauma, infection, testicular tumor
Investigation
U/S: fluid collection around the testis
Hydrocele
PE:
10-20 yo
Acutely inflamed testis
Abnormal elevation and/or axis (horizontal lie) of the affected testicle
*Ipsilateral loss of the cremasteric reflex
(-) Prehn’s sign
Recurrent/ acute twisting of the spermatic cord
“Bell clapper” deformity
Ultrasound and doppler: absent flow*
testicular torsion
+ reflex does not R/O torsion
Solid firm mass within the testis
Painless testicular swelling
10% have an associated hydrocele which transilluminates
More common before age 40
Risk factor: cryptorchidism
Seminoma: + ↑beta-hCG, normal AFP
testicular cancer
Painless mass (unless strangulated)
Inguinal bulge that may increase in size and disappear when recumbent
Testis separable from hernia
No transillumination unless with hydrocele
indirect inguinal hernia
Irritative Sx: F/U/D
Obstructive Sx: dribbling & hesitancy
Perineal/ suprapubic pain
Very tender, warm, swollen, boggy, enlarged gland
risk factors: Unprotected anal intercourse
UTI, Acute epididymitis
Mid-stream urine C/S: usually E. coli
Acute Bacterial Prostatitis
Recurrent exacerbations of acute prostatitis-like symptoms
Post-ejaculatory pain
Normal prostate OR enlarged, boggy, moderately-severe tender prostate
Expressed prostatic secretion (EPS) > 10 WBC/HPF AND
Urine culture: E. coli most common
Chronic Bacterial Prostatitis
Bone pain may be the presenting symptom
Urinary frequency, urgency, nocturia, and hesitancy 2ndary to BPH
: Slightly enlarged asymmetric prostate with nodularity noted
elevated PSA
Prostate Cancer
BPH vs Prostate Cancer slide 37
BPH: •Age >50 •Central portion (transitional zone) •Symmetrically enlarged, smooth prostate •Can have ↑PSA
Prostate cancer
•Age> 40
•African American
•Family Hx
•Usually peripheral zone but can be anywhere
•Asymmetrically enlarged, nodular, firm prostate
•Markedly ↑PSA
Urine + for HB and RBC casts
glomerulonephritis
Urine + for HB but no RBC
hemoglobinuria (hemolytic anemia)
myoglobinuria (↑creatine kinase (CK) levels)
painful hematuria
RCC
ADPKD
Calculus
Trauma
painless hematuria
bladder cancer
RCC
ADPKD
Urine - for Hb and no RBC
psuedohematuria
Foods: Beets, blackberries, rhubarb
Meds: Levodopa, rifampin, phenytoin
Metabolites: Porphyrin, bilirubin
asymptomatic, usually incidental finding
“Painless hematuria” (40%)
“Too Late Triad”(10%) – advanced disease
flank pain, hematuria, and a palpable abdominal renal mass
Paraneoplastic Syndrome: 1/3 of patients:
EPO, renin, PTHrP
Risk Factors
Smoking
HTN
Obesity
U/A: +RBC
Abdominal CT is imaging of choice
RCC
persistent (> 3 mos) inability to achieve or maintain a penile erection
precedes angina by 3 years
Investigations: Testosterone, HgbA1C, Lipid Panel
Erectile Dysfunction
Non-colicky flank pain
Recurrent infections, or infections that will not clear
Kidney Stone:
Severe waxing and waning flank pain radiating to groin, testis, or tip of the penis
Painful hematuria
Writhing, nausea, vomiting, diaphoresis
Ureteral Stone:
Most common in men secondary to BPH
Storage and voiding LUTS, terminal hematuria, suprapubic pain
Bladder Stone:
Branched stones that occupy a large portion of the collecting system,
Typically filling the renal pelvis and several or all of the calyces
Staghorn Calculus
Hypertension (early onset)
Palpable abdominal masses (usually bilateral)
Urinalysis: Proteinuria, hematuria
Progressive renal insufficiency to chronic kidney disease
Ultrasonography: enlarged kidneys +
multiple renal cysts
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Asymptomatic
Intermittent, gross, painless hematuria, present throughout micturition
Irritative symptoms: frequency, urgency, dysuria, incontinence
NO FLANK MASS
Bladder Cancer
