Male GU Conditions Flashcards
BPH
Age
Symptoms
PSA levels
50% > age 50, 80% > age 70
S/S: Weak stream, post-void dribbling, feelings of incomplete emptying, occasional retention, nocturia
PSA > 4 (normal 0-4)
BPH
Lifestyle changes to decrease S/S
Herb that may help
Decrease caffeine, ETOH, night fluids
Avoid diuretics
Saw palmetto
BPH
Meds to avoid
Anticholinergics and sympathomimetics (cause retention)
Antihistamines
Decongestants
Cold meds
Antipsychotics
TCAs
Chronic Bacterial Prostatitis
C/O
DRE findings
DX with
Tx med
C/o SEVERAL WEEKS suprapubic or perineal discomfort and irritative voiding symptoms
May not have symptoms
DRE: Prostate NOT tender, may be boggy
Dx: UA with C+S, PSA
Tx: Cipro x4wk
Acute Prostatitis
Classic presentation
DRE findings
Dx
Tx meds
Older/adult man c/o SUDDEN onset high fever/chills with suprapubic and/or perineal pain/discomfort, UTI symptoms
DRE: VERY tender, warm
Dx: CBC reveals left shift, UA with C+S
TX:
<35: IM Rocephin and Doxy x10days
>35: Cipro or Levaquin x10-14 days
Acute Bacterial Epididymitis
What happens?
Classic case
+ what sign
Tx
Urethral bacterial ascend into epididymitis
Classic: adult to older man complains of acute swollen/red scrotum with one-sided testicular pain and green/serous discharge
+ Phren’s sign (pain relief with scrotal elevation)
TX:
<35: IM Rocephin and Doxy x10 days
>35: Levaquin x10 days
Erectile Dysfunction
Causes: Organic, drug-induced, psych
Check what reflex to rule out neuro causes?
Labs to rule out what conditions?
Tx:
Organic: Neuropathy, spinal cord damage, MS, low testosterone
Drugs: SSRI (paxil), antipsychotics, lots of alcohol, beta blockers, thiazide diuretics, smoking
Psych: stress, anxiety
Low libido
If cremaster reflex is missing, rule out neuro causes
Rule out DM, thyroid, check am testosterone
Tx: phosphodiasterase type 5 inhibitor
Peyronie’s Disease
What is it
Symptoms
Plan of care
Localized inflammatory condition of penis resulting in fibrotic plaques
S/S: Palpable nodules and penile deformities (crooked penis). Can affect ability to have erection
Plan: Refer to urology, may need surgical intervention
Balanitis
What is it?
What increases risk?
Classic case
Tx:
Fungal infection of the glans
Increased risk with SGLT2 and uncircumcised
S/S: Red/pain/tender/itchy glans or foreskin with shallow ulcers and curd-like discharge
Tx: OTC Azoles BID 7-14 days
Cryptochidism
What is it?
Increased risk for what?
Tx:
Testicle doesn’t descend by 4mo - empty sac
Most will descend by 12mo
Increased risk testicular CA
Tx: Usually corrected during infancy
Phimosis
Physio vs. pathological
Foreskin unretracted
Physiological: Most newborns with, foreskin not swollen or red
Pathological: Truly can’t retract d/t inflammation –> Refer to urology
Varicocele
What is it
May lead to what?
New findings may indicated what?
Left vs. right sided
affect fertility?
Varicose veins in scrotal sac (bag of worms)
May lead to infertility
New findings may indicate tumor –> order US
Left: usually benign (will decrease in volume when supine)
Right: May indicate tumor in chest/abd/pelvis d/t large vein compression (vena cava)
May affect fertility - would need surgical removal
Hydrocele
What is it
S/S
When to order testing
Serious fluid collection in tunica vaginalis
Usually no symptoms. Glows with transillumination
Order doppler US if new onset pain/swelling/increased size - rule out tumor, hematoma, torsion, rupture, orchitis, torsion
Refer to urology
Spermatocele
What is it
Affect fertility?
Fluid-filled cyst at head of epididymus
May palpate as smooth/firm lump
Will glow with transillumination
Does not affect fertility
Refer to urology if causing pain/embarrassment - can surgically remove
Orchitis
Complication of what?
Inflamed testicle
Complication of mumps virus
