Male GU Disorders Flashcards
Pain in GU disorders
o Can be severe
- Urinary tract obstruction (kidney stones) - Inflammation
o most severe when it involves the parenchyma of a GU organ
- Pyelonephritis - Prostatitis - Epididymitis
o Inflammation of the mucosa of a hollow viscous usually produces discomfort
- Cystitis - Urethritis
o Tumors - No pain unless :
- Obstruction - Extend beyond the primary organ to involve adjacent nerves - Gastrointestinal symptoms - Nausea - Vomiting - Ileus
Renal pain
o Ipsilateral costovertebral angle just lateral to the sacrospinalis muscle and beneath 12th rib
o Acute distention of the renal capsule
o Renal pain may also be confused with pain resulting from irritation of the costal nerves, most commonly T10-T12
-Not colicky in nature
-Severity of radicular pain may be altered by changing position
o Pyelo is usually diffuse pain
o Colicky is usually sharp pain
uretheral pain
o Usually acute and secondary to obstruction
- Midureter (Rt side) referred to the right lower quadrant (McBurney's point) and simulate appendicitis - Midureter (Lt side) referred over the left lower quadrant and resembles diverticulitis. - Scrotum in the male or the labium in the female. - Lower ureteral obstruction frequently produces symptoms of bladder irritability (frequency, urgency, and suprapubic discomfort)
o Sometimes right kidney stones can mimic an appendicitis
o Kidney stones have a colicky waxing and waning quality to them
vesical (bladder) pain
o Vesical pain is due to
- Overdistention - Inflammation
prostatic pain
o Inflammation with secondary edema and distention of the prostatic capsule o Poorly localized -Lower abdominal -Inguinal -Perineal -Lumbosacral -Rectal pain -Irritative urinary symptoms (frequency and dysuria) -Acute urinary retention
o Poorly localized often means its in the prostate
Penile pain
o Pain in the erect penis is usually due to Peyronie’s disease or priapism
o Pain in the flaccid penis
-usually secondary to inflammation in the bladder or urethra
-referred pain that is maximally at the urethral meatus
o Paraphimosis
o Priapism is erection lasting 4-6 hrs í usually Viagra or even sickle cell can cause this
o Peyronie’s Disease upward penile curvature - common
o Paraphimosis í usually an iatrogenic problem; gets edematous and stuck
Testicular pain
-Epididymitis
-Torsion of the testicle
o Chronic scrotal pain
-Hydrocele
-Varicocele
-Dull, heavy sensation that does not radiate
-Referred pain to kidneys or retroperitoneum
o Pretty common, differential is wider í is it acute or chronic
o Epididymitis is usually localized to epididymis
o Torsion í usually younger men (high school, etc.) í accompanied with n/v and requires surgical intervention
o Chronic pain í think prostatitis, sometimes epididymitis
-Hydrocele and varicocele tend to be a heavy feeling
-Referred pain usually indicates prostate, not testicle
Lower urinary tract symptoms
o Irritative Symptoms -Urinary frequency -Nocturia -Dysuria -Incontinence -Stress -Urge o Obstructive Symptoms -Decreased force of urination -Urinary hesitancy -Intermittency -Post void dribbling -Straining o Obstructive is usually seen with prostate enlargement o Irritative is usually associated with infection
Infection sxs
o Urethral Discharge: -Most common symptom of venereal infection o Fever and Chills: -Pyelonephritis -Prostatitis -Epididymitis (acute)
Past medical history
o Systemic diseases that may affect the GU system
-Diabetes Mellitus
-Multiple Sclerosis - due to demyelinating of nerve fibers affecting bladder control.
-TB - reactivation can occur (rarely) anywhere in GU but usually kidney
-Schistosomiasis
o Family history
-Prostate cancer
-Stones (cystine)
-Renal tumors (some types)
o The more first degree relatives that had prostate cancer means your patient has a higher likelihood of having prostate cancer
o Cigarette smoking
-Urothelial carcinoma, mostly bladder cancer
-Erectile dysfunction
o Chronic alcoholism
-Impaired urinary function
-Sexual dysfunction
-Testicular atrophy, decreased libido
physical examination
o General Observations " Visual inspection of the patient " Cachexia " Malignancy, TB " Jaundice or pallor " Gynecomastia " Endocrinologic disease " Alcoholism " Hormonal therapy for prostate cancer
physical examination findings: kidneys
o The most common abnormality detected on examination of the kidneys is a mass
physical examination findings: bladder
o At least 150 ml of urine in it to be felt
o Percussion is better than palpation
o A bimanual examination, best done under anesthesia, is valuable to asses bladder tumor extension
physical examination findings: penis
o The position of the urethral meatus " Variations of hypospadius (right) o Priapism " sickle cell disease " ED medications
physical examination findings: scrotum and contents
o Painful " Torsion " Epididymitis o Painless " Spermatocele " Hydrocele " Varicocele o Transillumination " Cystic vs solid o Painless solid testicular mass is tumor until proven otherwise
rectal and prostate examination in the male
o Digital rectal examination (DRE):
“ Every male after age 50 years (controversial)
“ Men of any age who present for urologic evaluation
male GU disorders
o Benign Prostatic Hyperplasia (BPH) o Erectile dysfunction o Hypogonadism o Varicocele o Hydrocele
