Male GU Issues Flashcards
Erectile Dysfunction
failure to achieve erection suitable for sex or dissatisfaction w/ size, rigidity or duration
What are the 2 most common underlying causes of ED?
- organic: problem w/ vascular, nervous or hormonal system
- psychogenic: interference w/ perception of psychological stimuli
Tx Options for ED
-PDE5 inhibitor: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)
- lifestyle modifications
- alprostadil
- psychotherapy
- vacuum erection device, surgery
What is BPH and how does it happen?
- nonmalignant enlargement of prostate gland
- leads to bladder outlet obstruction
- testosterone conversion causes prostate enlargement and growth
Signs and Sxs of BPH
- weak strain
- straining to void, hesitancy
- post-void residual urine, sense of incomplete void, urinary retention
- overflow or urge incontinence
- enlarged prostate (DRE)
- gross hematuria
Dx of BPH
- DRE
- PSA
- post void residual
Tx of BPH (3 different levels)
- watchful waiting for mild
- alpha 1 and 1A blockers for moderate (terazosin or tamsulosin); or 5 alpha reductase inhibitor (finasteride)
- surgery if more severe sxs
What is prostatitis?
- inflammation of prostate gland and surrounding tissues due to infx
- can be acute or chronic
Most Common Causative Organisms of Acute Bacterial Prostatitis
- E.coli 75%
- also Klebsiella, Pseudomonas, Enterobacter, Serratia
Most Common Causative Organisms of Chronic Bacterial Prostatitis
- E. coli
- other gram negatives (EKP)
Sxs of ABP
- high fever
- perineal pain
- frequency, urgency, dysuria
- obstructive sxs
- nocturia
- retention
Sxs of Chronic BP
- vague sxs
- recurrent UTI or prostate infx
- voiding difficulties
- prostatic enlargement
Dx of ABP
- clinical presentation
- significant bacteriuria (UA)
- midstream urine culture
Dx of CBP
- urinary tract localization studies critical
- sequential cultures
Tx of ABP <35 yo
- ceftriaxone 250 mg IM then
- doxycycline 100 mg po bid x10 days
- treat partners!
Tx of ABP >35 yo
-cipro ER 500 mg po qd or 400 mg IV bid
Tx of CBP
- cipro 500 mg po bid x4 wks
- may be longer or need surgery
What is the cause of epididymitis?
- can be trauma, but usually 2/2 infx
- 35 yo or MSM: Enterobacteriaceae
Sxs of Epididymitis
- unilateral pain and swelling of scrotum
- hydrocele formation
- urethral discharge
- elevation of testes improves discomfort
- signs and sxs or UTI or prostatitis
Dx of Epididymitis
-culture voided urethral and midstream specimens to get specific organism
Tx of Epididymitis <35 yo
- ceftriaxone 250 mg IM then
- doxycycline 100 mg po bid x10 days
- scrotal elevation, analgesics
Tx of Epididymitis >35 yo
- cipro ER 500 mg po qd or 400 mg IV bid
- bedrest, scrotal elevation, analgesics
What is a hydrocele?
- fluid-filled sac surrounding testicle
- results in swelling of scrotum anterior to testicle
What is a communicating hydrocele?
-has an associated indirect inguinal hernia
Sxs of Hydrocele
- painless
- swelling
- changes size
- sense of a heavy scrotum
Dx of Hydrocele
- transillumination
- cremaster reflex intact
- don’t aspirate!
- US if large to rule out tumor
Tx of Hydrocele
-observation: should be rapid recovery
What is a spermatocele?
-diverticulum of the epididymis (posterior to testicle)
Dx of Spermatocele
- may transilluminate
- cremaster reflex intact
- can be separated from testes on exam
- almond size/shape
Tx of Spermatocele
-surgical removal if painful
What is a varicocele?
- dilations of pampiniform venous plexus
- “bag of worms”
On which side does a varicocele occur?
- almost 100% on left (drains to renal vein)
- right side warrants further investigation
Sxs of Varicocele
-painless
Tx of Varicocele
-surgery for relief of sxs and cosmetic concerns
What is testicular torsion?
- SURGICAL EMERGENCY
- twisting of testis and spermatic cord
- leads to acute ischemia and impeded venous/lymphatic drainage
- lack of normal attachments to scrotum
Signs and Sxs of Testicular Torsion
- acute scrotal pain
- enlarged, red, edematous, tender scrotum
- testes “riding high”
- N/V
- fever may occur
- ABSENT cremaster reflex
Dx of Testicular Torsion
- Prehn sign: elevation of testis does not relieve pain
- US reveals reduced blood flow
Tx of Testicular Torsion
- surgical urology consult indicated!
- manual reduction: untwist right clockwise and left counter-clockwise
- orchidoplexy to tack down
What is phimosis?
-foreskin too tight to retract
What is paraphimosis?
- foreskin too tight to get back
- may need emergent circumcision
In which male GU issues is the cremaster reflex intact?
- hydrocele
- spermatocele
In which male GU issues is the cremaster reflex ABSENT?
-testicular torsion
Which male GU issues are painless?
- hydrocele
- varicocele
Which male GU issues have acute severe pain?
testicular torsion
Which male GU issues are NOT associated with infertility?
- hydrocele
- spermatocele
Which male GU issues may cause infertility?
- varicocele
- testicular torsion
What is Prehn sign and which male GU issue is it a sign of?
- elevation of testis does not relieve pain
- testicular torsion
