Male problems Flashcards

1
Q

What is benign prostate hyperplasia

A

Common benign condition in men caused by hyperplasia of the stromal and epithelial cells of the prostate

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2
Q

Benign prostate hyperplasia most commonly affect

A

older men, 40-80 years olds
Black ethnicity

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3
Q

Symptoms of benign prostate hyperplasia

A

Nocturia (most common early symptom)
Hesitation in initiating urination
Reduced force of urination
Retention of urine
Incontinence (overflow, urgency incontinence)
Post-urination dribbling

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4
Q

Because BPH causes bladder outflow obstruction, it can also lead to

A

Recurrent UTI
Impaired renal function
Haematuria

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5
Q

What score is used to classify the symptoms of BPH

A

IPSS (International prostate symptoms score)

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6
Q

Investigations for BPH

A

Urine dipstick
U+E
PSA (prostate specific antigen)
Rectal exam
US pelvis with post-void bladder volume - see extent of obstruction
Urinary frequency-volume chart

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7
Q

What conditions can raise PSA

A

Prostate cancer
BPH
Prostatitis
Ejaculation

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8
Q

What would the rectal exam for benign prostate hyperplasia be like

A

Smooth, symmetrical prostate enlargement

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9
Q

Management of benign prostatic hyperplasia

A

Reassurance and monitor
If IPSS >8
- alpha-1 antagonists (tamsulosin, alfuzosin)
If significantly enlarged prostate
- 5 alpha-reductase inhibitors (finasteride)

Alpha-1 antagonist + 5 alpha-reductase inhibitor if moderate-severe voiding symptoms + prostatic enlargement

Surgery If needed

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10
Q

Examples of alpha-1 antagonists

A

Tamsulosin
Alfuzosin

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11
Q

Function of alpha-1 antagonists in managing BPH

A

Promotes relaxation of the smooth muscle of the prostate and bladder to reduce voiding symptoms

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12
Q

Side effects of alpha-1 antagonists

A

Dizziness
Postural hypotension
Dry mouth
Depression

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13
Q

Function of 5-alpha reductase inhibitors

A

Blocks the conversion of testosterone to di-hydrotestosterone to REDUCE the size of the prostate

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14
Q

Does alpha-1antagonists reduce the size of the prostate

A

No

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15
Q

Why is it helpful to block the production of di-hydrotestosterone in managing BPH

A

Because di-hydrotestosterone induces growth of prostate

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16
Q

Example of 5-alpha reductase inhibitors

A

Finasteride

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17
Q

Does finasteride (5-alpha reductase inhibitor) work immediately

A

No, it takes around 6 months to see improvement

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18
Q

Side effects of 5-alpha reductase inhibitors

A

Erectile dysfunction
Reduced libido
Ejaculation problems
Gynaecomastia

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19
Q

When are 5-alpha reductase inhibitors indicated

A

If there is significant enlargement of the prostate

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20
Q

What is the name of surgery for BPH

A

Transurethral resection of the prostate (TURP)

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21
Q

Which form of malignancy is prostate cancer part of

A

Adenocarcinoma

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22
Q

Prostate cancer mostly affects

A

> 40 years olds

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23
Q

Risk factors of prostate cancer

A

Increasing age
Afro-Carribean ethnicity
Obesity
Family history
Cadmium batteries

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24
Q

Is BPH a pre-malignant condition of prostate cancer

A

No, it does not increase the risk of prostate cancer. Both can occur in a patient at the same time

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25
What are the 3 zones of the prostate
Central zone Peripheral zone Transitional zone
26
Where is the central zone located at
Surrounds the ejaculatory ducts
27
Where is the transitional zone located at
Surrounds the prostatic urethra
28
Where is the peripheral zone located at
Posterolaterally
29
Prostate cancer most commonly arise from
Peripheral zone
30
What condition most commonly occurs in the transitional zone
BPH
31
Symptoms of prostate cancer
Asymptomatic at early stage Late stages - haematospermia - haematuria - obstruction - urinary hesitancy, reduced flow - bone pain (metastasis) - weight loss, fatigue, anorexia
32
Why is prostate cancer usually asymptomatic at early stages
Because it occurs at the peripheral zone so it is unlikely to cause obstructive symptoms early on
33
Prostate cancer usually metastasises to
Bones and lymph nodes
34
Investigations for prostate cancer
Multiparametric MRI (replaced transrectal ultrasound guided biopsy) Bloods - PSA PR exam Bone scan
35
What may PR exam show in prostate cancer
Enlarged, hard, irregular, asymmetrical prostate
36
What is the scoring used for the results of multi parametric MRI
Likert scale
37
If Likert scale is >/3, you should
Offer a multi-parametric MRI influenced prostate biopsy
38
Management of prostate cancer
If early (T1, T2) - Observation and follow ups if late - anti-androgen therapy - radical prostatectomy - radiotherapy If metastatic - anti-androgen therapy
39
What is a common side effect of radical prostatectomy
Erectile dysfunction
40
Radiotherapy may increase the risk of
Bladder, colon and rectal cancer following radiotherapy for prostate cancer
41
What are the agents in hormonal therapy used for prostate cancer
GnRH agonist - Goserelin Bicalutamide Cryproterone acetate Abiraterone
42
Bicalutamide is a
non-steroidal anti-androgen which blocks the androgen receptor
43
Cryproterone acetate is a
steroidal anti-androgen
44
Abiraterone is a
androgen synthesis inhibitor
45
Testicular cancer is the most common malignancy affecting
Men 20-30 years old Younger age group compared to prostate cancer
46
Risk factors of testicular cancer
Infertility Cryptorchidism FH White caucasians Klinefelter's syndrome
47
What is cryptorchidism
When one or both testicles fail to descend (undescended testicles)
48
Testicular cancer is usually a ____ cell tumour
Germ cell tumour
49
Testicular cancer can also be non-germ cell tumour. What are the non-germ cell tumours called
Leydig cell tumours Sarcomas
50
What are leydig cells
Cells in seminiferous tubules that produce testosterone
51
What are the types of germ cell tumours
Seminoma Teratoma Yolk sac tumour Choriocarcinoma Embryonic
52
What is seminoma
germ cell tumours that arise from seminiferous tubules
53
Which type of germ cell tumour is more common
Seminoma
54
Which types of germ cell tumours have worse prognosis
Teratoma Embryonal cell carcinoma These metastasise quicker
55
Describe the prognosis of seminoma
95% cure rate, very responsive to radiotherapy
56
Teratomas are rarely
Rarely occur on their own, usually associated with other non-seminomatous tumours
57
Describe the age groups commonly affected by seminoma and teratoma
Seminoma - >30 years old Teratoma - <30 years old
58
Symptoms of testicular cancer
Painless lump Hydrocele Gynaecomastia
59
What are the signs of advanced testicular cancer
Neck lumps Bone pain Abdominal mass
60
How does testicular cancer cause gynaecomastia
Due to increase in oestrogen:androgen ratio
61
What are the investigations for testicular cancer
Bloods - AFP - hCG - LDH US testicle (first line) CT chest, abdomen
62
Describe the presence of tumour markers in seminoma/non-seminoma testicular cancer
Seminoma - raised hCG in 20% but AFP is NOT RAISED Non-seminoma - raised hCG in 80% and raised AFP
63
Management of testicular cancer
Radical inguinal orchidectomy Re-check tumour markers 1 week post operation Chemotherapy post op
64
Risk factors of penile cancer
50-60 years old Asian, African HPV Smoking Phimosis causing chronic inflammation
65
What is phimosis
the inability to retract the foreskin of the penis causing inflammation due to poor hygiene
66
Most common form of penile cancer
Squamous cell carcinoma
67
investigation for penile cancer
biopsy
68
Management for penile cancer
if on foreskin - Circumcision If on glans (head) - glans resurfacing or glansectomy
69
What is hydrocele
Collection of fluid between the two layers (parietal and visceral) of the tunica vaginalis
70
Causes of hydrocele
Communicating: Patency of processus vaginalis -> peritoneal fluid drain down into the scrotum Non-communicating: Excessive fluid production
71
Communicating hydrocele is common in
newborn babies
72
Symptoms of hydrocele
Soft, smooth, non tender swelling around one of the testes Transilluminate with pen torch
73
Investigation for hydrocele
Usually clinical US if indicated
74
When is US indicated for hydrocele
In adult patients to exclude underlying malignancy (testicular cancer can cause hydrocele
75
Management of hydrocele
Communicating hydrocele in babies can resolve spontaneously within first few months If not -> surgical repair Non-communicating hydrocele usually resolve in 2 years
76
What is varicocele
abnormal enlargement of the testicular veins
77
What are the testicular veins called
Pampiniform plexus
78
Varicocele is more common on the left / right
Left
79
Why is varicocele more common on the left
Due to increased resistance to flow because left gondola vein needs to drain into the left renal vein first whereas the right drains straight into inferior vena cava
80
What can cause varicocele
Dilation of superior mesenteric artery -> compresses the left renal vein
81
Symptoms of varicocele
Usually asymptomatic looks like "bag of worms" Subfertility
82
Varicocele may be seen in
renal cell carcinoma - tumour invading left renal vein can cause blockage hence engorgement of downstream veins
83
Investigations for varicocele
US kidneys, ureters and bladder
84
Management of varicocele
No treatment Surgery if pain
85
What is spermatocele
Fluid-filled cyst that develops at the head of epididymis