Male Reproductive system

Question 1

What are the indications for cystoscopy

Answer 1

• Gross hematuria with no evidence of glomerular disease or infection
• Microscopic hematuria with no evidence of glomerular disease or infection but increased risk for malignancy
• Recurrent UTIs
• Obstructive symptoms with suspicion for stricture, stone
• Irritative symptoms without urinary infection
• Abnormal bladder imaging or urine cytology

Question 2

Symptoms of chronic prostatitis/chronic pelvic pain syndrome

Answer 2

• Pain in pelvis, perineum, genitalia
• Irritative voiding symptoms (eg, urgency, hesitancy)
• Hematospermia, pain with ejaculation

Question 3

Diagnosis of chronic prostatitis/Chronic pelvic pain syndrome?

Answer 3

• No or mild prostate tenderness

- Sterile urine culture

Question 4

Management of chronic prostatitis/Chronic pelvic pain syndrome?

Answer 4

• Alpha blockers (eg, tamsulosin)
• Antibiotics (eg, ciprofloxacin), especially if hx of UTI
• 5-alpha-reductase inhibitors (eg, finasteride)

Question 5

The exact etiology of chronic prostatitis/Chronic pelvic pain syndrome is unclear, but it is thought to be due to what?

Answer 5

NONinfectious chronic prostate inflammation

Question 6

This can present with irritative voiding symptoms, but patients usually have scrotal pain, swelling, and tenderness as well as a purulent urethral discharge

Answer 6

epididymitis

Question 7

This presents with dysuria and urinary frequency. Patients often have a hx of UTI, prostatic tenderness or induration, and a positive urine culture. Characterized by fever, perineal pain, and severe tenderness on prostate exam

Answer 7

Chronic bacterial prostatitis . . not to be confused with chronic prostatitis/Chronic pelvic pain syndrome

Question 8

Fever, leukocytosis, and prostate tenderness suggests acute bacterial prostatitis. This is Typically caused by the same organisms that cause other infections of the urinary tract (especially E coli), and initial symptoms may resemble cystitis. However, acute bacterial prostatitis can be differentiated from cystitis by more pronounced systemic symptoms (eg, fever, chills, ill appearance), associated regional pain, and tenderness on prostate exam. Describe the management?

Answer 8

• Obtaining mid-stream urine sample is most appropriate next step
• Empiric antibx therapy with TMP-SMX or a fluoroquinonlone should be started while awaiting culture results
• Treatment should be continued for 4-6 weeks in most cases

Question 9

Elderly man with urinary retention and absent Achilles tendon relexes

Answer 9

• Most likey BPH
• The Achilles tendon reflex can decrease or even be absent with age, so this can be a normal finding in many elderly patients

Question 10

Adverse effects of phosphodiesterase-5 inhibitors (eg, sildenafil)

Answer 10

• Cardiovasular: Hypotension (especially with nitrates but also alpha blocker (-zosins)
• Ocular: Blue discoloration of vision, nonarteritic anterior ischemic optic neuropathy
• Genitourinary: priapism
• Other: flushing, HA, hearing loss

Question 11

What is usually first line agent for BPH

Answer 11

Alpha-adrenergic antagonists . . . terazosin or tamsulosin

Question 12

Describe the difference in the mechanism of action between Alpha-1 blockers and 5-alpha-reductase inhibitors in treatment of BPH

Answer 12

• Alpha-1 blockers provide rapid relief of symptoms by relaxing bladder neck and prostatic smooth muscle
• 5-alpha-reductase inhibitors can be used in addition to alpha blockers for patients with persistent symptoms or as an alternate therapy for those who do not tolerate alpha blockers (eg, hypotension) . . . they act by reducing the prostate size and have a much slower onset of action (ie, months)

Question 13

These are the most common type of testicular sex cord stromal tumors, which may occur in all age groups, including young children

Answer 13

Leydig cell tumors

Question 14

Describe the hormone ramifications and symptoms associated with Leydig cell tumors

Answer 14

• Leydig cells are the principal source of testosterone and are capable of estrogen production, due to markedly increased aromatase expression
• Estrogen in markedly increased in tumorous growth of Leydig cells . . secondary inhibition of LH and FSH
• Endocrine manifestations are found in only 20-30% of adults, the most common being gynectomastia
• In prepubertal cases, precocious puberty is common

Question 15

This is a germ cell tumor characterized by increased serum beta-hCG

Answer 15

Choriocarcinoma

Question 16

Describe AFP and beta-hCG in teratoma?

Answer 16

• elevations in serum AFP and beta-hCH CAN appear, which cannot be attributed to teratomatous element
• They indicate the coexistence of other germ cell tumor components

Question 17

Describe blood levels of seminomas

Answer 17

• serum tumor markers are usually normal

- beta-hCG may be somewhat elevated with seminomas that contain syncytiotrophoblastic giant cells

Question 18

this is a germ cell tumor accompanied by an increase in serum AFP

Answer 18

Yolk sac tumor (endodermal sinus tumor)

Question 19

patients with lower urinary tract symptoms and suspected BPH should have what workup

Answer 19

• urinalysis to evaluate for hematuria (eg, bladder cancer, Kidney stones) and infection
• PSA should be obtained in Symptomatic patietns to assess the risk for prostate cancer unless predicted life expectancy is < 10 years