Male Reproductive System Flashcards
Testicular Torsion
x
epid
x
who most commonly gets these?
most common in adolescents
syx
x
what are the common syx of testicular torsion?
n/v, testicular inguinal and abdominal pain
PE
x
what are physical exam findings?
horizontal testicular lie with elevated testicle, absent cremasteric reflex, swollen and erythematous scrotum
dx
x
what would imaging show for testicular torsion?
U/S with doppler: no blood flow to scrotum
management
x
what is the management plan?
surgical detorsion and fixation (orchiopexy) with exploration of the contralateral side
how soon should management be implemented?
within 24 hours, do an orchiopexy. Torsion within 6 hours typically allows for complete viability
if immediate surgery is not available, what do you do?
manual detorsion
Epididymitis
x
Syx
x
what are the syx of epididymitis?
Coliform infxn: Dysuria, frequency
Other syx: unilateral scrotal pain, swelling, and tenderness
PE
x
what is the classic physical exam findings?
prehn sign (pain relief with scrotal elevation)
Dx
x
what should initial evaluation involve?
UA and culture, NAAT for chlamydia and Gonorrhea
cause
x
if <35 y.o, what is the most common cause of epididymitis?
N. Gonorrhoeae and Chlamydia trachomatis
if >35 y.o, what is the most common cause of epididymitis?
bladder outlet obstruction (coliform bacteria-E.Coli)
Trx
x
what are comfort measures that can be taken?
scrotal elevation and NSAIDs (ibuprofen)
what is the trx for acute epididymitis if STI-i.e. gonorrhea and chlamydia?
ceftriaxone/doxycycline
what is the trx for acute epididymitis if coliform bacteria-i.e. E.Coli (older nonsexually active men)?
Levofloxacin
Retrocecal Appendicitis
x
PE
x
what is the physical exam finding?
psoas sign: pain in the RLQ with passive ipsilateral hip extension
Leriche Syndrome
x
syx
x
what is the triad of leriche syndrome?
LE claudication, absent or diminished femoral pulses, Erectile Dysfunction
Erectile Dysfunction (ED)
x
causes
x
what are causes of ED ?
vascular, neurolgic, psychogenic, endocrine, medications, hypogonadism
vascular ED
x
syx
x
what are syx?
abnormal vascular exam (eg bruits, decreased pulses)
risk
x
what are risk factors?
cardiovascular (HTN, smoking, DM)
dx
x
how do you best dx it before initiating trx?
ABI index, cardiac stress testing prior to initiating trx
trx
x
what is first line trx?
PDE5 inhibitors (sildanefil, vardenafil, tadalafil)
neurologic ED
x
syx
x
what are syx of neurologic ED?
gradual onset, loss of bulbocavernosus reflex
risk
x
what are risk factors?
Neurologic comorbidity (eg, diabetic neuropathy, multiple sclerosis, spinal injury/surgery)
psychogenic ED
x
risk
x
what are risk factors?
interpersonal conflict, performance anxiety, underlying emotional disorder
syx
x
what are the symptoms?
sudden onset, Situational (eg, ED with partner, normal erection during masturbation), persistence of nonsexual nocturnal erections
PE
x
what are the physical exam findings?
normal nonsexual nocturnal erections
endocrine ED
x
what are additional endocrine syx?
underlying disorder
dx
x
how do you dx it?
abnormal hormone levels (eg TSH, prolactin)
Medication induced ED
x
cause
x
what are the meds that causes ED?
anti-HTN (i.e. carvedilol), SSRIs, anti-androgenic medications
hypogonadism ED
x
syx
x
what are syx of hypogonadism ED?
gradual onset
PE
x
what are physical exam findings?
decreased libido, gynecomastica, testicular atrophy
Dx
x
what would lab values show?
low serum testosterone
Pearly Penile Papules
x
PE
x
what are the physical exam findings of penile papules?
> =1 rows of small, flesh colored, dome topped or filiform papules positioned circumeferentially around the corona or sulcus of the glans penis
management
x
what is the management of pearly penile papules?
normal variant, no intervention, just reassurance
Condyloma Acuminata
x
PE
x
what are physical exam findings?
skin colored or pink, smooth flattened papules to verrcous, papilliform growths
trx
x
what is the treatment?
topical imiquimod, an immunomodulatory drug
Acute Urinary Incontinence
x
causes
x
what are reversible causes of incontinence?
“DIAPPERS”
Delirium Infection (eg, UTI) Atrophic urethritis/vaginitis Pharmaceuticals (eg, alpha blockers, diuretics) Psychological (eg, depression) Excessive urine output (eg, diabetes mellitus, CHF) Restricted mobility (eg, postsurgery) Stool impaction
what are neurologic causes?
MS, dementia (parkinsons, alzheimer, NPH), spinal cord injury, disc herniation
what are genitourinary causes?
- Decreased Detrusor contractility, detrusor overactivity
- Bladder or urethral obstruction (eg, tumor, BPH)
- Urethral sphincter or pelvic floor weakness
- Urogenital fistula
dx
x
what is the best initial dx test for elderly with urinary incontinence?
UA with culture
Chronic Prostatitis
x
timing
x
how long must you have prostatitis to call it chronic?
> 3 months
syx
x
what are syx of chronic prostatitis?
> 3 months of dysuria, pelvic pain, and/or pain during ejaculation
dx
x
what should you do first to evaluate?
UA and urine culture before and after prostate massage
what does chronic prostatitis UA normally show?
> 20 leukocytes/hpf after prostate massage
urine culture is then used to differentiate what?
chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)-urine culture is aseptic
chronic bacterial prostatitis-urine culture results >10 fold increase after prostate massage
PE
x
what would physical exam show?
hypertrophy, tenderness, or edema
management
x
what is the best treatment for chronic prostatitis?
no clear approach- alpha blocker, abx, anti-inflammatories, and/or psychotherapy are all reasonable
Acute Prostatitis
x
syx
x
what are syx of acute prostatitis?
high fever, dysuria, pelvic /perineal pain, cloudy urine, generalized body aches
PE
x
what does rectal exam show?
warm, edematous, very tender prostate
dx
x
what does the UA show?
mod blood, LE positive, nitrites positive, many bacteria, WBC many, RBC some
what does urine culture show?
gram negative organism (E Coli or Proteus)
complications
x
what are complications of acute prostatitis?
bladder outlet obstruction w acute urinary retention
trx
x
what is the trx for acute prostatitis?
urgent bladder decompression (suprapubic catheter, since uretheral cath increases risk of septic shock) and Abx (TMP-SMx, Ciprofloxacin)
Interstitial Cystitis
x
syx
x
what are syx ?
longstanding dysuria, discomfort worse when bladder is full and improved with voiding
dx
x
what does UA show?
aseptic dysuria
Benign Prostate Hyperplasia (BPH)
x
syx
x
what are syx of BPH?
urgency, hesitancy, nocturia, weak urinary stream
dx
x
what does the PSA show?
elevation
trx
x
what is a typical surgical trx?
TURP
what is a common complication of TURP?
retrograde ejaculation (urinary incontinence and ED are uncommon)
Elvated PSA’s (Prostate Specific Antigen)
x
causes
x
what are causes of transient elevated PSA?
urine retention, mild acute prostate infections/inflammation, urologic procedure (eg cystoscopy), DRE (minimal elevation), recent ejaculation
what are causes of chronic elevated PSA?
BPH, prostate cancer, severe or chronic prostatitis
management
x
what should you do if you encounter elevated PSA
repeat PSA in 4-6 weeks
Constitutional Delay of Growth and Puberty
x
syx
x
what are syx of consitutional delay?
fam hx of “late bloomers”, delayed puberty, short stature, normal growth velocity, delayed bone age
management
x
what is management for constitutional delay?
reassurance, watchful waiting, +/- hormonal therapy
when should you give hormonal therapy (testosterone in boys, estrogen in girls)?
consider in boys >14y.o, or girls >12 y.o.
when psychosocial concerns are expressed, what should you do?
confidential interview should be conduccted to screen for depression and anxiety
prognosis
x
what is the prognosis?
puberty onset correlates with fam members, normal expected adult height
Kallman Syndrome
x
syx
x
what are syx of kallman syndrome?
anosmia, hypogonadism, cryptorchidism, micropenis
Cryptorchidism
x
define
x
what is it ? what age is it concerning?
> =6months infants with undescended testis (normally drop through inguinal canal at 28 wks)
risk
x
what are the risks of cryptorchidism?
prematurity, small for gestational age, low birth weight (<2.5kg), genetic disorders
PE
x
what are Physical exam findings of cryptorchidism?
empty, hypoplastic, poorly rugated scrotum or hemiscrotum
+/-inguinal fullness
management
x
what is the management?
orchiopexy after 6 months and before 1y.o. (it is done during infancy to optimize fertility and testicular growth)
how does orchiopexy change risk of testicular malignancy ?
it will decrease after orchipexy but remain higher than in patients without a hx of cryptorchidism
complications
x
what are complications?
inguinal hernia, testicular torsion, subfertility, testicular cancer
Scrotal Trauma
x
syx
x
what are the symptoms of scrotal trauma?
scrotal pain, swelling, bruising
PE
x
what is a common physical exam finding?
absent or present cremasteric reflex
management
x
what is appropriate management for mild scrotal trauma?
mild: analgesics and supportive care
what is appropriate management for moderate/severe scrotal trauma?
U/S, plus or minus surgical exploration w/n 3 days
dx
x
what consitutes moderate/severe scrotal trauma?
moderate bruising, sig swelling, marked pain
preventative measures
x
what are preventative measures to be used?
protective cup
Testicular Cancer
x
epid
x
what is the epidemiology of testicular cancer?
15-35 y.o.
risks
x
what are risk factors for testicular cancer?
fam hx, cryptorchidism
syx
x
what are syx of testicular cancer?
unilateral, painless testicular nodule, dull lower abdominal ache
what are mets syx associated with testicular cancer?
dyspnea, neck mass, low back pain
PE
x
what are physical exam findings ?
firm, ovoid mass
dx
x
what labs do you order?
UA, tumor markers (AFP, b-hcG)
what imaging do you order?
scrotal U/S, then staging imaging (CT scan, CXR)
trx
x
what is the treament?
radical orchiectomy and chemotherapy,
what is the cure rate?
cure rate ~95%
Priapism
x
risk
x
what are common risk factors for ischemia?
PDE5 inhibitors, intracavernosal injections (eg alprostadil), certain meds (eg trazaodone), and sickle cell disease
syx
x
what are syx?
persistent >4h, painful erection
PE
x
what are the physical exam findings?
engorged and tender to palpation corpus spongiosum
Dx
x
what is the best way to diagnose priapism?
blood gas analysis of a corporeal aspirate
management
x
what is the best management at the onset of syx?
terminated with simple interventions (eg urination, cold compresses)
if syx last >4 hours, what do you do?
require invasive treatment
what does management involve?
aspiration of corpora cavernosa and intracavernosal injection of alpha agonist (eg phenylephrine)
what is the trx of choice for nonischemic (high flow) priapism- due to traumatic fistula from the cavernosal artery?
angiographic embolization
complications
x
what are complications?
irreversible ischemic injury, tissue acidosis, anoxia
