MDT's Part 2 Flashcards
Normal male erection is a neurovascular event that relies on what?
- Intact autonomic and somatic nervous system
- Arterial blood flow
- Smooth and striated musculature of corpora cavernosa and pelvic floor
Erection is caused and maintained by?
- Increase in arterial flow
- Active relaxation in smooth muscle
- Increase in venous resistance
What is a key neurotransmitter that initiates and sustains erections?
Nitric oxide
What is Peyronie disease?
A fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity
What is anejaculation?
inability to ejaculate
What are signs and symptoms of ED?
- History
- Lifestyle factors
- Sexual orientation
- Quality of relationship
- Alchohol
- Tobacco
- use of porn
- Medication
What may be the first sign of endothelial dysfunction?
Ability to achieve but not maintain an erection
Physical exam for erectile dysfunction?
- Vitals
- Obesity?
- Cardio
- Neuro
- Genitalia
Treatment of ED?
- Lifestyle modification and reduction of cardiovascular risk factors
- If psychogenic component, therapy or counseling
- Hormonal replacement
- Oral agents (Sildenafil, Vardenadil, Tadalafil)
Refer to Urology for ED?
- Priapism (MEDEVAC)
- Initial oral therapy
- Inadequate response to medication
- Unable to tolerate side effects
- Peyronie disease
- Hx of pelvic/perineal trauma, surgery, or radiation
What are some general considerations for benign prostatic hypertrophy?
- Hyperstatic process = increased number of cells
- Most common benign tumor in men
- At 55 yrs, approx 25% of men report obstructive voiding Sx
- At 75, 50% report decreased force and caliber of urinary system
- Risk factors are poorly understood
Obstructive symptoms associated with benign prostatic hypertrophy?
- Hesitancy
- Decreased force and caliber of stream
- Sensation of incomplete bladder emptying
- Double voiding (urinating twice within 2 hours)
- Straining to urinate
- Postvoid dribbling
Irritative symptoms associated with benign prostatic hypertrophy?
- Urgency
- Frequency
- Nocturia
What is the most important tool and should be calculated for all patients before starting benign prostatic hypertrophy?
American Urological Association (AUA) index
- Seven questions that quantify severity of Sx’s on a 0-5 scale
Treatment for benign prostatic hypertrophy?
- Watchful waiting (for mild Sx, AUA scores 0-7)
- Medical Therapy ( Alpha blockers, 5-alpha-reductase inhibitor)
Absolute surgical indications for benign prostatic hypertrophy?
- Refractory urinary retention
- Large bladder diverticula
- Sequela of benign prostatic hyperplasia
When to refer to urology for benign prostatic hypertrophy?
- AUA score greater than 7
- Urinary retention
- Hematuria
- Recurrent UTI
- Evidence of kidney disease
What is the most common non-cutaneous cancer in American men and second leading cause of cancer related death in men?
Prostate Cancer
What are risk factors for prostate cancer?
- African American
- Family Hx of prostate cancer
- Hx of high dietary fat intake
- Known or likely to have BRAC1 or BRAC2 mutations
Signs and symptoms of prostate cancer?
- Most cases detected due to elevated serum PSA
- May manifest as focal nodules or areas of induration on DRE
- Can cause obstructive symptoms
- Lymph node metastases (axial skeleton most common)
Lab finding for prostate cancer?
- PSA > 4.0 ng/mL
- Prostate biopsy
- Misc labs:
- BUN and creatinine
- Alkaline phosphate and calcium
- CBC
Imaging for Prostate cancer?
- Transrectal U/S
- MRI
- Bone scan (eval for bony metastases)
What is the screening for prostate cancer?
- DRE
- PSA testing
- Transrectal U/S
What is the treatment for prostate cancer?
- As dictated by urology and oncology
- Active surveillance
- Radical Prostatectomy
- Radiation therapy
- Cryosurgery
- Androgen deprivation therapy for advanced disease
Complications of prostate cancer?
- Urinary retention
- Renal failure
- Metastatic bone pain
- Thromboembolic events
- Neuro Sx’s
- Pathologic fractures
Who must be referred to urology with suspicion of prostate cancer?
All patients with:
- Focal nodule
- Induration on DRE
- Elevated PSA
What are some signs and symptoms of scrotal trauma?
- Evaluate Airway/breathing, circulation for all blunt/penetrating trauma
- TTP
- Ecchymosis
- Swelling
- Laceration
- Bleeding
Imaging for scrotal trauma?
- Scrotal and testicular U/S
* colored doppler study to determine extent of testicular involvement
Treatment of scrotal trauma?
- Blunt/penetrating testicular injuries require MEDEVAC
- Lacerations/avulsions just involving skin can be repaired by IDC
What is Fournier’s Gangrene?
Necrotizing fasciitis of the subcutaneous tissues of the perineum often involving the scrotum
- typically begins as benign infection or simple abscess
Signs/symptoms of fournier’s gangrene?
- Tense edema of scrotum and other skin
- Blisters/bullae
- Crepitus
- Fever
- Pain (out of proportion)
- Tachycardia
- Hypotension
Imaging for Fournier’s gangrene?
- CT Scan and MRI
Treatment for Fournier’s gangrene?
- Aggressive Surgical exploration and debridement
- Broad spectrum antibiotics
- Ertapenem
- Fluid resuscitation
- MEDEVAC
What is varicocele?
Dilation of the pampiniform plexus of spermatic veins and is generally left sided
Signs and symptoms of varicocele?
- Usually asymptomatic mass
- Mass separate from testis
- Feels like “bag of worms”
- Size increased by valsalva
What should right sided varicocele raise suspicion of?
Inferior Vena cava and intraabdominal pathology
What should left sided varicocele raise suspicion of?
Left renal vein obstruction or renal tumor
What is a hydrocele?
Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord
Signs/symptoms of hydrocele?
Gradually enlarging painless cystic mass that transilluminates
What is a spermatocele?
Fluid filled cyst at the head of the epididymitis that may contain nonviable sperm
Signs/symptoms of spermatocele?
- Painless
- Palpated as distinct from testis
- Typically transilluminated as cystic in nature
Imaging for scrotal/testicular abnormalities?
Scrotal and testicular U/S
What are some general consider for testicular cancer?
- Malignancy is often painless
- Most common neoplasm in age 20-35
- Orchiectomy necessary for diagnosis
What are some signs and symptoms of testicular cancer?
- Painless enlargement of testis
- Pt first to recognize abnormality but waits 3-6 months
- Sensations of heaviness
- Acute testicular pain
Lab findings for testicular cancer?
- HCG
Imaging for testicular cancer?
- Scrotal U/S
- Clinical staging (upon Dx)
- Chest, abdomen, pelvic CT scan
Treatment of testicular cancer?
- Radical orchiectomy
- Retroperitoneal irradiation
- Potential chemotherapy
Referrals for testicular cancer?
- Urology
- Oncology (if metastatic disease suspected)
