Men' Health Flashcards by Megan McStay

Obstructive Symptoms of Prostatism

Decreased and Intermittent Urinary Stream
Double Micturition
Hesitancy
Feeling of incomplete Emptying 
Straining to Void

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Causes of Obstructive Symptoms?

Prostatic Enlargement
Strictures 
Tumours
Urethral Valves 
Bladder Neck Contracture

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Irritative Symptoms of Prostatism

Detrusor Muscle Hypertrophy

Frequency
Urgency
Dysuria
Nocturia

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Causes of Irritative Symptoms?

Enlarged Prostat
UTI
Polydipsia
Hypercalcaemia
Uraemia
Detrusor Instability

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Complications of BPH?

Recurrent UTI
Bladder Stones
Haematuria
Acute retention of Urine 
Chronic Urine Retention
Overflow Incontinence
Obstructive Nephropathy

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Management of BPH?

-Mild symptoms + No complications: Decreased fluid and caffeine intake, bladder retraining, prevent constipation

-mild/mod symptoms:
alpha adrenoceptor antagonists: prazosin, doxazosin (Stops worsening)
5alpha reductase inhibitors: finasteride (bulky prostate)

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What should you watch out for in a patient taking alpha adrenoceptor antagonists prazosin/ daxazosin?

Postural Hypotension

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How long will it take for 5alpha reductase inhibitors (finasteride) to work?

upto 6mnths

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How much more does combination therapy decrease progression by compared to either agent alone?

66%

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BPH Referral to urologist?

Complicated BPH
Nodeular/Firm protate on DRE 
Failure to respond to tx - 3-12mnths/6-12mnths
Increased PSA:
age 50-59: >/=3
age 60-69: >/= 4
age 70-79: >/= 5
Severe Symptoms

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Acute Bacterial Prostatitis

Suspected UTI
Fever, arthralgia/myalgia- low back, perineal, penile +/- rectal pain
DRE: swollen, painful prostate
Check MSU

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Treatment for acute bacterial prostatitis?

Ciprofloxacin 4wks

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Complications of acute bacterial prostatitis?

Acute retention of urine
Chronic bacterial prostatitis
Prostate abscess

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Chronic prostatitis (chronic pelvic pain syndrome)

>3mnth Hx of;
-Urological Pain- lower abdomen, pelvis/perineum, penis (esp. tip on ejaculation), testicles, rectum, low back 
\+/-
-Irritative/obstructive symptoms 
-Ejaculatory Disturbance

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Tx chronic prostatitis

alpha blockers

Remission may be spontaneous

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Reasons for increased PSA?

Prostate Ca
BPH
Acute or Chronic Prostatitis
Physical Exercise
Acute Urinary Retention
Prostate Instrumentation 
Old Age

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Do not do a PSA test if?

UTI-treat and postpone PSA >1mnth 
Ejaculation within 48hrs 
Exercise within 48hrs
Prostate Biopsy < 6wks 
*Finasteride + Ddutasteride decrease PSA by 50%

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Number of men that have prostate cancer in their lifetime?

1 in 6

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PSA test and DRE are recommended for patients with the following unexplained symptoms?

Erectile Dysfunction
Haematuria
Lower back pain
bone pain
Obstructive/ Inflammatory symptoms 
weight loss esp. in elderly

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Urgent Referral

DRE: hard, irreg prostate (not simply enlarged)
DRE: Normal, PSA raised/rising +/- LUTS
LUTS + High PSA

If borderline PSA results how should you proceed?

Repeat after 1-3mnths

Treatment options in symptomless, local prostate cancer?

Monitor:
Radical Prostatectomy: complications-impotence 50% + incontinence 25%
Radiotherapy
Hormone Tx

Treatment of symtomatic prostate cancer

Hormone Manipulation:
-Leutenizing Hormone releasing hormone analogues- Goserelin
SC injection every 4-6wks
-Anti androgens
Crypterone acetate, flutamide, bicalutamide
Prevent S/E due to testosterone flare after admin of first dose of LHRH analogues
given a few days in advance

Side effects of LHRH analogues?

Impotence
Hot Flushes
Bruising
Gynaecomastia
Infection -injection sites

Gleason Score

Graded 1-5 | Two areas of highest grade cells are added together

Torsion of the testes?

Sudden onset, severe scrotal pain Ass. w/t RIF pain, nausea + vomiting 15-30yrs tender, hard testes riding higher than contralateral testes

Torsion of the hydatid Morgagni (Appendages)?

Small embryological remnant at the upper pole of the testes | Presents similiarly to torsion of the testes

Epididymo-orchitis?

Inflammation of the testes and epidymis due to infection Viral: Mumps Bacterial: Chlamydia or Gonococcal (<35yrs) + coliforms(>35yrs)

Presentation pf epididymo-orchitis?

Acute onset of pain, swelling and tenderness fever and rigors +/- urethritis, dysuria, frequency

A positive prehn's sign indicates?

Acute epididymo-orchitis

Treatment for epididymo-orchitis?

Elevation of scrotum Mumps: Paracetamol, Fluids, Rest Chlamydia: Doxycycline 10-14days Gonnorrhoea: Ceftriaxone + Doxycycline 10-14days

Causes of Secondary Hydrocele (collection of fluid in the tunica vaginalis)

Infection Tumour (adults presenting) Torsion

Hydrocele Management?

Children: Congenital, resolve within 1yr Adults:USS if testes non palpable Tapping- surgery inappropriate, infection or recurrence Surgery

Hydrocele of the cord?

Arises in part of the processus vaginalis in the spermatic cord above the testes Rounded lump which slips up and down the inguinal canal

Haematocoele?

Damage to the testes | Tunica Vaginalis fills with blood

Varicocele?

Varicose veins in pampiniform plexus Secondary to :obstruction of the testicular veins in the abdomen L > R Infertility Dull ache in testes @ end of day/ after exercise Seen on standing

Epididymal Cyst?

Multiple, painles lump Smooth walled cyst palpable above and behind the testes, bilateral USS referral if unsure

Spermatocoele?

Cyst containing sperm Located in the head of the epididymis Presents the same as epidermal cyst

Benign Testicular tumours?

-Sertoli Cell Adenomas -Leydig Cell Adenomas Produce sex hormones

Testicular Cancer?

-Seminoma (60%) -Teratoma 20-34yrs Painless lump in testes Painful if hydrocele Mets: back pain/ dyspnoea

Risk Factors for testicular cancer

Undescended testes Bilateral undescended testes (increased risk 10x) PHx testicular cancer

Empty Scrotum vs Hypoplastic?

Hypoplastic if scrotum never contained testes

Causes of an empty scrotum?

Undescended or retractile testes Surgical Removal-torsion, trauma or tumour Testicular Atrophy-mumps or trauma Ambiguous genitalia

Mixed testicular tumours are treated?

``` Like teratomas B-HCG, aFP, LDH Fast Growing Tx: stage 1 (60%) Inguinal Orchidectomy and surveillance of tumour markers Sperm Banking Tx: relapses (25% < 18mnths) and metastatic disease Chemotherapy ```

Fournier's Gangrene

Necrotizing Fascitis of the scrotal skin +/- penis Elderly Hydrocele Tx: surgical depridement and IV antibiotics (Flucloxacillin

Undescended Testis affects what percentage of neonates?

2-3% | Descend within 1yr

If testes do not descend after 1 yr how should you proceed?

Refer for surgical descent/ fixation | Decrease risk of malignancy and infertility in later life

Retractile tetis is due to?

Active Cremasteric Reflex