Men's Health Flashcards
What is phimosis?
When the prepuce of the penis can’t be fully retracted
It can be physiological for up to 17 years of age
What are the risks of phimosis?
- poor hygiene - increase STI risk
- pain on intercourse - splitting/bleeding
- balanitis - inflamed glans
- posthitis - inflamed foreskin/prepuce
- balanitis xerotica obliterates (BXO) - scarring of tip of glans leads to meatal stenosis
- urinary retention
- penile cancer
What is paraphimos
painful constriction of the glans penis by the retracted prepuce proximal to the corona
What are the 3 common causes of paraphimosis?
- phimosis
- catheterisation
- penile cancer
What are the best treatments for phimosis and paraphimosis?
Phimosis - circumcision, think about any other possible pathologies associated
Paraphimosis - reduction - manually with local anaesthetic, sometimes need a dorsal slit as well
What type of cancer is penile cancer? What are it’s risk factors
squamous cell carcinoma
phimosis - hygiene, smegma, HPV 16 and 18
it’s rare
When does circumcision occur?
- paediatric - religious, recurrent balanitis/UTIs
* adulthood - recurrent balanitis, phimosis, recurrent paraphimosis, balanitis xerotica obliterans, penile cancer
What are the causes of acute scrotal pain?
- testicular torsion
- epidiymitis/orchitis/epididymo-orchitis - UTI/STI/mumps
- torsion of hydatid of Morgagni
- trauma
- ureteric calculi (rare)
What is the history of someone with testicular torsion? What about on examination?
- younger (under 30)
- sudden onset
- unilateral pain
- nausea/vomit
- no LUTS
- tender testis
- lying high in scrotum with horizontal lie
Treatment of testicular torsion?
Emergency scrotal exploration - don’t waste time on USS, etc
What is the history, examination and investigations found with epididymo-orchitis?
- History - 20-40/50 - STI, 40/50+ - UTI, gradual onset, unilateral, recent hx of UTI, unprotected sex, catheter, mumps hx
- Examination - pyrexic/septic, erythematous scrotum, enlarged testis/epididymis, fluctuant (abscess), reactive hydrocoele, necrotic area (rare)
- Investigation - FBC, U&Es, cultures (in sepsis), MSU for MC&S, scrotal USS if abscess
What is the treatment for epididymo-orchitis?
Antibiotics
Surgical drainage and antibiotics if with an abscess and emergency debridement and antibiotics if Fournier’s gangrene
What are the key questions of ask about the hx and ex of someone with a scrotal lump?
- History - is it painful? how quickly has it appeared?
- Examination - can I get above it? is it in the body of the testis? is it separate to the testis? does it fluctuate and transilluminate?
What are some possible causes with a painless scrotal lump?
- testis tumour
- epididymal cyst
- hydrocele
- reducible inguino-scrotal hernia
What is the possible cause of a painless scrotal lump that aches at the end of the day?
Varicocele
What are the possible causes of a painful/tender scrotal lump?
- epididymitis
- epididymo-orchitis
- strangulated inguino-scrotal hernia
What are the common types of testicular tumours?
Germ cell (seminoma/teratoma) in under 45 year olds and lymphoma in older men
How do you examine/investigate a testicular tumour?
- lump in body of testis, can get above it
Refer to urology (2 week wait)
- USS
- tumour markers - aFP, hCG and LDH
How does a hydrocele present in an adult?
- slow or sudden onset
- uni or bilateral scrotal swelling
- can get above swelling
- testis not palpable separately
- transilluminates
What causes a hydrocele?
Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis
How does an epididymal cyst present on examination?
- separate from testis
- can get above the mass
- transilluminates
Hows do varicocele’s present?
- Dull ache at end of day
- more common in left than right testis
- possible reduced fertility, esp if bilateral
- feels like a bag of worms
- not tender
- possible palpable abdominal/renal mass
How do you treat each, testicular tumour, epididymal cyst, adult hydrocele, varicocele and inguinal-scrotal hernia?
- Tumour - inguinal orchidectomy
- Cyst - reassure, excise if large
- hydrocele - if normal on USS, reassure, surgical removal if large/symptomatic
- varicocele - reassure, radiological embolisation if symptomatic, infertile, in adolescence
- hernia - surgery (emergency if strangulated)
What is urinary retention?
Inability to pass urine, common in males
What are the causes of urinary retention in males?
- prostatic enlargement - BPH, cancer
- phimosis/urethral stricture/meatal stenosis
- constipation
- UTI
- drugs - anticholinergics
- over-distention
- post-surgery
- neurological
What are the 3 types of urinary retention and how do you treat each?
- Acute (painful) - trial with catheter after addressing cause of retention
- Chronic (painless/less painful) - learn to self catheterise
- Acute on chronic (painful) - trial without catheter, long term catheter or surgical intervention
What do older men with nocturnal enuresis have until proven otherwise?
Chronic retention with overflow incontinence
What are the two categories of LUTS?
Voiding and storage
What are the symptoms of voiding LUTS?
Hesitancy
Poor flow
Post micturition dribble
Imply bladder outflow obstruction
What are the symptoms of storage LUTS?
Frequency
Urgency
Nocturia
What could cause storage LUTS?
- irritative - bladder infection/inflammation, bladder stone, bladder cancer
- idiopathic or neuropathic (Parkinson’s, MS, stroke) overactive bladder
- Scarred bladder (reduced compliance) - post TB, schistosomiasis infections of pelvic radiotherapy
- polyuria - uncontrolled DM, sleep apnea (increased ANP production so increased urine production)
What could cause voiding LUTS?
- Bladder outflow obstruction - phimosis, urethral stricture, BPH, prostate cancer, lack of coordination between bladder and urinary sphincter (UMN lesion)
- Reduced contractility - physical, neurological (LMN lesion)
How do you assess, examine and investigate LUTS?
- international prostate symptom score (IPSS)
- DRE
- palpable bladder?
- neurological exam
- urine dipstick - UTI/blood
- PSA
How is BPH managed in primary care?
- Lifestyle - reduce caffeine intake, avoid fizzy drinks, drink no more than 2.5L of water a day
- Alpha blockers - tamsulosin - relaxing smooth muscle in prostate and bladder neck - rapid symptom relief
- 5alpha reductase inhibitors - finasteride - shrink the prostate by androgen deprivation, slower symptom relief, slows progression and reduces retention risk
How is BPH managed in secondary care?
- Flow rate
* Surgery - if failed lifestyle and medical management - transurethral resection of prostate (TURP)
What conditions are men more likely to suffer from?
- men are 67% more likely to die from common cancers
- Twice as likely to suffer complications of diabetes e.g. foot ulcers and are more likely to be overweight/obese
- Poor mental health/suicide rates
- CVD
What are the risk factors for men’s mental health?
- more likely to respond to stress by risk-taking behaviour - alcohol misuse
- relationship breakdown - marriage breakdown more likely to lead men to suicide
- emotional factors - men are less likely to have a positive view on talking therapies
- socio-economic factors - unemployment can sometimes hit men harder as they’re seen as the breadwinners
- midlife
What are some physical causes of erectile dysfunction?
- diabetes
- atherosclerosis
- smoking
- regular heaving alcohol drinking (damage penile nerves, reduce testosterone and increase levels of oestrogen)
- spinal cord injury
- prescribed drugs (for HTN, CVD, depression, PUD and cancer)
- prostate gland surgery/pelvic surgeries
What are some psychological causes of erectile dysfunction?
- stress and anxiety
- depression
- relationship conflicts
- sexual boredom
- unresolved sexual orientation
How do you treat erectile dysfunction?
- oral drugs - viagra (SE: flushing and headaches)
- injection therapy - relaxes blood vessels and muscles allowing increased blood flow
- medicated urethral system for erection (MUSE) - pellet into urethra
- vacuum pumps
- penile implants (permanently rigid or hydraulic action, operated by a valve in scrotom)
- therapy
