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ICA > Men's Health > Flashcards

Men's Health Flashcards

1
Q

What is phimosis?

A

When the prepuce of the penis can’t be fully retracted

It can be physiological for up to 17 years of age

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2
Q

What are the risks of phimosis?

A
  • 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
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3
Q

What is paraphimos

A

painful constriction of the glans penis by the retracted prepuce proximal to the corona

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4
Q

What are the 3 common causes of paraphimosis?

A
  • phimosis
  • catheterisation
  • penile cancer
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5
Q

What are the best treatments for phimosis and paraphimosis?

A

Phimosis - circumcision, think about any other possible pathologies associated

Paraphimosis - reduction - manually with local anaesthetic, sometimes need a dorsal slit as well

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6
Q

What type of cancer is penile cancer? What are it’s risk factors

A

squamous cell carcinoma

phimosis - hygiene, smegma, HPV 16 and 18

it’s rare

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7
Q

When does circumcision occur?

A
  • paediatric - religious, recurrent balanitis/UTIs

* adulthood - recurrent balanitis, phimosis, recurrent paraphimosis, balanitis xerotica obliterans, penile cancer

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8
Q

What are the causes of acute scrotal pain?

A
  • testicular torsion
  • epidiymitis/orchitis/epididymo-orchitis - UTI/STI/mumps
  • torsion of hydatid of Morgagni
  • trauma
  • ureteric calculi (rare)
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9
Q

What is the history of someone with testicular torsion? What about on examination?

A
  • younger (under 30)
  • sudden onset
  • unilateral pain
  • nausea/vomit
  • no LUTS
  • tender testis
  • lying high in scrotum with horizontal lie
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10
Q

Treatment of testicular torsion?

A

Emergency scrotal exploration - don’t waste time on USS, etc

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11
Q

What is the history, examination and investigations found with epididymo-orchitis?

A
  • 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
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12
Q

What is the treatment for epididymo-orchitis?

A

Antibiotics

Surgical drainage and antibiotics if with an abscess and emergency debridement and antibiotics if Fournier’s gangrene

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13
Q

What are the key questions of ask about the hx and ex of someone with a scrotal lump?

A
  • 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?
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14
Q

What are some possible causes with a painless scrotal lump?

A
  • testis tumour
  • epididymal cyst
  • hydrocele
  • reducible inguino-scrotal hernia
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15
Q

What is the possible cause of a painless scrotal lump that aches at the end of the day?

A

Varicocele

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16
Q

What are the possible causes of a painful/tender scrotal lump?

A
  • epididymitis
  • epididymo-orchitis
  • strangulated inguino-scrotal hernia
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17
Q

What are the common types of testicular tumours?

A

Germ cell (seminoma/teratoma) in under 45 year olds and lymphoma in older men

18
Q

How do you examine/investigate a testicular tumour?

A
  • lump in body of testis, can get above it

Refer to urology (2 week wait)

  • USS
  • tumour markers - aFP, hCG and LDH
19
Q

How does a hydrocele present in an adult?

A
  • slow or sudden onset
  • uni or bilateral scrotal swelling
  • can get above swelling
  • testis not palpable separately
  • transilluminates
20
Q

What causes a hydrocele?

A

Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis

21
Q

How does an epididymal cyst present on examination?

A
  • separate from testis
  • can get above the mass
  • transilluminates
22
Q

Hows do varicocele’s present?

A
  • 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
23
Q

How do you treat each, testicular tumour, epididymal cyst, adult hydrocele, varicocele and inguinal-scrotal hernia?

A
  • 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)
24
Q

What is urinary retention?

A

Inability to pass urine, common in males

25
Q

What are the causes of urinary retention in males?

A
  • prostatic enlargement - BPH, cancer
  • phimosis/urethral stricture/meatal stenosis
  • constipation
  • UTI
  • drugs - anticholinergics
  • over-distention
  • post-surgery
  • neurological
26
Q

What are the 3 types of urinary retention and how do you treat each?

A
  • 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
27
Q

What do older men with nocturnal enuresis have until proven otherwise?

A

Chronic retention with overflow incontinence

28
Q

What are the two categories of LUTS?

A

Voiding and storage

29
Q

What are the symptoms of voiding LUTS?

A

Hesitancy
Poor flow
Post micturition dribble

Imply bladder outflow obstruction

30
Q

What are the symptoms of storage LUTS?

A

Frequency
Urgency
Nocturia

31
Q

What could cause storage LUTS?

A
  • 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)
32
Q

What could cause voiding LUTS?

A
  • 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)
33
Q

How do you assess, examine and investigate LUTS?

A
  • international prostate symptom score (IPSS)
  • DRE
  • palpable bladder?
  • neurological exam
  • urine dipstick - UTI/blood
  • PSA
34
Q

How is BPH managed in primary care?

A
  • 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
35
Q

How is BPH managed in secondary care?

A
  • Flow rate

* Surgery - if failed lifestyle and medical management - transurethral resection of prostate (TURP)

36
Q

What conditions are men more likely to suffer from?

A
  • 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
37
Q

What are the risk factors for men’s mental health?

A
  • 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
38
Q

What are some physical causes of erectile dysfunction?

A
  • 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
39
Q

What are some psychological causes of erectile dysfunction?

A
  • stress and anxiety
  • depression
  • relationship conflicts
  • sexual boredom
  • unresolved sexual orientation
40
Q

How do you treat erectile dysfunction?

A
  • 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

ICA (7 decks)

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