Men's Health Flashcards
What is priapism
Prolonged and painful erection for several hours that is not associated with sexual stimulation or desire
The 2 types of priapism are
Ischemic and non-ischemic
What are causes of priapism
- idiopathic
- medications (ie. intracavernosal injections, medications for ED)
- Cocaine
- Quadrapelgia
Does sickle cell increase or decrease risk for priapism
Increase
What is paraphimosis?
-When the foreskin cannot be returned back to iuts original position because of swelling of the head (glans) of the penis
What are sx of paraphimosis
-Red, swollen and painful glans of the penis
Who is at highest risk of paraphimosis
Uncircumcised infants and toddlers
What is the management of paraphimosis
- Refer to ED
- Requires a small slit in the foreskin to relieve pressure or circumcision
- Is a urological emergency
What are sx of testicular cancer
- nodule in the testicle
- sensation of heaviness or aching
- one larger testicle
- tenderness in the testicle
- new onset hydrocele (from tumor pressing on vessels)
- Affected testicle feels heavier and more solid
At what tanner stage does sperm production begin?
Tanner stage IV
Where are sperm produced?
seminiferous tubules of the testes
What is fournier’s gangrene
-rare, rapid progressing polymicrobial necrotizing fasciitis of the external genitalia and perineum
What are risk factors for fournier’s gangrene
- DM
- Trauma to the urethral/penile area
- Use of SGLT2i
What are sx of fournier’s gangrene
-acute severe pain
-redness
-swelling
of perineum
What are sx of testicular torsion?
- abrupt onset of extremely painful and swollen red scrotum
- acute hydrocele
- inguinal pain
- lower abdominal pain
- nausea
- vomiting
- affected testicle sits higher and closer to the body
- blue dot sign
- absent cremasteric reflex
Cryptorchidism increases patient’s risk for
Testicular cancer
Spermatogenesis is stimulated by the following 2 hormones:
Testosterone and follicle stimulating hormone
What is the function of the epididymis
Storage of immature sperm cells
What is the cremasteric reflex
Testicle is elevated towards the body in response to stroking or lightly pinching the ipsilateral inner thigh (thigh that is on the same side as the testicle)
What is the role of transillumination of the scrotum
-useful for evaluating undescended testicles, hydrocele, spermatocele and other scrotal masses
Which will not transilluminate?
a) Hydrocele
b) Variocele
c) Spermatocele
d) Tumors
Varicocele, and tumors
What is the most common tumor in males age 15-30
Testicular
What is the gold standard diagnosis for testicular cancer?
Testicular biopsy
Regarding testicular torsion, permanent testicular damage results if not corrected in ____ hours and the testicle will need to be surgically removed if not corrected in ____ hours
<6 hours and 24 hours
What is the most common cancer in Men?
Prostate
What are risk factors for prostate cancer
- 50 years +
- Black
- Obesity
- 1st degree relative (2x the risk)
What is the current recommendation for Prostate cancer screening
Routine screening is not recommended as studies have shown that absolute risk reduction with screening is minimal
-individualize based on risk and discuss risk with testing (bleeding, infection, impotence, psychological trauma)
What are sx of prostate cancer
- Often asymptomatic
- Painless and hard fixed nodule or indurated area on the prostate gland on an older man that is deteceted by DRE
- frequent urination
- urinary hesitancy
- nocturia
- decreased force of urination
- incomplete emptying
- hematuria
- elevated PSA >4.0ng/mL
What is the diagnostic test for prostate cancer
biopsy via transurethral ultrasound
How should you management urinary symptoms of prostate cancer?
-alpha blockers (terazosin/hytrin)
What are questionnaires to assess the severity of a patient’s BPH sx
- American urological association urinary symptom score
- International prostate symptom score
What are sx of BPH
Gradual onset of urinary obstructive symptoms such as:
- weak stream
- post void driblling
- feelings of incomplete emptying
- urinary retention
- nocturia
PSA is elevated
Prostate is symmetrically enlarged on DRE
What are some lifestyle changes that may decrease symptoms of BPH
- reduce/eliminate caffeine and alcohol
- avoid fluids after dinner before bed
- avoid use of diuretics if possible
What are the first line medications for BPH
Alpha-adrenergic antagonists
- Tamsulosin (flomax)
- Terazosin (Hytrin)
- Doxazosin (cardura)
What medications should be avoided in patients with BPH
- anticholinergics
- sympathomimetics (cause urinary retention)
Besides alpha-adrenergic antagonists, what are medications including herbal remedies can be used in BPH
1) 5-alpha-reductase inhibitors: FInasteride (proscar)
2) Saw-palmetto
What is an adverse effect of alpha blockers
orthostatic hypotension
While on Proscar (Finasteride) the prostate shrinks by ___ %, so in obtaining a PSA on a patient you must ____ the result
50%, double
In a male patient with BPH and hypertension what medication can you consider to help both conditions
Hytrin
What happens to the prostate gland when you stop taking finasteride (proscar)
-Proscar inhibits type 2 5-alpha-reductase (blocks androgen receptor) and acts directly on the prostate gland to shrink it temporally when on the medication, if a patient stops taking the medication the prostate will return to its original size
Proscar is a category ___ drug. Can it be handled by reproductive aged females?
X; NO Teratogenic and adversely affect male fetus
What is chronic bacterial prostatitis
Chronic >6 week infection of the prostate gland