Men's health Flashcards
what is phimosis?
Prepuce (foreskin) cannot be retracted fully as an adult.
*physiological until puberty.
what are some consequences of phimosis?
- poor hygiene and STD incidence.
- pain on intercourse leading to splitting or bleeding.
- Balantis.
- Urinary retention.
- Penile cancer.
what is paraphimosis? and what causes it?
the painful constriction of glans penis by retracted prepuce.
- phimosis, catheterisation (elderly), penile cancer.
how would you treat phimosis?
circumcision!
*beware if elderly and has phimosis and balantis (glans penis inflammation and tightness of prepuce)
how would you treat paraphimosis?
reduction by puncturing holes into oedematous foreskin, or dorsal slit.
what are the risk factors for squamous cell carcinoma?
- phimosis.
- hygiene.
- smegma.
- HPV 16 & 18
what are the key indications for circumscision?
- paediatric: religious or recurrent balantis/ UTIs.
- adults: recurrent balantis, phimosis, recurrent paraphimosis, penile cancer, BXO.
how would testicular torsion present?
- younger patient with unilateral pain with nausea and vomiting and to lower urinary tract symptoms.
- very tender and lying high in scrotum with horizontal line of examination.
EMERGENCY SCROTAL EXPLORATION without wasting time on USS etc.
what in a patients history could suggest epididymo-orchitis?
- gradual onset, unilateral.
- with recent history of UTI, unprotected intercourse, catheter or urethral instrumentation, mumps.
how would epididymo-orchitis present on examination?
- pyrexial, septic possibly.
- erythematous scrotum.
- testis. epididymis enlarged and tender.
- rarely necrotic.
- investigate with bloods for sepsis, urine mid stream, radiology for abscess.
- treat antibiotics, drain also if abscess, gangrene debridement also.
what could a painless scrotal lump suggest as opposed to a painful one?
- painless: testis tumour, epididymal cyst, hydrocele or varicocele aches at end of day.
- pain: epididymitis, epididymo-orchitis, strangulated inguino-scrotal hernia.
how would testicular tumour present?
- painless.
- germ cell tumours (seminoma/ teratoma) in 45yr men with history of undescended testes.
- older men could be lymphoma.
- on examination testis body abnormal (firm and hard) and ‘can get above testes’.
- urology checks for tumour markers, USS.
- treatment - inguinal orchidectomy.
how would hydrocele present?
(caused by imbalance of fluid production and resorption between tunica albuginea and vaginalis).
slow/ sudden onset, uni/bilateral scrotal swelling.
on examination testis not palpable separately, can usually above, transilluminates.
*treated with reassurance if normal testes, surgical removal if large and symptomatic.
how would an epididymal cyst present?
- painless.
- separate from testis, can get above mass, transilluminates.
*treated with reassurance or excision if large.
how would a varicocele present?
- dull ache, end of day.
- left more than right, associated with reduced fertility esp. in bilateral.
- on examination bag of worms above testes, NOT tender, palpable abdo/renal mass.
*reassure, radiological embolisation if symtomatic, infertile, adolescent.
how would you treat an inguino-scrotal hernia?
surgery if strangulated especially.
what causes urinary retention in males?
- prostatic enlargement in BPH, cancer.
- phimosis/ stenosis/ stricture.
- constipation, UTI.
- drugs like anti-choligernics.
- neurological.
how would you treat acute/ chronic retention?
- acute painful: drain with catheter, trial without catheter addressing cause first.
- chronic painless: abdo swelling, kidney insult could cause, learn to self-catheterise.
- if painful and trial without catheter wont work then long term catheter or surgical intervention.
what could cause LUT other than prostate?
- irritative infections or inflammations.
- overactive bladder idiopathic or neuropathic like MS.
- low compliance in scarring like post TB.
- polyuria.
what could cause voiding symtoms?
- obstruction physical like in urethra or prostate, dynamic in bladder neck or prostate or neurological loss of sphincter coordination in upper motor lesion.
- reduced contractility lower motor lesion.
how would LUT present?
- examination: DRE, bladder palpable, neurological?
- investigations: dipstick, PSA
LUT inteventions?
- lifestyle: reduce caffeine, avoid fizzy, don’t drink more than 2.5L.
- alpha blockers like tamsulosin to relax smooth muscle.
- 5ARI’s to shrink prostate via androgen deprivation like finasteride.
- BPH: TURP if above fails.
