Men's Health Flashcards
What would an enlarged, warm, boggy prostate on exam indicate?
Acute prostatitis
what are the most common pathogens for acute prostatitis?
Older patients –> E. Coli (typically)
Younger patients –>Typicall from STI (chlamydia, trichomonas vaginalis, N. gonorrhea)
Why do we NOT do a DRE during suspected acute prostatitis?
Pain + Translocation of bacteria to urethra
What is the treatment for Prostatitis?
Bactrim (TMP/Sulfamethoxazole)
Fluroquinolone (Levofloxacin or Ciprofloxacin)
Doxycycline 100mg BID - Gonorrhoea coverage
Azithromycin 1g weekly x 4 weeks if chlamydial prostatitis suspected
which medication is the first line treatment for chronic bacterial prostatitis (CBP)
Sulfamethoxazole/trimethoprim (bactrim DS) 1 tab BID x 4-12 weeks
Prolonged ABX needed b/c prostate absorbs ABX poorly. 4-12 weeks REQUIRED
Other options:
Fluroquinolong (Levo) 500mg daily x 4-6 weeks
Macrolide
tetracycline (Doxycycline)
what symptoms would you see in prostatitis?
Back pain
boggy and tender prostate
perineum pain
pain of defecation/ejaculation
What are the assessment findings for epididymis?
Gradual development of unilateral scrotal pain, over a FEW days
- positive prehn sign (lift scrotum, if pain relief = positive sign) - helps differentiate epididymis vs testicular torsion
what is the treatment for epididymis?
Doxycycline & Ceftriaxone
how to differentiate epididymis vs testicular torsion
if testicular torsion present then there is ABSENT cremasteric reflex & Negative prehns sign
what is the cause of erectile dysfunction in older men?
- Low testosterone
- drug induced (antihypertensives, antidepressants, antipsychotics, antiandrogens, recretational drugs, pain medications, anticholinergic)
**AGING IS NOT a cause for ED
what is a hydrocele and how does it form?
its a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum
assessment findings for hydrocele?
Enlarged scrotum
typically unilateral
PAINLESS & SOFT
+ transillumination
which medications shrink the prostate?
5-Alpha reductase inhibitors - inhibit conversion of testosterone to DHT
ex: Dutasteride (Avodart) & Finasteride (proscar)
SE: Sexual dysfunction
Need to use for 6-12 months for maximum efficacy
a 45 year old male has one testicle that is larger than the other, nontender. what do you suspect?
hydrocele
what is the purpose of alpha adrenergic blockers in BPH?
“-Sin”
causes relaxation of smooth muscle in the prostate and neck of the bladder
Ex: Doxazosin, Terazosin, Tamulosin, Alfuzosin
Describe lesion seen in penile cancer
Solid, Firm, nontender lesion or nodule
Presentation of testicular torsion
Sudden, severe, unilateral testicular pain
what is usually associated with testicular cancer?
cryptochidism
Alpha 1 Adrenergic Antagonist
Med examples/MOA
(“-sin” / “It would be a SIN to not treat their symptoms)
Ex: Tamsulosin
MOA- inhibit smooth muscle retraction –reduces symptoms
Can affect BP since it blocks Alpha 1 adrenergic receptors causes blood vessels to dilate
What meds classe/examples do you avoid in patients with BPH?
- Antihistamines (Benadryl or Tylenol PM which contains diphenhydramine)
- nasal decongestants (Pseudoephedrine)
- tricyclic antidepressants (Amtriptyline)
**these will promote urinary rentention & excacerbate symptoms
How long do we treat acute prostatitis? Why?
4-6 weeks
Limited blood flow to prostate so takes awhile for abx to work against infection
when should the PSA be rechecked in a patient with bacterial prostatits?
4 weeks
50yr old male patient presents with fever, chills, pelvic pain and dysuria. pain with ejaculation or defecation, what do you suspect?
Acute Prostatitis
*UTI significantly less common in men
Common organisms for Acute prostatitis or epididymis in Men <35 yrs old and Men >35yrs old
<35 yr —> STI (Chlamydia/Gonorrhea/Tricohomonas)
> 35yr –> E.coli, enterococci (UTI)
Why do we NOT do a DRE during a suspected acute prostattis?
Translocation of bacteria
What trade job is most at risk for non infectious epidiymitis?
Truck drivers — polonged sitting causes urine reflux into epididymis
S/S of epididymitis
GRADUAL onset dysuria epididymis tender Cremasteric reflex present Prehns sign --> elevation of testicle relieves pain (positive)
S/S of testicular torsion
Sudden SEVERE, UNILATERAL scrotal pain
high riding testicle
LACK of cremasteric reflex
Negative prehns sign (no pain relief with testicle elevation)
Diagnosis for testicular torsion?
Ultrasound ASAP. Medical emergency.
will show reduced blood flow to testicle
Treatment for epididymitis secondary to chlamydia/Gonorrhea
Doxycycline –> tx chlamydia!
Ceftriaxone IM –> tx gonorrhea
Tx for epidiymitis secondary to UTI
Bactrim x 10 days (renal function good)
Cipro 500mg BID - renal adjust
Major risk factor for testicular cancer
cryptorchidism
How will testicular cancer present?
Solid, firm, NON tender, UNILATERAL testicular mass. negative transillumination.
examine both testicles and compare for size, tenderness, symmetry, presence of nodules.
How will a hydrocele present?
Enlarged scrotum
PAINLESS
soft scrotum
+ transillumination
d/t fluid filled scrotum
**Often in conjunciton with inguinal hernia
Name for the location of most inguinal hernia
Hesselbacks triangle
- inguinal ligmaent
- rectus muscle
- epigastric vessel
PDE 5 inhibitors
Ex & use
(-Fil) “Try to fill up the penis with blood”
Sildenafil
Tadalafil
ED medicaitons
Important things regarding for PDE 5 inhibitors
Start low and go slow –> Hypotension
No Nitrates or Alpha blockers
Contraindicated in HF, Recent MI, CVA
Take on empty stomach
