Men's health

Question 1

What is balanitis?

Answer 1

Inflammation of the glans penis
NB: posthitis describes inflammation of the prepuce

Question 2

Describe the presentation of balanitis

Answer 2

History – penile soreness & itch, bleeding from the foreskin, dysuria, difficulty passing urine and/or dyspareunia
Examination – redness & swelling of the glans penis with exudate, tightening of the foreskin, inability to retract the foreskin

Question 3

List differentials of balanitis

Answer 3

Non-specific urethritis
Drug reactions
Erythema multiforme

Question 4

Describe the management of balanitis

Answer 4

Advise the person to clean under the foreskin daily with lukewarm water & dry it gently
Written information & support on NHS & patient.info leaflet
Hydrocortisone creams if dermatitis
Do swabs if doesn’t improve after treatment

Question 5

What is erectile dysfunction?

Answer 5

Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
Complicated disorder with several possible organic and/or psychogenic causes; can also be drug induced

Question 6

Describe management for erectile dysfunction

Answer 6

Arrange referral – urology, endocrinology, cardiology, mental health services
Identify & manage any reversible or modifiable risk factors
Prescribe a PDE-5 inhibitor regardless of suspected cause (eg. sildenafil, tadalafil)
Arrange follow-up 6-8 weeks after initiation of treatment to assess the efficacy and safety of treatment & patient satisfaction

Question 7

Describe acute prostatitis

Answer 7

Severe, potentially life-threatening bacterial infection of the prostate

Question 8

Describe the presentation of acute prostatitis

Answer 8

Suspected in a man presenting with:
1) UTI: dysuria, frequency & urgency
2) Prostatitis: perineal, penile/rectal pain, acute urinary retention, obstructive voiding symptoms
3) Bacteraemia: rigors, arthralgia/myalgia

Question 9

List differential diagnoses of acute prostatitis

Answer 9

BPH
Chronic prostatitis
UTI

Question 10

Describe the management of acute prostatitis

Answer 10

Oral abx treatment: ciprofloxacin 500mg twice daily or ofloxacin 200mg twice daily first line
Take paracetamol for pain
Drink enough fluids to avoid dehydration
Arrange follow up after 48 hours to check man’s response to treatment & urine culture results

Question 11

Describe chronic prostatitis

Answer 11

At least 3 months of urogenital pain (perineal, suprapubic, inguinal, rectal, testicular/penile) & often associated with LUTS and sexual dysfunction

Question 12

List differentials of chronic prostatitis

Answer 12

Acute prostatitis
BPH
Cancer of the prostate, bladder or colon

Question 13

Describe the management of chronic prostatitis

Answer 13

Advice: treatment is more about controlling symptoms rather than effecting an immediate cure
Drugs: paracetamol and/or NSAID for pain-relief, alpha-blocker for 4-6 weeks if significant LUTS are present
Refer to urologist if diagnostic uncertainty, severe symptoms & symptoms persist after initial management

Question 14

List possible causes of scrotal swelling/pain

Answer 14

Testicular torsion
Testicular cancer
SCC of scrotum
Indirect inguinal hernia
Epididymo-orchitis
Haematocele, hydrocele & varicocele

Question 15

What is urethritis?

Answer 15

Inflammation of the urethra is usually caused by a STI
Classified as:
- Gonococcal urethritis
- Non-gonococcal urethritis
- Persistent/recurrent urethritis

Question 16

Describe the common presentation of urethritis

Answer 16

Urethral discharge (may be minimal or copious)
Dysuria
Penile irritation
Balanoposthitis (inflammation of both the glans penis and prepuce)
Urethral discomfort

Question 17

List differentials diagnoses of urethritis

Answer 17

Physiological discharge
Balanitis
Acute prostatitis
Cystitis

Question 18

Describe the management of urethritis

Answer 18

Offer referral to GUM clinical or other local specialist sexual health service for treatment
If above not possible – offer empirical treatment for chlamydial infection (doxycycline twice a day for 7 days), screen for other STIs, urine dipstick

Question 19

What is a varicocele?

Answer 19

Scrotal swelling consisting of a collection of dilated veins of the pampiniform plexus in the spermatic cord
95% occur on the left side (because of the relation of the spermatic vein to the left renal vein -> opens at a sharp angle into LRV)

Question 20

List the clinical features of a varicocele

Answer 20

Painless scrotal swelling on the left side
- ‘bag of worms’ within the spermatic cord above the testis on the left side of the scrotum
Aged > 12 years
Infertility

Question 21

Describe the management of a varicocele

Answer 21

Subclinical or grade I varicocele – no treatment necessary
Grade II or III asymptomatic varicocele & normal semen parameters – observe with semen analysis every 1-2 years
Grade II or III symptomatic varicocele or with abnormal semen parameters – refer to urologist for possible surgery