Men's Health Flashcards
Epididymoorchitis
Treatment (no STI/not sexually active)
Treat like prostatitis
Trimethoprim 300mg nocte 14 days
or cephalexin 500mg Q6H for 14 days
Epididymoorchitis
Treatment (sexually active)
Treat like STI
Ceftriaxone 500mg in 2mL 1% lignocaine IM
PLUS
1g Azithromycin oral STAT
PLUS
1g Azithromycin 7 days later
OR Doxy 100mg BD for 7 days instead of azithro
Steps for genital exam (male)
- Vitals
- Inspection: Size, swelling, skin, colour, discharge)
- Herniae and groin (LN)
- Scrotum (varico/hydrocoele)
- Testes& epi (size, lie, tenderness, lumps) prehns sign
- DRE
- CREMASTERIC REFLEX!!
DDX for Epididmyoorchitis or testicular pain
Epididymoorchitis
Torsion
Prostatitis
Hernia
Varicocoele, hydrocoele
Mumps orchitis (7-10 days post infection)
Overactive bladder conservative management
- Bladder retraining
- Pelvic floor physiotherapy
- Reduce caffeine
- Reduce risk factors: etOH, obesity, spicy foods, bladder stones
Overactive bladder pharmacological management (specifics) 3 options
Oxybutynin 5mg TDS
non selective anticholinergic
Solifenacin 5-10mg daily
Selective anticholinergic
Mirabegnon 25-50mg daily
Beta 3 agonist
Contraindication for Oxybutynin
Glaucoma
Minimally invasive options for detrusor overactivity (specialist level)
Botox A
Sacral nerve stimulation
Peripheral tibial nerve stimulation
DDX for overactive bladder
UTI
Cancer
urolithiasis
Neurogenic cause: MS, Diabetic neuropathy
OSA
outlet obstruction
CCF, DM polyuria
Risk factors for overactive bladder (modifiable and non modifiable)
Modifiable
- etOH
- Caffeine
- obesity
- smoking
- spicy food
NON modifiable
- Female
- age
- POP
- BPH-
- Post menopausal
Macroscopic haematuria managment and investigations
- CT IVP (gold standard) or US KUB in low risk <50
- referral for cystoscopy
- Cytology x3
Microscopic haematuria with UTI
Repeat urine test in 6 weeks
Microscopic haematuria - when to consider for further evaluation
- > 50
- Smoker
- occupational exposure: benzene, dyes, amines
- cyclophosphamide
- pelvic irradiation
- irritative LUTS
- recurrent UTIs
IF these then refer for:
CT IVP
Cystoscopy
Cytology
IF NONE of these then repeat urine in 6 months
Urine cytology collection
Morning
3 consecutive days
3 samples
Causes of haematuria
TIP think top down
- IgA nephritis
- pyelonephritis
- Renal Stones
- Renal cell carcinoma
- Urothelial carcinoma
- Bladder stones
- Cystitis
- BPH
- Caruncle
Other: exercise, trauma, POP, vaginal atrophy
LUTS causes
Cystitis
BPH
Stones
Overactive bladder syndrome
Urothelial carcinoma
Diabetes- polyuria
Stricture
Phimosis
Vaginal atrophy
BPH investigations
US KUB (hydronephrosis and size of prostate)
Urine MCS/urinalysis (haematuria
EUCs
Consider PSA
Consider cytology
Non pharmacological management of BPH
Reduce Caffeine
Reduce spice
Reduce evening fluids
Reduce constipation
Bladder retraining
BPH pharmacology
Tamsulosin 400microg daily
Silodosin
(alpha blocker)
Prazosin 0.5 to 2 mg orally, BD
Dutasteride 500microg daily
Finasteride
(5alpha reductase inhibitor)
GOOD IF >40mL prostate
Can take moths to get max benefit
Sildenafil
(phosphodiasterase 5 inhibitors)
(less common)
Dose of tamsulosin for BPH
Dose of dutaseride for BPH
400mcg daily
500mcg daily