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
Bilateral impalpable undescended testes
URGENT REFERRAL to paediatric surgeon
Plus
EUC for hyponatraemia in CAH
Internal genitalia US
Karyotype
Unilateral undescended testes
Routine referral to paediatric surgeon for elective orchidopexy/repair at 6 months
Bilateral undescended BUT palpable testes (with Abnormal genitalia)
URGENT referral
Bilateral BUT palpable testes (with normal genitalia)
Routine referral to paeds surgeon
(no need for US )
Acquired or ascending descended testes.. What to do?
Urgent referral to Paeds surgeon
Retractile testes what to do
Annual review, if when you manipulate them down they stay then continue annual review
OR
if they do not stay post exam then REFER
Age group for retractile testes
2-6 yrs old usually
Age to review undescended testes
3 months (as only 1-2% not descended by then)
Testing for male infertility
Semen analysis
Morning testosterone
FSH
US
If abnormal then add Free testosterone, LH, prolactin and repeat morning testosterone
Counselling for semen analysis
Abstinence 2-3 days
Sample to lab within 1 hr
Abnormal
then repeat 1-3 months
grossly abnormal then 2-4 weeks
Side effects of Alphablockers (eg tamsulosin)
Nasal congestion
Retrograde ejaculation
Hypotension
Tachycardia
Heamatospermia first line investigations
Urine MCS and cytology (plus baseline bloods)
Abnormal semen analysis - where to from here?
- Repeat in specialised andrology lab
- Mildy deranged in the next 3 months
- Very deranged in the next 2-4 weeks
Leukocyte count >1x10^6 in semen analysis next step ?
Needs urine MCS
Male infertility blood tests
FSH and morning testosterone
If abnormal then
Repeat morning, LH and prolactin
Hypogonatotropic hypogonadism: blood pattern
LH low
FSH low
Testosterone Low
Prolactin normal or high
Testicular failure/ hypergonatotrophic hypogonadism: blood pattern
FSH and LH HIGH
testosterone LOW
Prolactin normal
History questions for haematospermia
- Recent urological procedure
- Prolonged masterbastion or intercourse
- Prolonged abstinence
- Pain on ejaculation (prostatits)
- TB
- anticoagulants
Ural cautions
- Reduces efficacy of nitrofurantoin
- Crystalluria with quinolones
Chronic bacterial prostatitis managment
Ciprofloxacin 500mg BD 4 weeks
or trimethorpim 300mg nocte 4 weeks
or norflox 400mg BD 4 weeks
Klinefelter syndrome hormonal findings
Primary hypogonadism:
Low testosterone
Raised LH and FSH
Karyotype 47XXY
Examination findings for erectile dysfunction
- Penile plaques
- Small testicular volume
- Lack of secondary sexual characteristics (lack of body hair)
- Weak peripheral pulses
- Lower limb neuro signs (decreased anal tone)
- Gynaecomastia
Risk factors for erectile dysfunction
- Peyronie’s disease (fibrous plaques)
- Recreational drug use (etOH)
- Age
- CVD and risk factors
- Endocrine: androgen deficiency
- Diabetes
- Medications: BB, antidepressants
- Prostate cancer therapy
First line treatment for erectile dysfunction
Sildenafil 50mg 1hour before sex
Paraphimosis management
- Transfer to emergency department with urology cover
- Anaesthetise penis with penile nerve block
- Apply circumferential pressure to the glans of the penis to disperse oedema (eg gloved hand)
- Intermittent ice to head of the penis
- Aspiration of blood from the head of the penis with a needle
- Apply granulated sugar to the head of the penis
Premature ejaculation pharmacology
Dapoxetine 30mg 1-3 hrs prior to intercourse
OR
Emla cream to glans and shaft 15-30 mins prior
Androgenic Alopecia treatment & side effects
Oral finasteride 1mg daily
OR
Topical minoxidil
(can use combo)
- Impotence
- Loss of libido
- Gynaecomastia
- Infertility
History questions for erectile disfunction
- Rapid onset
- Morning or spontaneous erections
- Sufficient for penetrative intercourse
- Premature ejaculation
- Changes to appearance of penis (peyronie’s )
- Reduced facial hair/gynaecomastia (Andgrogen insufficency)
- Low mood/anhedonia
- ## Inter-partner conflict
Klinefelter hormonal test results:
Low testosterone
HIGH FSH LH
Karyotype 47XXY
Most common adverse outcome of a TURP
Retrograde Ejaculation
Vasectomy counselling
- Permanent nature of procedure
- Need 3 months to be effective
- risk of infection
- risk of haematoma
- risk of failure
- risk of anti-sperm antibody
History questions for male infertility causes:
- Chemotherapy or radiotherapy
- Previous cryptoorchidism (undescended testicle)
- Previous torsion
- Delayed puberty
- Previous genital surgery/ pelvic surgery
- Spinal cord disease
- Erectile dysfunction
- Family history of infertility
- Exogenous testosterone use
