Men's health

Question 1

Treatment for bacterial prostatitis

Answer 1

Trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg by mouth twice daily x 10-14 days​

Question 2

Paraphimosis

Answer 2

the foreskin cannot be returned back to its original position because of swelling of the head (glans) of the penis

This is a urologic emergency

Question 3

Priapism

Answer 3

prolonged and painful erection for several hours (≥2–4 hours) that is not associated with sexual stimulation or desire

Urologic emergency

Question 4

Testicular Torsion

Answer 4

Abrupt onset of an extremely painful and swollen, occasionally red scrotum, usually <12 hours in duration. Lack of cremasteric reflex.

Urological emergency

Question 5

Torsion of the Appendix Testis

Answer 5

Abrupt onset of a blue-colored round mass located on the testicular surface. The mass resembles a “blue dot.”

The appendix testis is a round, small (0.03 cm), pedunculated polyp-like structure that is attached to the testicular surface (on the anterior superior area).

The blue dot is caused by infarction and necrosis of the appendix testis due to torsion. Cremasteric reflex is present.

Question 6

Cryptorchidism

Answer 6

Undescended testis

Question 7

Epididymis

Answer 7

storage area for immature sperm

Question 8

Acute Bacterial Prostatitis

Answer 8

Acute infection of the prostate, usually caused by gram-negative organisms. Infection ascends via the urethra with often concomitant infection of the bladder or epididymis.

Question 9

S/S of acute bacterial prostatitis

Answer 9

• fever and chills
• suprapubic and/or perineal pain which may radiate to back and rectum
• accompanied by urinary tract infection (UTI) symptoms such as dysuria, frequency, and nocturia with cloudy urine.

Digital rectal exam (DRE) reveals extremely tender prostate that is warm and boggy. The patient may have an accompanying infection of the bladder (cystitis) or epididymitis.

Question 10

Treatment for bacterial prostatitis

Answer 10

Fluoroquinolone (e.g., ciprofloxacin 500 mg PO BID) or trimethoprim-sulfamethoxazole (one double-strength tablet PO BID).

Question 11

Acute Epididymitis

Answer 11

A condition that causes pain, swelling, and inflammation of the epididymis,

Question 12

S/S acute epidiymitis

Answer 12

• Acute onset of a swollen, red , painful scrotum
• unilateral testicular tenderness with urethral discharge.
• Scrotum is swollen and erythematous with induration of the posterior epididymis.
  Sometimes accompanied by a hydrocele and signs and symptoms of UTI. May have systemic symptoms such as fever.

Positive Prehn’s sign: Relief of pain with scrotal elevation

Cremasteric reflex: Positive

Question 13

Treatment for acute epididimitys

Answer 13

Fluoroquinolone (e.g., levofloxacin 500 mg PO daily × 10 days) or trimethoprim-sulfamethoxazole (one double-strength tablet PO BID × 10 days).

Treat pain with NSAIDs (ibuprofen, naproxen) or acetaminophen with codeine (for severe pain)

Scrotal elevation and scrotal ice packs; bedrest for few days
Stool softeners (e.g., docusate sodium [Colace]) if constipated

Refer to ED if septic, severe intractable pain, abscessed, and so forth

Question 14

Balantitis

Answer 14

Candidal infection of the glans penis

Question 15

s/s balantitis

Answer 15

Redness, pain, tenderness, or pruritis of the glans and/or foreskin that develops over 3 to 7 days. Physical exam of penis will show redness and shallow ulcers with curd-like discharge on the glans penis.

Question 16

Treatment for balantitis

Answer 16

Cleanse with saline solution BID.

(OTC) azole creams such as clotrimazole 1% or miconazole 2% BID for 7 to 14 days may be needed.

If partner has candidiasis, treat at the same time.

Question 17

Lifestyle modifications for BPH

Answer 17

• reduction of caffeine and alcohol intake
• avoidance of fluids before bedtime, and diuretic medications

Question 18

Treatment for BPH

Answer 18

5-alpha-reductase inhibitors such as finasteride (Proscar). Duration is usually 6 to 12 months before prostate size is sufficiently reduced to improve symptoms.

Question 19

Chronic Bacterial Prostatitis

Answer 19

Chronic (>6 weeks) or recurrent bacterial infection of the prostate

s/s dysuria, nocturia, and frequency, low grade fever, bladder irritation, bladder outlet obstruction, blood in semen

Question 20

Treatment for chronic bacterial prostatitis

Answer 20

ciprofloxacin (Cipro) 500 mg PO BID

Question 21

Cryptorchidism

Answer 21

Testicle that does not descend spontaneously by age 4 months.

Question 22

Chronic vs acute prostatitis

Answer 22

Chronic prostatitis is of gradual onset; prostate can feel normal with DRE (older males).
Acute prostatitis presents as sudden onset; prostate is swollen and very tender (often younger males).

Question 23

Hydrocele

Answer 23

Serous fluid collects inside the tunica vaginalis. During scrotal exam, hydroceles are located superior and anterior to the testes. Generally asymptomatic. Doppler ultrasound to rule out tumor, testicular hematoma, rupture, testicular torsion, orchitis, or epididymitis. Refer to urologist.

Question 24

Peyronie’s Disease

Answer 24

inflammatory and localized disorder of the penis that results in fibrotic plaques on the tunica albuginea. Results in penile pain that primarily occurs during erection; palpable nodules and penile deformity (crooked penile erections) occur

May require surgical correction

Question 25

Phimosis

Answer 25

foreskin unable to be retracted due to swelling

Refer to urologist.

Question 26

Paraphimosis

Answer 26

The foreskin cannot be returned back to its original position because of swelling of the head (glans) of the penis.

The glans is swollen, reddened, and painful. The highest incidence is among uncircumcised infants and toddlers.

Requires emergency treatment because it may cause ischemic changes. A small slit in the foreskin (with topical anesthesia) can help relieve the pressure. In severe cases, a circumcision may be needed. Paraphimosis is considered a urologic emergency.

Question 27

Findings for prostate CA

Answer 27

• Painless and hard fixed nodule
• Elevated PSA of >4.0 ng/mL
• Diagnostic test is biopsy of prostatic tissue (obtained by transurethral ultrasound)
• refer to urology for management

Question 28

Spermatocele

Answer 28

A fluid-filled cyst that contains nonviable sperm.

Will transilluminate.

separate smooth and firm lump at the head of the epididymis, which lies above and behind each testicle.

Question 29

Spermatocele treatment

Answer 29

Only treat if they cause pain, discomfort, or embarrassment (surgical excision).

An ultrasound is the imaging test of choice.

Question 30

Testicular Cancer

Answer 30

Painless testicular mass, sensation of heaviness or aching, one larger testicle, or tenderness in one testicle.

May present as a new onset of a hydrocele (from tumor pressing on vessels). Usually painless and asymptomatic until metastasis

Affected testicle feels heavier and more solid.

Question 31

Diagnostics for testicular cancer

Answer 31

US & biopsy

Refer to urologist for biopsy and management or surgical removal (orchiectomy).

Question 32

Testicular torsion

Answer 32

Twisting of the spermatic chord which cuts off blood supply to the testicle. May occur after injury or spontaneously.

Question 33

Varicocele

Answer 33

Varicose veins in scrotal sac (feels like “bag of worms”

Volume reduces when patient is supine as fluid drains out.

Question 34

Management of varicocele

Answer 34

Order an ultrasound of the scrotum. Can contribute to male infertility if large enough (increases temperature of affected testicle).

Treatment is surgical removal of varicosities if infertile. Most benign varicoceles are left sided.

Question 35

In a male with BPH and hypertension what medication should be prescribed

Answer 35

Alpha-blocker to concomitantly treat blood pressure (e.g., terazosin, doxazosin) first. Works by relaxing smooth muscles on prostate gland and bladder neck.

Question 36

Treatment for gonorrhea

Answer 36

Ceftriaxone

Question 37

Treatment for chlamydia

Answer 37

Doxycycline