Men's health Flashcards
Treatment for bacterial prostatitis
Trimethoprim/sulfamethoxazole (TMP/SMX) 160 mg/800 mg by mouth twice daily x 10-14 days
Paraphimosis
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
Priapism
prolonged and painful erection for several hours (≥2–4 hours) that is not associated with sexual stimulation or desire
Urologic emergency
Testicular Torsion
Abrupt onset of an extremely painful and swollen, occasionally red scrotum, usually <12 hours in duration. Lack of cremasteric reflex.
Urological emergency
Torsion of the Appendix Testis
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.
Cryptorchidism
Undescended testis
Epididymis
storage area for immature sperm
Acute Bacterial Prostatitis
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.
S/S of acute bacterial prostatitis
- 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.
Treatment for bacterial prostatitis
Fluoroquinolone (e.g., ciprofloxacin 500 mg PO BID) or trimethoprim-sulfamethoxazole (one double-strength tablet PO BID).
Acute Epididymitis
A condition that causes pain, swelling, and inflammation of the epididymis,
S/S acute epidiymitis
- 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
Treatment for acute epididimitys
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
Balantitis
Candidal infection of the glans penis
s/s balantitis
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.
Treatment for balantitis
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.
Lifestyle modifications for BPH
- reduction of caffeine and alcohol intake
- avoidance of fluids before bedtime, and diuretic medications
Treatment for BPH
5-alpha-reductase inhibitors such as finasteride (Proscar). Duration is usually 6 to 12 months before prostate size is sufficiently reduced to improve symptoms.
Chronic Bacterial Prostatitis
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
Treatment for chronic bacterial prostatitis
ciprofloxacin (Cipro) 500 mg PO BID
Cryptorchidism
Testicle that does not descend spontaneously by age 4 months.
Chronic vs acute prostatitis
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).
Hydrocele
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.
Peyronie’s Disease
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
Phimosis
foreskin unable to be retracted due to swelling
Refer to urologist.
Paraphimosis
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.
Findings for prostate CA
- 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
Spermatocele
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.
Spermatocele treatment
Only treat if they cause pain, discomfort, or embarrassment (surgical excision).
An ultrasound is the imaging test of choice.
Testicular Cancer
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.
Diagnostics for testicular cancer
US & biopsy
Refer to urologist for biopsy and management or surgical removal (orchiectomy).
Testicular torsion
Twisting of the spermatic chord which cuts off blood supply to the testicle. May occur after injury or spontaneously.
Varicocele
Varicose veins in scrotal sac (feels like “bag of worms”
Volume reduces when patient is supine as fluid drains out.
Management of varicocele
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.
In a male with BPH and hypertension what medication should be prescribed
Alpha-blocker to concomitantly treat blood pressure (e.g., terazosin, doxazosin) first. Works by relaxing smooth muscles on prostate gland and bladder neck.
Treatment for gonorrhea
Ceftriaxone
Treatment for chlamydia
Doxycycline
