Men’s Health Flashcards
Testicular Torsion
Can occur from trauma, vigorous physical activity or spontaneously
Presentation:
- Significantly erythematous and tender scrotum
- Pain is typically localized to either the anterior aspect (torsion of the appendix testes) or the pain is described as diffuse
- Affected testicle is higher than unaffected testicle (d/t shortening of the spermatic cord from twisting)
- ABSENT cremasteric reflex
Diagnosis:
- Testicular ultrasound (preferably within 1 hour of presentation)
Treatment:
- Emergent referral to ER
Epididymitis
Inflammation of the epididymis
Presentation:
- Gradual onset of unilateral testicle pain, testicle swelling and tenderness (posterior aspect)
Diagnosis:
- Positive nucleic acid amplification test for gonorrhoeae or chlamydia, a positive urine culture for a UTI or improvement of symptoms as a result of empiric antibiotics
Treatment:
- Sexually active patients who do not practice anal intercourse and no risk factors for UTI:
- Treat for chlamydia and gonorrhea (Rocephin and Doxycycline)
- Patients who practice anal seX:
- Ceftriaxone plus Levofloxacin (recommended to cover enteric pathogens)
- Patients who are not sexually active
- Fluoroquinolone or Bactrim
Perineal Necrotizing Fasciitis
AKA Fournier’s gangrene
Presentation:
- Systemic illness, hemodynamic instability, or rapidly progressing erythema and swelling of the scrotum
Risk Factors:
- Diabetes, urethral trauma, indwelling catheter, immunocompromised
Treatment:
- Urgent surgical or urological evaluation
Hypospadias
- Congenital anomaly of the male urethra, foreskin, and penis that results in abnormal ventral placement of the urethral opening
- Form fruste of hypospadias (incomplete): Mostly mild, no penile curvature present
- Standard hypospadias: Ectopic urethral meats and penile curvature that varies from none to mild or moderate
- Severe hypospadias: Ectopic urethral meats located in the scrotum or perineum, small glans (<14mm at maximal diameter, severe penile curvature)
Diagnosis:
- Typically made on newborn exam
Treatment:
- Routine circumcision is contraindicated
- Indication or urological referral nad surgical correction
- Difficulty urinating
- Inability to urinate while standing
- Erectile dysfunction due to curvature
- Fertility concerns/issues
- Concern for developmental difficulties based on appearance
Hydrocele
Collection of peritoneal fluid in the scrotum
- Non-communicating Hydrocele: Sac closes around the testicle, however, the fluid is not absorbed back into the body.
- Communicating Hydrocele: Sac does not close, fluid can continue to collect causing continuous swelling.
Presentation:
- Asymmetrical testicles, mild tenderness described as “pressure-like”
- Transillumination: Brighter light on the affected side.
Treatment:
- Most resolve by 1 to 2 years of age.
- Surgical repair indicated:
- Communicating Hydrocele that persist beyond 1 to 2 years.
- Idiopathic, non-communicating Hydrocele that are symptomatic or compromise the skin integrity.
Varicocele
- Enlargement of the beings within the scrotum
- 85% to 95% occur on the left side
Presentation:
- Dull/aching pain and atrophy of affected testicle
Diagnosis:
- Scrotum should be palpated while the patient is standing
- Palpation is often described as a “bag of worms”
- Grade 1: Palpable only with valsalva maneuver
- Grade 2: Palpable without valsalva maneuver, not visible
- Grade 3: Visible on gross exam
Treatment:
- Doppler ultrasonography indicated
- Varicocele persists in the supine position, has acute onset or is right-sided
- Refer to urology
- Pain, decreased testicle size, or with large Varicocele.
Testicular Cancer
Accounts for 20% of cancers diagnosed in males ages 15-35 years old.
Risk factors:
- Cryptorchidism, family history of testicular cancer, cancer of other testicle, HIV
Presentation:
- Typically firm, non tender mass
- Does not transilluminate
- Some patients will also experience testicular enlargement, an aching in the lower abdomen or scrotum, gynecomastia
Diagnosis:
- Scrotal ultrasound, radiographic testing (abdomen pelvis and chest to observe for metastasis), serum tumor markers
- Orchiectomy to establish the histologic diagnosis and for definitive treatment of the tumor.
Inguinal hernia
Protrusion of an organ/part of an organ through the muscle or tissue
Presentation:
- Heaviness, discomfort with lifting or straining
- If hernia is incarcerated or strangulated, may see abdominal pain with nausea and vomiting.
Diagnosis:
- Clinical exam (75% sensitivity, 96% specificity)
- US to confirm
Treatment:
- Watch and wait
- Males with asymptomatic or minimally symptomatic inguinal hernias, pregnant patients with uncomplicated inguinal hernias
- Surgical repair
- Incarcerated or strangulated hernias
Benign Prostatic Hyperplasia
Enlarged prostate gland that occurs in all men starting as early as 40 years old.
Presentation:
- Can be asymptomatic, however, can also cause lower urinary tract symptoms such as polyuria, nocturia, urgency, incontinence, slow stream, dribbling and straining to void.
- Symmetrically enlarged, smooth, non-tender prostate.
Diagnosis:
- Presumptive diagnosis of BPH is made in patients with both urinary storage and urinary voiding complaints to and without evidence of another diagnosis causing th symptoms.
- Evaluation should include a urinalysis, a post void residual volume and a DRE.
Treatment:
- Lifestyle modifications
- Avoiding fluids prior to going to bed at night, reducing diuretics including caffeine and alcohol, increasing activity, avoiding constipation, maintaining a healthy weight, timed voiding, pelvic floor muscle training.
- Pharmacotherapy:
- Monotherapy with alpha-1 adrenergic antagonists are first line
- Examples: Tamsulosin, alfuzosin, silodosin, doxazosin, terazosin
Indications for urology referral:
- Severe symptoms or pain, men <45 years old, abnormality on DRE, hematuria, elevated PSA, dysuria, in continence, urinary retention, suspicion of another urologic disease.
Acute Bacterial Prostatitis
- Acute infection of the prostate that typically occurs in young and middle-aged men
- Sexually transmitted pathogens, such as Neisseria Gonorrhoeae and Chlamydia Trachomatis, are possible causes.
Presentation:
- Fevers, chills, dysuria, pelvic or perineal pain and cloudy urine
- Obstructive symptoms such as dribbling of urine
- Prostate is often firm, edematous and exquisitely tender
Diagnosis:
- Typical symptoms of prostatitis and the finding of an edematous and tender prostate on physical exam usually confirms the diagnosis
- Common laboratory findings include peripheral leukocytosis, pyuria and bacteriuria
Treatment:
- Empirical treatment with Trimethorpim-Sulfamethoxazole (Bactrim) or Fluoroquinolones are preferred treatment options
Prostate Cancer
Among the most common cancers in men worldwide
Risk factors:
- BRCA carriers, Lynch syndrome, black males, males with a family history of prostate cancer
Presentation:
- Rarely presents with clinical symptoms
- If symptoms present: Nonspecific lower urinary tract symptoms or more rarely hematuria, hematospermia or bone pain.
Diagnosis:
- PSA value of >4.0 ng/mL is estimated to have a sensitivity of 21% and a specificity of 91% for detecting prostate cancer.
- Requires biopsy for definitive diagnosis
Treatment:
- Any individuals who have clinical suspicion for prostate cancer should be referred to urology.
