Men's Health Flashcards
What is phimosis?
When the foreskin cannot be fully retracted in an adult, physiological phimosis is normal up until adolescence.
What is paraphimosis?
When the foreskin can be retracted but can’t be pulled back over the glans, can cause painful constriction of the glans.
Name some causes of paraphimosis.
- phimosis
- penile cancer
- catheterisation (especially in elderly)
What is balanitis?
Inflammation of the glans, can be caused by phimosis or paraphimosis.
What type of cancer is penile cancer?
Squamous cell carcinoma
State some consequences of phimosis.
- pain, splitting or bleeding on intercourse
- balanitis (inflammation of glans)
- posthitis (inflammation of foreskin)
- balanitis xerotica obliterans (BXO, scarring of foreskin)
- paraphimosis
- penile cancer
- increased risk of STDs due to poor hygeine
- urinary retention
What is smegma?
Sebaceous secretions under the fold of the foreskin.
What strains of the HPV virus increase the risk of penile and cervical cancer?
HPV 16+18
What is balanitis xerotica obliterans?
Scarring of the foreskin, can be caused by phimosis or paraphimosis.
List some reasons for circumcision.
- religious practice
- recurrent balanitis
- phimosis
- recurrent paraphimosis
- penile cancer
- balanitis xerotica obliterans
Name some causes of acute scrotal pain.
- testicular torsion
- ureteric calculi - can get referred pain to the testes
- epididymo-orchitis (inflammation of epididymis and testes)
- trauma
What is Founier’s gangrene?
Rare condition where area of scrotal skin becomes necrotic due to an anaerobic infection - emergency debridement is needed and ABX treatment - can be fatal.
Name some risk factors for epididymo-orchitis.
- STI (especially chlamydia)
- UTI (especially E.coli)
- mumps
- recent catheter insertion
If someone has a scrotal lump that fluctuates and illuminates, what is it likely to be?
Hydrocoele, collection of fluid in the tunica vaginalis.
If someone has a scrotal lump that you can’t get above, what is it likely to be?
Inguinal hernia
What is the lymphatic drainage of the testes?
Para-aortic lymph nodes
What is the treatment for a cryptorchid/undescended testicle?
Orchiopexy - moves the undescended testicle down into the scrotum and fixes it.
Name 3 tumour markers for testicular cancer.
- beta hcg
- alpha fetoprotein (AFP)
- lactate dehydrogenase (LDH)
What is hydrocoele?
Swelling of scrotum unilaterally or bilaterally due to collection of fluid in the tunica vaginalis, caused by imbalance of fluid production and resorption.
What is varicocoele? Which side is it more common?
Scrotal swelling due to enlargement of the pampiniform plexus in the scrotum, caused by venous blockage higher up.
It is more common on the left side due to longer venous drainage (testicular vein drains into left renal vein).
What is an inguino-scrotal hernia?
When part of the intestines descend down through the embryological remnant of the gubernaculum.
What is urinary retention?
Inability to pass urine.
What is nocturnal enuresis?
Bed wetting at night, commoner in older men who have chronic retention and overflow incontinence.
Name the 4 types of urinary incontinence.
- urge
- stress
- mixed
- overflow
What is the difference between acute and chronic urinary retention?
Acute - painful, no kidney insult, residual volume <1000ml
Chronic - less painful, kidney insult, residual volume >300ml
What is acute-on-chronic urinary retention?
When someone with chronic urinary retention suddenly develops acute urinary retention, can be painful and may have kidney insult, residual volume >1000ml.
List some causes of urinary retention.
- prostatic enlargement e.g. BPH or cancer
- phimosis/urethral strictures/meatal stenosis
- UTIs
- neurological
- drugs e.g. Anticholinergic drugs calm the bladder
- over-distension due to too many fluids
What are male LUTS (lower urinary tract symptoms)?
Can be:
- voiding - hesitancy, dribbling, poor flow
- storage - frequency, urgency, nocturia
What examinations would you do for male LUTS?
- DRE
- neurological examination is suggestive history
- dipstick - check for UTIs
- PSA test
What is the international prostate symptom score (IPSS)?
Score used to assess male LUTS.
Name some causes of male LUTS.
- obstruction e.g. Phimosis, urethral stricture, enlarge prostate
- neurological e.g. UMN lesion or LMN lesion
- increased smooth muscle tone at alpha-1 receptors
Name 2 drugs that can be given for management of male LUTS.
1) alpha blockers e.g. Tamsulosin
2) 5-alpha reductase inhibitors (5ARIs) e.g. Finasteride, dutasteride
What is the MOA of alpha blockers? What are some side effects?
- relax smooth muscle sphincter mediated by alpha-1
- side effects: postural hypotension, nausea, oedema
What is the MOA of 5ARIs and are there any side effects?
- given for enlarged prostate
- block dihydrotestosterone, blocking testosterone production and shrinking prostate
- side effects: reduced libido
What is a TURP and when would it be done?
Transurethral resection of the prostate, surgical procedure that can help male LUTS, especially problems with voiding.
What is the biggest cause of death in men under 45?
Suicide
Name some causes of erectile dysfunction.
- physical e.g. Diabetes, atherosclerosis, smoking, cycling
- psychosexual e.g. Stress, anxiety, guilt, loss of sex drive, relationship problems
- prostate surgery
- drugs e.g. Those used for hypertension, CVD, depression
- regular heavy drinking
Name some treatments for erectile dysfunction.
- oral drugs
- injected therapies
- vacuum pumps
- penile implants
- MUSE (pellet inserted into urethra)
