Men's health Flashcards
Causes of haematospermia
Infection (prostatitis, urethritis, epididymo-orchitis - including TB and schisto)
Iatrogenic (post biopsty, vasectomy, orchidectomy, RTx)
Malignancy (prostate, bladder, testicular, urethral)
Trauma (coital, perineal)
Prolonged abstinence
Obstruction (ductal, cysts, calculi)
Systemic disorders (HTN, liver disease, lymphoma, leukaemia, amyloid, coagulopathies)
Idiopathic
Red flags for haematospermia
Patient >40y
Recurrent or persistent haematospermia
Prostate cancer risk factors (family history, African heritage)
Constitutional symptoms (weight loss, anorexia, bone pain)
How long after a prostate biopsy will it take for haematospermia to resolve?
approx 20 ejaculations
How to investigate haematospermia in presence of haematuria
As per haematuria work up
- urine cytology
- CT IV pyelogram
- Cystoscopy
Examination required in work up for haematospermia
BP ?severe hypertension
Temp
Genital examination (penis, urethral meatus, testes, epididymis and spermatic cord) for masses, tenderness or superficial lesions
DRE ?prostatitis or prostate Ca
Investigations for patients with haematospermia
ALL patients:
- urine MCS
- urine cytology
- CBE and coagulation studies
As indicated:
- Chlamydia/gonorrhoea NAAT
- PSA if abnormal DRE, >40y or high risk
- urine and semen acid-fast bacilli OR parasites if suspect TB or schistosomiasis
When to refer patients with haematospermia to urology
Men >40y
Persistent or recurrent haematospermia
Suspicious DRE findings
Abnormal PSA results
Suspicion of prostate, bladder, testicular or urethral malignancy on history, examination or investigations
Concurrent haematuria
Haematospermia continues despite treatment for suspected cause
Prevalence of erectile dysfunction
20% of men >40yo
only 30% of these will discuss the issue with their GP
Risk factors for erectile dyfunction
Advanced age
Atherosclerosis risk factors (smoking, HTN, CVD, Lipids, DM)
Neuro conditions (MS, PD, AD, CVA, Spinal cord disorders, peripheral nerve disorders e.g. diabetic neuropathy)
Pelvic surgery (e.g. prostatectomy), radiation or trauma
Endocrinology (hypogonadism, hyperprolactinaemia, hyperthyroidism)
Obesity and metabolic syndrome
Sleep apnoea
Penile abnormalities
Psychological and psychiatric conditions (GAD, MDD, psychosis, partner-related stress/guilt, low self esteem, prior sexual abuse)
medications (antihypertensives, psychotropic medications, anticonvulsants, anti-Parkinson’s, anti-antrogens, steroids, chronic opioids)
Substance abuse (alcohol, illicit drugs)
Important info to ascertain on history of erectile dysfunction
Onset Spontaneous morning erections Is penetration possible Maintenance of erection after penetration Penile deformity Penile pain Ejaculation Orgasm
Validated questionnaire to assess baseline male sexual function/erectile function
Sexual Health Inventory of Men
Examination of man presenting with erectile dysfunction
Examination of penis and testes ?Signs of hypoandrogenism CVD: - BP/HR - BMI and wasit circumference - Cardiac examination - carotid bruits, foot pulses Focused neuro examiantion
Investigations in erectile dyfunction
FBG/HbA1c
Morning testosterone
Lipids
If indicated: prolactin, thyroid function, EUC, LFT
First line treatment of erectile dysfunction
CONSERVATIVE
Review medications
Manage androgen deficiency if indicated
Address psychosocial issues (relationship issues, anxiety, stress)
Lifestyle changes: smoking cessation, alcohol reduction, improved diet and exercise, weight loss, stress reduction, illicit drug cessation, compliance with chronic disease management
Discuss importance of sufficient arousal and lubrication
Discuss realistic expectations including normal age-related changes
Common side effects of PDE5 inhibitors
Headaches Flushing Dyspepsia Nasal congestion Backache Myalgia
