Men's Health Flashcards
Priapism
Long, painful erection
>2-3 hours
People at highest risk for priapism
sickle cell anemia
Risks for priapism
- high doses of ED medication
- cocaine
- quadripelgia
- etc
Which form of priapism is a medical emergency
ischemic
People at risk for testicular cancer
- teenage to young adult (15-30)
- White males
Testicular cancer presentation
- nodule
- sensation of heaviness or aching
- one larger testicle
- tenderness
Prostate cancer presentation
- low back pain
- rectal area/perineal pain
- obstructive voiding symptoms
- may be asymptomatic
Highest risk for prostate cancer
- > 50
- obese
- Black
- family history
Blue dot sign indicates
torsion of appendix testes
Torsion of appendix testes occurs in..
school age
-infarction
Testicular torsion presentation
- acute onset
- affected testicle higher and closer to body
- negative cremasteric reflex
where is sperm produced
seminiferous tubules of testes
cryptochordism increases risk for what
testicular CA
Spermatogenesis is stimulated by
testosterone
FSH
Which testicle usually hangs lower
left hangs lower than right
Function of prostate fluid
- alkaline pH
- helps sperm survive in vagina
Where is immature sperm stored
epididymis
What transports sperm from epididymis to urethra
vas deferens
What structure is clipped during a vasectomy
vas deferens
Where is cremasteric reflex illicted
-stroke ipsilateral inner thigh
What condition with testes will transluminate
-hydrocele
Gold standard for testicular CA
biopsy
Testicular CA treatment plan
- US
- Urology referral for biopsy
When will permanent testicular damage occur with testicular tosion
<6 hours
Is digital rectal exam with PSA (Screening) recommended?
no
Diagnostic test for prostate cancer
biopsy
PSA level for prostate CA
> 4
Prostate CA plan
- Refer to urology if PSA >4
- individualize screening
BPH presentation
- elevated PSA
- prostate is rubbery and enlarged
- gradual urinary obstructive symptoms
Alpha-adrenergic antagonist
Terazosin (Hytrin)
Tamsulosin (Flomax)
5-alpha reductase inhibitors
Finasteride (Proscar)
What herbal remedy may be used for BPH
- saw palmetto
- mild benefit
- not effective for everyone
adverse effect of alpha blockers
orthostatic hypotension
Male with BPH and HTN
- start with alpha-adrenergic antagonist (Flomax)
- relaxes smooth muscles on prostate gland and bladder neck
Mechanism of Finasteride
blocks androgen receptor
- temporarily shrinks prostate
- will return to original size if medication stopped
Chronic bacterial prostatis duration
> 6 months
Organisms that cause chronic bacterial prostatitis
- E.coli
- proteus
Chronic bacterial prostatitis presentation
- elderly
- several weeks of suprapubic or perineal discomfort
- dysuria
- nocturia
- frequency
- no systemic symptoms
Chronic bacterial prostatitis treatment
-Bactrim 4-6 weeks
Screening tool for BPH severity
American Urologic Assessment Prostate Symptom Score
Duration of treatment needed to see 5alpha reductase effects
6-12 months
Which BPH medication works the fastest
-alpha adrenergic antagonists
PDE-5 inhibitor for BPH
Tadalafil (Cialis)
Patient education for alpha-adrenergic antagonists
- take at bedtime
- orthostatic hypotension
- may feel lightheaded in am
Acute prostatitis presentation
-fever
-chills
pain at tip of penis
-enlarged, boggy, tender prostate
-urinary symptoms
-pain with BM
-elevated PSA
Acute prostatitis management
-urine dip with C&S
Acute prostatitis treatment
- Bactrim, cipro, levofloxacin for 6 weeks
- if <35, consider STD’s
- stool softeners
- fluids
- if symptoms do not improve in 2-3 days, refer to urologist
When should prostate cancer screening conversations begin
age 40-45
-screen if at least 10 year life expectancy with PSA alone
PSA value that rules out prostate CA
none
Which medication can alter PSA levels
5-alpha reductase inhibitors
When to consider urology referral with BPH
- PSA >4
- rise in PSA while on 5-alpha reductase inhibitor
- abnormal DRE
Acute prostatitis labs
- leukocytosis with left shift (bandemia)
- UA: pyuria, hematuria
SSRI with highest risk of ED
paroxetine (Paxil)
Acute bacterial epididymitis affects which groups
- <35 more likely to be infected with STI
- >35: usually E.coli
Acute bacterial epididymitis presentation
- swollen red scrotum
- tenderness
- urethral discharge
- induration of posterior epididymitis
- UTI symptoms
- possible fever
- positive Prehn’s sign
Positive Phren sign
- relief of pain with scrotal elevation
- indicates epididymitis vs. testicular torsion
Acute bacterial epididymitis treatment
- <35: doxycycline PO x 10 days plus ceftriaxone IM
- > 35: ofloxacin (Floxin) or levofloxacin x 7-10 days
- scrotal elevation and ice packs
- stool softeners if constipated
- ED if septic or severe pain
Erectile dysfunction causes
- vascular insufficiency
- neuropathy
- medications
- smoking
- alcohol
- hypogonadism
First line treatment for ED
- PDE-5 inhibitors
- Take Viagra on empty stomach for optimal effectiveness
- 30-60 minutes before sex
- Tadalafil can be take for combined BPH and ED
PDE-5 inhibitor contraindications
- concomitant nitrates
- alpha blockers
- recent MI
- post-cerebrovascular accident
- major surgery
- any condition in which exertion is contraindicated
Can a hydrocele be present with testicular CA
yes
Conditions with acute scrotum
- epididymitits
- testicular torsion
Acute onset of testicular pain with negative cremasteric reflex
-testicular torsion
Acute or chronic testicular pain with positive cremasteric reflex
-epididymitis
Etiology of noninfectious epididymitis
- relfux of urine
- prolonged sitting
- underlying congenital defect
Management of noninfectious testicular pain
- conservative treatment
- scrotal support
- NSAIDs/tylenol
Gradual onset of ED indicates what
organic disease
Hydrocele is common in..
- newborns, usually disappears by age 1
- older boys and adults due to inflam or injury
Nonpainful hydrocele diff dx
- spermatocele
- varicocele
- hematocele
- inguinal hernia
- testicular tumor
Painful hydrocele diff dx
- infection
- epididymo–orchitis
- hematoma
- testicular torsion
- trauma
- thrombosis
Varicocele
-enlargement of veins within scrotum
Varicocele risks
- low sperm production
- decreased sperm quality
- infertility
Varicocele treatment
- pain killers
- surgery
Peyronie’s disease
- inflammatory disorder of penis
- fibrotic plaques on tunica albuginea
- penile pain primarily during erection
- palpable nodules and penile deformity (crooked erections)
- may resolve spontaneously
- surgical correction if needed
Balanitis
-candidal infection of glans
Balanitis is more common in
-uncircumcised
-diabetic
-IC
use of SGLT2 inhibitors
Balanitis treatment
- topical OTC azoles
- treat partner if they also have symptoms
Phimosis
foreskin unretractable due to edema
Varicocele also called
bag of worms
New onset varicocele can indicate what
testicular tumor
mass that is impeding venous drainage
Where does fluid collect in hydrocele
-tunica vaginalis
Treatment for adult with enlargin or new onest hydrocele
US and urology referral
PSA level when patient is on Finasteride
multiple PSA by 2
