men's health review Flashcards
priapism
prolonged painful erection
> risk is sickle cell
ischemic form is emergency
testicular cancer
new onset of hydrocele
painless/asymptomatic until metastasis
common in young white males
prostate cancer
NEW onset of LOW back pain/rectal area with 50yo, obese, black, family hx
testicular torsion
ABRUPT extremeley painful scrotum, n/v
affected testicle is higher
no cremasteric reflex
age 10-20
cremasteric reflex
testicle elevates toward body (dt stroking/pinching of inner thigh).
ABSENT with testicular torsion
cryptoorchidism
undescended testes
> risk of testicular cancer
spermatogenesis stimulated by what
LH
testosterone
prostate gland
produces PSA (prostate specific antigen) and prostatic fluid
helps sperm survive in vagina
50% of 50 yo males have BPH
epididymis
coiled tubular organ loacted posterior aspect of the testis. stores immature sperm for 3 months , these are cut during vasectomy
transillumination scrotum
beam of life behind the scrotum
Serous fluid- bright red glow (hyrocele)
blood/mass- dull or NO glow (cancerous tumor)
testicular cancer common in whom, s/s, labs
most common males 15-30 yo, white
s/s: testicle feels “heavier”
nodule
new hydrocele
labs: ultrasound, biopsy, refer to urologist
removal- orchiectomy
testicular torsion
definition and s/s
spermatic cord becomes twisted
blood supply interrupted
if not corrected within 24 hours, 100% of the testicles become gangrenous/surgical removed
classic case: 14 yo with SEVERE testicular pain, extremely red swollen, n/v.
call 911!, doppler sound, tx is manual reduction or surgery
prostate cancer
risk factors
risk factors:
>50 yo, AA, obese, family member (1st degree relative doubles the risk)
digital rectal exam (DRE) and PSA routine NOT recommended.
do exam based on pt’s age and risk factor
prostate cancer s/s
PAINLESS nodule (hard/indurated)
Elevated PSA >4.0
screen: PSA with DRE, If 4.0 PSA
drug therapy: anti androgens (proscar), hormone blockers (lupron)
BPH
seen in 50% of males >50
urinary obstruction s/s
nocturne common
PSA is elevated (norm: 0-4)
enlargd prostate, symmetrical, rubbery
medictions:
Alpha andrenergic antagonist: Terazin (HYTRIN) )/tamsulosin/flomax
***5 alpha reductase inhibitors: Fiasteride (PROSCAR) (blocks testosterone)
avoid cold medications, antihistamine, caffeine
herbal: saw palmetto
how to determine effectiveness of proscar
MULTIPLE PSA by 2. value should be below baseline.
proscar
category X
teratogenic
should not be touched with bare hands by reproductive aged female
chronic bacterial prostatis
>6 wks E.coli UTI s/s boggy prostate NORMAL UA unless urine mixed with prostatic fluid= E. Coli
labs: urine/prostatic fuid. Use 3 tubes (urethra, bladder, urine)
PSA will elevated
medications: Bactrim (trimethoprim-sulfamethoxale)
Ofolzcin (floxin) or levofloxacin (levaquin)
acute prostatis
YOUNG male enterobacter UTI s/s, cloudy urine, fever prostate WARM and TENDER DO NOT massage virorously dt risk of infection
tx >35 yo fluoro
bacterial epidiymitis
bacteria ascends up the urethra (urethritis) and reaches epidymis
RULE OUT testiculor torsion
POSITIVE PHRENS SIGN (relief of pain with scrotal elevation)
tx: 35 levo
scrotal elevation, ice packs, bed rest.
erectile dysfunction rx
1st line: phosphodiesterase type 5
viagra/levitra on empty stomach 30-60 min before sex
other: intravernous injections (alpostadil or caverject)
contraindicatsion: nitrates, alpha blockers, post MI
peyronie’s disease
penile pain during erection/nodles/crooked penile dt fibrotic plaques on the tunica albuginea.
no labs, refer to urologist
phimosis
foreskin cannot be pushed back dt edema ( seen in neonates)
varicocele
veins “bag of worms” in scrotal sac. new onset can be testiculr tumor
order ultrasound
> 35 think E. coli
true
