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Intergration Of Clinial Understanding > Men's Health: Urology > Flashcards

Men's Health: Urology Flashcards

1
Q

What is phimosis?

A

Prepuce (foreskin) cant be retracted in an adult (1% prevalence).

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2
Q

What is the sequelae of phimosis?

A

Can be caused by Poor hygiene (STI) or catheterisation by urinary retention.
Can cause pain on intercourse, balanitis (inflamed glans), posthitis (inflamed foreskin), BXO (scarred foreskin), paraphimosis and penile cancer.

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3
Q

What is paraphimosis?

A

Painful constriction of the glans penis by the retracted prepuce proximal to the corona.

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4
Q

What are the common causes of paraphimosis?

A
  1. Phimosis.
  2. Catheterisation (elderly).
  3. Penile cancer.
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5
Q

How do you treat Phimosis?

A

Consider an elderly man with phimosis and balanitis (PENILE CANCER).
Circumcision best.

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6
Q

How do you treat Paraphimosis?

A

Reduce it usually manually or sometime put a dorsal slit in.

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7
Q

What type of penile cancer occurs?

A

Squamous Cell Carcinoma.

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8
Q

Identify the risk factors for SCC penile cancer.

A
  1. Phimosis (hygiene with smegma).

2. HPV 16 and 18.

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9
Q

What is the prognosis of penile cancer?

A

Most not treated will die within 2 years.

Almost all will die within 5 years.

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10
Q

When is circumcision done in paediatric patients?

A
  1. For religious reasons.

2. Recurrent balanitis/UTI.

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11
Q

What are the indications of circumcision in an adult?

A
  1. Recurrent balanitis.
  2. Phimosis.
  3. Recurrent Paraphimosis.
  4. Balanitis Xerotica Obliterans.
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12
Q

What are the causes of acute scrotal pain?

A
  1. Testicular torsion.
  2. Epididmyitis/Epididymo-orchitis (from UTI/STI or mumps).
  3. Torsion of hydatid of Morgagni (remnant of top of testis, localised).
  4. Trauma.
  5. Ureteric calculi.
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13
Q

What is the typical history of someone with testicular torsion?

A

Young patient with sudden unilateral pain.

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14
Q

What is the typical examination of someone with testicular torsion?

A

Tender, lying high in scrotum with horizontal lie.

EMERGENCY!

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15
Q

What is the typical history of a patient with Epididymo-orchitis?

A

20-40/50: STI (chlamydia).
40/50+: UTI.
Gradual onset of unilateral pain with a recent history of UTI, unprotected intercourse, catheter or mumps.

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16
Q

What is the typical examination of someone with epididmyo-orchitis?

A

Pyrexia (potential sepsis), with scrotum erythematous, enlargement of the testis.
Abscess may be present with a fluctuating area.
May have a reactive hydrocoele.
RARE: Fournier’s gangrene: necrotic area of scrotum skin. EMERGENCY!

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17
Q

How would you investigate someone with suspected epididymo-orchitis?

A

Blood: FBC/U+E.
Urine: MSU.
Radiology: USS of scrotum (abscess.

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18
Q

What are the treatments of epididymo-orchitis and its complications?

A

Epididymo-orchitis: antibiotics.
Abscess: surgical drainage and antibiotics.
Fournier’s gangrene: emergency debridement and antibiotics.

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19
Q

What are the differential diagnosise for a patient presenting with a painless, non-tender scrotal lump?

A
  1. Testis tumour.
  2. Epididmyal cyst.
  3. Hydrocele.
  4. Reducible inguino-scrotal hernia.
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20
Q

What does it mean if you cannot get above the scrotal swelling?

A

Likely a inguinal-scrotal hernia.

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21
Q

How does a varicocele present?

A

Painless, aching towards the end of the day.
Most commonly affects the left (LTV drain to LRV ).
Can cause reduced fertility esp bilateral.

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22
Q

What are the differential diagnoses of a patient presenting acutely with a painful, tender scrotal lump?

A
  1. Epididymitis.
  2. Epididymo-orchitis.
  3. Strangulated inguino-sctoral hernia: EMERGENCY!
23
Q

What is the typical history of someone who has a testicular tumour?

A

Painless germ cell tumour (seminoma/teratoma) under 45 with a history of an undescended testis.
If an older men likely to be a lymphoma.

24
Q

What is the typical examination of a patient with a testicular tumour?

A

Body of testis feel abnormal but can get above.

25
Q

If you suspect a testicular tumour what’s the next step?

A

Refer via 2 week wait to urology, who will arrange urgent ultrasound of scrotum to confirm diagnosis and check testis tumour markers

26
Q

What is the typical presentation of a patient with a hydrocele?

A

Slow/sudden onset of a uni/bilateral scrotal swelling caused by an imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis.

27
Q

What will a hydrocele examination typically be like?

A

Unpalpable testis, can get above.

Transilluminates.

28
Q

What is the typical examination of a patient who has an epididymal cyst?

A

Usually painless, separate from the testis. Can get above the mass and it does transilluminate.

29
Q

How will a varcocele present on examination?

A

Like a bag of wombs that is non-tender with or without a palpable abdo/renal mass.

30
Q

How do you treat a testicular tumour?

A

Inguinal orchidectomy.

31
Q

How do you treat an epididmyal cyst?

A

Reassure.

Excise if large.

32
Q

How do you treat an adult hydrocele?

A

If normal testis on ultrasound, reassure.

Surgical removal if large and symptomatic.

33
Q

How do you treat a varicocele?

A 
Reassure.
Radiological embolisation (symptomatic, infertility, if adolescence and growth of testis effected).
34
Q

How do you treat an inguino-scrotal hernia?

A

Surgery.

EMERGENCY if strangulated.

35
Q

What is urinary retention?

A

Inability to pass urine, rather than inability to make urine.

36
Q

Urinary retention is less common in women. What is the most common cause of urine retention in women?

A

Fibroids in the womb.

37
Q

Identify the 8 main causes of urinary retention.

A
  1. Prostatic enlargement (PC/BPH).
  2. Phimosis/urethral stricture/meatal stenosis.
  3. Constipation.
  4. UTI.
  5. Drugs (AACh).
  6. Over-distension.
  7. Post-surgery.
  8. Neurological.
38
Q

Describe acute urinary retention.

A

Painful, relieved by draining.
Residual vol of <1000ml.
No kidney insult.

39
Q

How do you treat acute urinary retention?

A

Trial without catheter.

Address underlying cause.

40
Q

Describe chronic urinary retention characteristics.

A

Painless, may just notice abdo swelling.
Residual vol of >300ml.
May have kidney insult.

41
Q

How do you treat chronic urinary retention?

A

Learn to self catheterise.

42
Q

Describe the characteristics of acute on chronic.

A

Painful.
Residual vol of >1000ml.
Usually kidney insult.

43
Q

How do you treat acute on chronic urinary retention?

A

Trial without catheter (not if KI).

Long-term catheter/surgical intervention.

44
Q

What do older men with nocturnal enuresis (bed wetting) have until proven otherwise?

A

Chronic retention with overflow incontinence.

45
Q

Identify and describe the 2 main categories of LUTS.

A
  1. Voiding: hesitancy, poor flow, post micturition dribbling.
  2. Storage: frequency, urgency, nocturia.
46
Q

What are the causes of storage LUTS?

A
  1. Irritative: infection, stone or cancer of bladder.
  2. Overactive bladder (idiopathic/neuropathic).
  3. Low compliance of bladder from scarring (e.g. TB).
  4. Polyuria (too much urine in diabetes).
  5. Nocturnal (venous stasis or sleep apnoea).
47
Q

What are the causes of voiding LUTS?

A
  1. Bladder outflow obstruction (physical, dynamic or neurological).
  2. Reduced contractility due to physical or neurological issues (LMN lesion).
48
Q

What does spraying urine suggest?

A

Urethral stricture.

49
Q

What is sympathetic smooth muscular tone mediated by?

A

a1 receptors.

50
Q

How do you assess LUTS in men?

A

International Prostate Symptom Score.

51
Q

How should you examine a male with LUTS?

A

DRE, palpate bladder.

Neurological suggestive history

52
Q

How should you investigate a man with LUTS?

A

Dipstick for UTI/ blood signs.

Consider PSA

53
Q

How should you manage BPH in primary care?

A

Lifestyle modification: reduce caffeine, avoid fizzy drinks, don’t drink more than 2.5L a day.
Alpha blockers: relax sm in prostate, immediate (TAMSULOSIN).
5a-Reductase Inhibitors: shrink prostate depriving of androgen. Slow to work but reduce risk of retention (FINESTARIDE).

54
Q

How should you treat BPH in secondary care?

A

Measure flow rate to aid diagnosis.
If the lifestyle and medications are not effective undergo a Transurethral Resection of Prostate (TURP) wit a monopolar/laser/bipolar energy.

Intergration Of Clinial Understanding (13 decks)

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