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S4 Integration > Men's Healthy - Urology > Flashcards

Men's Healthy - Urology Flashcards

1
Q

What is phimosis, how common is it?

A

Inability to retract the foreskin back over the glans

1% adult non-circumcised population

50% at 1yr old

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2
Q

Problems with phimosis and treatment

A

Poor hygiene, increased STDs

Balanitis (inflamed glands)

Posthitis (inflames foreskin/ prepuce)

Balanitis xerotica obliterans

Paraphimosis

Urinary retention

Penile cancer

✅circumcision

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3
Q

What is paraphimosis? Common causes and treatment

A

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

Phimosis
Catheterisation esp elderly
Penile cancer

✅needs reduction, manually
✅occasionally dorsal slit needed

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4
Q

Risk factors of penile cancer - squamous cell carcinoma. Mortality

A

20% <50yrs old

Risk factors: phimosis, poor hygiene-> smegma, HPV 16 & 18

Untreated leads to death <2yrs, almost all <5yrs

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5
Q

Key paediatric and adult indications for circumcision

A

Paediatric:
Religious
Recurrent balanitis/ UTIs

Adult:
Recurrent balanitis
Phimosis
Recurrent paraphimosis
Balanitis xerotica obliterans
Penile cancer
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6
Q

Causes of acute scrotal pain - emergency presentation

A

Testicular torsion

Epididymitis/ orchitis/ epididymo- orchitis

UTI

STI

Mumps

Torsion of hydatid morgagni

Trauma

Ureteric calculi - rare

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7
Q

History of testicular torsion and examination, investigations

A 
Usually younger <30yrs
Sudden onset (awoken)
Unilateral pain 
May nausea/ vomiting
Often no LuTs

Examination:
Testis v tender
Lying high in scrotum with horizontal line

✅emergency scrotal exploration, emergency

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8
Q

Epidiymo- orchitis history

A

Age 20-50/50 - STI (chlamydia)

40/50+ UTI (E.coli)

Gradual onset

Usually unilateral

Often recent history UTI/ u protected sex/ catheter/ urethral instrument

Check for mumps history

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9
Q

Epididymo- orchitis examination

A

May be pyrexial, can be septic

Scrotum erythematous

Testis/ epididymis enlarged, tender

Fluctuate areas may represent abscess

May relative hydrocoele

Necrotic area skin (Fournier’s Gangrene) - rare, high mortality 50%

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10
Q

Epididymo - orchitis investigations and treatment

A

Bloods - FBC/ U&Es/ cultures if septic

Urine - MSU for MC&S

Radiology - scrotal USS if suspect abscess

✅antibiotics, abscess = surgical drainage/ antibiotics, Fourier’s gangrene = emergency debridement & antibiotics

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11
Q

History to find out for scrotal lumps and examination

A

Is it painful? (How quickly has it appeared?

Can I get above it (if not= hernia)
Is it in body of testis (yes= tumour)
Separate to testis 
Does it fluctuate/ trans illuminate? (=hydrocele/ cyst) 
Feel like bag of worms = varicocele
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12
Q

Causes of painless/ painful and aching scrotal lumps

A

Not tender:
Testis tumour, epididymal cyst, hydrocoele, reducible inguinal-scrotal hernia

Painless but aching at end of day:
Varicocele

Acute presentation, painful:
Epididymitis, epidiymo-orchitis, strangulated inguinal-scrotal hernia (emergency)

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13
Q

History of testicular tumour, examination, treatment

A

Usually painless

Germ cell tumours (seminoma/ teratoma) usually <45yrs, risk factor = history of undescended testis (either side of tumour)

Lymphoma - older men

Examination:
Body of testis abnormal, can get above

✅refer 2week wait to urology then they:

  • ultrasound to confirm
  • check testis tumour markers (aFP,hCG, LDH) = doesn’t rule out of normal, if abnormal v likely
  • inguinal orchidectomy
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14
Q

History of hydrocele, what is it, examination, treatment

A

Slow/ sudden onset

Uni/bilateral scrotal swelling

Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis

Testis not palpable separately, usually can get above, trans illuminates

✅in adult - if normal on ultrasound reassure, surgical removal if large or symptomatic

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15
Q

Epididymal cyst examination, treatment

A

Usually painless

Separate form testis
Can get above mass
Transilluminates

✅reassure, excise if large

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16
Q

Varicocele symptoms, examination, treatment

A

Dull ache at end of day
Let>Rt
May be associated reduced fertility

‘Bag of worms’
Not tender
Palatable abdo/ renal mass

✅reassure, radiological embolisation, only treat: adolescent and growth of testis affected/ symptomatic/ infertility - slow motility of sperm

17
Q

Treatment of inguinal-scrotal hernia

A

Surgery

emergency if strangulated

18
Q

Causes of urinary retention

A
  • prostatic enlargement, BPH/ cancer
  • phimosis/ urethral stricture/ meatal stenosis
  • constipation
  • UTIs
  • drugs (anticholinergic e.g. schizophrenia)
  • over distension (too much fluids at party)
  • following surgery (not linked e.g anaesthetic, linked e.g cholecystectomy)
  • neurological *
19
Q

Types of urinary retention and treatment

A

Acute
Painful - relieved by catheter, residual volume <1000ml, no kidney insult ✅trial without catheter after addressing exacerbating factor

Chronic
- painless/ less painful, May notice abdo swelling, residual volume >300ml, May kidney ✅learn to self catheterise

Acute on chronic
- painful, residual volume >1000ml, usually have kidney insult ✅TWOC (not if kidney insult), long term catheter or surgical intervention

20
Q

Diagnosis of older men with nocturnal enuresis

A

Chronic retention with overflow incontinence until proven otherwise

21
Q

History of LUTs

A

Voiding (suggestive bladder outflow obstruction), hesitancy, poor flow, post micturition dribbling

Storage - frequency, urgency, nocturia

22
Q

Causes of storage LUTS (other than prostate)

A
  • irritating (bladder infection/ inflammation, bladder stone, bladder cancer

Overactive bladder - idiopathic, neuropathic e.g. CVA, Parkinson’s, Ms

Low compliance of bladder (scarred) e.g. after TB/ schistosomiasis/ pelvic radiotherapy

Polyuria (making too much urine) - global eg uncontrolled diabetes
- nocturnal e..g venous stasis, sleep apnoea

23
Q

Causes of voiding symptoms?

A

Bladder outflow obstruction

  • physical urethra (phimosis, stricture - spraying urine), prostate (benign, malignant, bladder neck)
  • dynamic prostate, bladder neck (sympathetic smooth muscular tone mediated alpha 1 receptors)
  • neurological lack of coordination bladder & urinary sphincter =upper motor neurone

Reduced contractility:

  • physical
  • neurological (LMN lesion)
24
Q

International prostate symptom score

A

Slide 38

25
Q

Male LuTs examination, investigations

A

DRE
Is bladder palatable
Neurological if suggestive history

Investigations:
Dipstick - UTI/ blood
Consider PSA (counsel before requesting, not surrogate for DRE, if UTI reta first and palpable benign prostate wait 4-6weeks)

26
Q

Management BPH primary care and side effects of medication

A

Reduced caffeine
Avoid fizzy drinks
No need drink >2.5L per day

International prostate symptom score
Urinalysis
Urine diary

✅alpha blockers - relax smooth muscle within prostate and bladder neck, rapid symptom relief e.g. Tamsulosin. Side effects: hypotension, dizziness, fainting, fatigue, nausea
✅5ARIs - shrink prostate by androgens deprivation, slower symptom relief, slows progression, reduced risk of retention e.g. Finasteride or Dutasteride. Loss sex drive, dizziness, abnormal ejaculations, swelling/ tenderness of breast, impotence
,

27
Q

Management BPH secondary care

A

Carry out flow rate before considering surgery
Either: normal, suggestive of prostatic obstruction, suggestive of urethral stricture

✅surgery if: failed lifestyle and medical management, urinary retention needing intervention
- standard is transurethral resection of prostate (monopolar/ laser/ bipolar)

28
Q

Why can decongestants cause urinary symptoms?

A

Prevent smooth muscles in prostate and bladder neck relaxing,
Alpha 1 receptor agonists

S4 Integration (12 decks)

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