Mens Health

Question 1

List 3 urinary storage symptoms and 3 obstructive symptoms

Answer 1

Storage symtpms (bladder filling symptoms): F.U.N
> frequency
> urgency
> nocturia (more than once / night abnormal)

Obstructive symptoms (voiding symptoms) 
> dribbling
> hesitency
> straining
> poor stream

Question 2

List 3 differentials for voiding ddx and 4 differentials for storage ddx

Answer 2

Storage symptom ddx:
- Bladder Irritation from 1: bladder Stone, 2: Cancer (transitional cell ) , 3 UTI

or 4: Detrusor overactivity (OABS)(idopathic / neurological)

Obstructive symptoms

1: Urethral stricture
2: BP hyperplasia
3: prostate cancer

Other causes for LUTS

• phimosis - severe
• neurogenic bladder
• intersitial cystitis
• polydipsia - T2DM
• CCF/ OSA

Question 3

list 4 non phrmacological treatments for BPH if symptoms are mild

*note - doesnt need rx unless causing pt distress (use international prostate severity score)

Answer 3

1: avoid caffeine, etoh, bladder irritants - spicy foods
2: treat constipation with high fibre diet
3: reduce evening H20 intake
4: bladder re-training

Question 4

List 2 treatment options for BPH and drug class (pharmological)

Answer 4

1: alpha blockers “tamsulosin”/ “prazosin”
- smooth mm relaxation of prostate
- Tamsulosin is prefered unless pt has HTN also.

2: 5a reductase inhibitors : (finasteride / dutasteride)
- work well in combo with alpha blockers
- reduce prostate growth / size
- ise if Prostate >30cc
- take 6-12 months to work
- drops PSA ,
Combo = tamsulosin and dutasteride

Question 5

A man presents with nocturia and frequency. After ruling out prostatic conditions you determine he has OAB syndrome. what medical management can you provide (list 2)

*note to self: OABS is F.U.N in the absence of detectable disease. URGENCY and URGE are key features.

Frequency = 8 or more voids / 24hrs 
Nocturia = >1 per night void

Answer 5

Anticholinergic medication

• oxybutynin 2.5 -5mg TDS
• can use patch

S/E: urinary retention, dry mouth, dry eyes, arrythmia, headache, constipation

2: Mirabegron 25mg daily : Beta 3 Androreceptor agonist :
S/E : HTN

Question 6

List 5 causes of male infertility

Answer 6

• hyperprolactinoma
• varicocele
• klinefelters syndrome
• previous radiation/chemo
• previous infection ie Mumps
• retrograde ejaculations, Erectile Dysfunction

Question 7

Haemospermia: List 4 causes and when you would refer to a urologist

Answer 7

1: iatrogenic most common
2: infection - STI/ prostatitis/ urethritit/ epididymo-orchitits- also most common
3: Malignancy: Prostate, bladder, testicle,
4: trauma
5; prolonged abstinence

Referral to be made if
- >40, recurrent/persistent/ suspicious DRE findings, concurrent heamaturia

Usually- re assurance + IX: urine mcs, coags, STI screen, PSA if >40

Question 8

how would you describe bladder training to someone

Answer 8

Goal: to modifiy bladder function, reduce frequency, increase capacity.
method:
> review bladder diary - find longest time between voiding - this is starting point
> pt instructed to empty bladder on waking and then each time / day when interval is reached
> if urge to void occurs- supprss using relaxation , self affirming statements
> after 1-2 weeks increase interval by 15min
> slow depe breaths , concentrate on breathing no bladder sensation

6 weeks is needed before benifits

Question 9

what follow up do the following need:

1: if testicles undescended at birth but felt in groin
2: if not testicles in scrotum / groin (empty scrotum)
3: testicle that rides high in scrotum that can be manipulated into scroptum
4: both testicles in scrotum at birth then on review at 5 yrs of age left testicle is missing

Answer 9

1: if felt in groin - need review in 3 moths and 6m . If still not in scrotum for referral to paeds (at 3m review)
> will require orchidopex before 12 months of age

2: for karyotpe , sodium and USS
- concerns for congenitla adreanl hyperplasia

3:grey zone - not completely normal
retractile testicle
- needs annual review
- if migrating up» referral

4: Ascending testis likely
- spermatic cord not elongated . AKA Aquired Undecended testies
> risk from retracted testicle (ie high riding)
> if ongoing at 8yrs&raquo_space; paed surgeon

Question 10

Whats the treatment for epididymo orchitis in a young sexually active male

Then in an elderly 65 year old male in a stable relationship

Answer 10

1: treat as chlamydia + gonorrhoea but with longer dose of doxy
> Doxycycline 100mg BD for 14 days
> ceftriazome 500mg 2ml in 1% NS IM

2: usually caused by UTI organisms
> treat same as bacterial prostatitis for 14 days
Trimethoprim 300mg OD for 14 days

Second line is cepalexin 500mg 6hrly for 2 weeks

Question 11

YOU CAN DO IT

Answer 11

No Stress