Mens Health Flashcards
What are the main symptoms of lower urinary tract infections in men and when do these symptoms usually start?
- Storage functional abnormality- urinary urgency, increased urination, nocturia( urination walking up in sleep), urinary incompletion, needing to urinate after just passing urine.
- Voiding- straining, incomplete emptying, often due to destructor under activity.( benign prostate hyperplasia)
- Post-micturition- sensation of incomplete emptying, post micturation dribble (weeing one self)
These symptoms begin to present with increasing age.
How to investigate lower urinary tract infections in men?
History:
-is the patient diabetic? (Uncontrolled)
-does the patient have MS? - UTIS can be common in MS but exacerbate neurological symptoms, refer to specialist.
Physical examination should always be undertaken.
-Have the patient complete a urinary frequency chart for 3days. This is to track how frequently the patient is urinating
-international prostate symptom score
What medication can cause LUTS in men?
-antidepressants
-antihistamines
-anticholingerics
What is the international prostate symptom score?
This is a tool for classifying the severity of lower urinary tract symptoms and assessing the impact on quality of life.
THIS CONSISTS OF 7 QUESTIONS THAT WILL GENERATE A SCORE:
-score 0-7: mildly symptomatic
-score 8-19:moderately symptomatic
-score 20-35: severely symptomatic
What is benign prostate hyperplasia?
This is when the prostate gland is enlarged and is the most common cause of voiding, it can cause uncomfortable urinary symptoms e.g. blocking the usual flow of urine.
How do we diagnose benign prostate hyperplasia?
- Check symptoms, mainly voiding
2.a biopsy should be done.(will show histologies signs of hyperplasia change)
- Prostate specific antigen(PSA) this is an antigen that will be present when the prostate gland enlarges,THIS IS NOT A DIAGNOSIS CONFIRMATION ALONE SHOULD BE USED ALONGSIDE OTHER DIAGNOSTIC TOOLS. This is because certain activities can raise these levels of the antigen e.g intense exercise or biopsy.
- THE ENLARGEMENT CAN BE FELT WHEN DOING AN EXAMINATION.
If a patients symptoms are not as bad what sorts of treatment do we offer?
Lifestyle changes:
-pelvic floor exercises
-healthy lifestyle measures
-use products such as pads
PATIENTS SHOULD ALWAYS NEED ACTIVE SURVEILLANCE TO ASSESS ANY CHANGES IN SYMPTOMS.
If a male has moderate to severe symptoms or a IPSS higher than 8 what treatment do we offer?
ALPHA BLOCKER E.G. tamsulosin and doxazosin
5 ALPHA REDUCTASE INHIBITORS
What is erectile dysfunction?
This is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
What are some causes of erectile dysfunction?
1.adverse drug effects
2.mental health or relationship issues
3.vasculogenic -CVD,hypertension,hyperlipidemia, smoking
(Problems with the blood)
- Neurogenic-tumours, stroke, spinal disorders, alcoholism, surgery
5.anatomical- penile function
6.congenital- curvature of penis
- Hormonal- hypothyroidism, cushings etc
What drugs can cause erectile dysfunction?
1.diuretics (thiazides) and spirolactone
2.antihypertensives (methyl dopa, beta blockers(propranolol), verapamil
3.fibrates (clofibrate)
4.antidepressants (amitriptyline)
5.histamine antagonists
6.hormones and hormone modifying drugs
- Cytotoxics (methotrexate)
8.anti-arrthymics and anticonvulsants (carbamazepine)
If a patient is at risk of prostate cancer and an enlarged prostate what would we offer as a treatment?
5 alpha reductase inhibitors e.g. dutasteride and finasteride
If a patient has moderate to severe voiding symptoms and the prostate is enlarged what treatment plan would we advise?
We would advise a combination of alpha blockers e.g. tamsulosin and doxazosin and a 5 alpha reductase inhibitor
When do we review an alpha blocker and what monitoring is required?
Titration slowly over time, and review every 4 to 6 weeks, to see if the dose will need increasing.
How do we diagnose Erectile dysfunction?
1.History (social, medical, surgical history etc)
- Examination -physical examination to include genitalia, gynaemastia and reduced body hair. Rectal examination if the patient is displaying signs of enlarged prostate.
3.investigation of 10 CVD risk (lipids and fasting blood glucose levels) and free testosterone levels ( positive FSH,LH and prolactin)
How do we manage a patient with erectile dysfunction?
- 1ST LINE =Switch any medication that the patient is currently taking that may cause ED
2.treat with meds called phosphodiesterase 5 inhibitors
E.g. sildenafil, tadalafil, verdenafil
- Prescribe the lower doses and consider titrating up if ineffective.
What are PDE-5 and give some examples and explain how they work?
Sildenafil, these drugs are not initiators of erections however they require a sexual stimulation in order to facilitate an erection.
When would you class a male as a non responder to a PDE5 ?
This is when a male has received * doses at maximum doses with sexual stimulation ands has not responded to this.
What are some common side effects of PDE 5 inhibitors?
-nausea and vomiting
-headache
-flushing
-dizziness
-palpitations
-Prolonged and painful erections
-tachycardia
-hearing loss
What drugs interact with PDE 5 inhibitors?
-nitrates e.g. GTN spray
What drugs interact with PDE 5 inhibitors?
-nitrates e.g. GTN spray
What drugs interact with PDE 5 inhibitors?
-nitrates e.g. GTN spray
What patients should you be careful with when you prescribe PDE5 inhibitors?
-recent stroke
-hepatic and renal impairment
-hypotension
What lifestyle recommendations would you provide to patients on PDE5 inhibitors and experiencing erectile dysfunction?
Encourage:
-weight loss
-smoking cessation
-healthy diet
-exercise
-stress relief
DONT DRINK MORTE THAN 14 UNITS OF ALCOHOL PER WEEK.
How is sildenafil dosed?
50mg at least one hour before sexual activity
-if a patient takes with food it should be left longer
-increased to a maximum of 100mg or reduced to 25mg once daily.
What does the creatinine clearance need to be in order to take sildenafil?
30-80 ml/min
-if the creatinine clearance is less than 30ml/min or impaired hepatic function
Start at 25mg starting dose then slowly titration up to 50mg and then 100mg if tolerated.
