Mens Health Flashcards
undescended testes. ↑ risk of testicular cancer.
Cryptorchidism
Inflammation of the testicle
Orchitis
stimulated by the release of testosterone and
follicle stimulating hormone (FSH).
Where does it take place?
Spermatogenesis
seminiferous tubules of the testes.
produced by the release of luteinizing
hormone (LH)
testosterone/ Androgens
Coiled tubular structure
located posteriorly to the testis. Stores
sperm for maturation
Epididymis
- Walnut size.
- Secretes fluid to protect and nourish sperm.
- PSA: 2.5-4.
Prostate
Normal DRE finding
smooth, rubbery, symmetrical.
BPH DRE finding
Enlarged, smooth, firm
Prostatitis DRE finding
bogginess, tender
Prostate Cancer DRE Findings
irregular borders, firmness, nodular
Inflammation of the penis, candida infection,
most common uncircumcised, DM,
immunocompromised.
Balanitis
Absence of one or two testicles from
scrotum. Usually resolve after 1 year.
Cryptorchidism
Fluid filled testicle.
Transillumination.
Hydrocele
Foreskin can not be pulled back over glans
penis due to penile edema.
Phimosis
Varicose veins on testicles.
“Bag of worms”
Varicocele
Enlargement of the prostate
gland.
* Symptoms: urinary frequency,
trouble starting urination, weak
stream, nocturia = urinary tract
infections (UTI), bladder stones,
chronic kidney problems.
* Cause: unclear.
* Risk factors: family hx, obesity,
DM, ↓exercise, erectile dysfunction.
Education:
* ↓BP = dizziness, orthostatic hypotension. Take meds PM.
* Herbal supplement: Saw palmetto.
BPH
Tx for BPH
- alpha blockers => terazosin (Hytrin), Tamsulosin (Flomax).(take at night to decrease sx)
- 5-alpha-reductase inhibitors (blocktes tosterone): Finasteride (Proscar).
- Surgery.
- Other: ↓alcohol, ↓weight.
Shrinks the prostate by 50%. If you stop taking, prostate enlarges.
Finasteride (Proscar).
Drugs that can worsen BPH symptoms:
pseudoephedrine, anticholinergics, CCB, caffeine.
Penis unable to stay erect during sexual
intercourse. Vascular insufficiency.
* Causes: Drugs (SSRIs like Paxil), neuropathy
(DM), alcohol, smoking, hypogonadism, psychiatric
Erectile Disfunction
Meds for ED
Sildenafil citrate (Viagra): take 30-60min before sex, duration 4 hrs.
* Vardenafil (Levitra): same.
* Tadalafil (Cialis): take 2 hrs before sex, lasts 36hrs!
Education
* May cause HA, facial flushing, dizziness,
hypotension, priapism.
* WARNING: nitrates, alpha-blockers, hx MI, post
cerebrovascular accident, major surgery.
> 6 weeks, gradual.
Symptoms: weeks worth of suprapubic or perineal pain, dysuria, frequency, nocturia. (No systemic symptoms).
May be asymptomatic.
DRE: normal or slightly boggy, non tender.
UA: normal (unless cystitis)
PSA: elevated (inflammation)
Organism: E.coli, Proteus
Chronic Bacterial Prostatitis
Tx for Chronic Bacterial Prostatitis
Bactrim PO BID 4-6 weeks
Fluoroquinolone (Floxin, Levaquin) daily 4-6 weeks.
<6 weeks, sudden.
Symptoms: sudden onset of high fever, chills,
suprapubic pain, perineal pain, dysuria, frequency,
nocturia, cloudy urine.
DRE: tender, warm, boggy.
Accompanied by cystitis or epididymitis.
UA: pyuria, hematuria
Organism: E.coli, Proteus
WARNING: vigorous palpation of infected prostate can lead to bacteremia.
Acute Bacterial Prostatitis
Tx for Acute Bacterial Prostatitis
<35 yr: Ceftriaxone 250 mg IM and Doxy 100mg BID x 10 days
>35 yr: Fluoroquinolone PO x 4-6 weeks (Cipro,
Levaquin, Floxin)
Penile plaque formations that
interfere with erection. Fibrotic
plaques, palpable nodules. Penile
pain, crooked penis.
* Tx plan: referral to urologist
Peyronie’s Disease
Inflammation of the epididymis caused by bacteria (E.coli), STI. <35yo.
Epididymitis
Swollen, painful/tender testicle (usually one side > than the other), red, warm scrotum, urethral discharge .
Labs: leukocytosis (CBC), pyuria/hematuria/nitrites (UA). + gonorrhea, chlamydia?
*Positive Prenh’s sign: relief of pain w/scrotum elevation
Epididymitis
tx for Epididymitis
Tx:
<35 yo STI; Doxy PO BID x 10 days + Ceftriaxone 250mg IM
> 35 yo; fluoroquinolone (Floxin, Levaquin).
Symptomatic management: ice, elevate, bed rest, stool softener.
relief of pain w/scrotum elevation
Positive Prenh’s sign
Ischemic: blood does not drain properly from the penis.
Non-ischemic:↑arterial flow, disruption of parasympathetic nervous system.
Causes: Sickle cell disease, antipsychotics, SSRIs, blood thinners, cocaine, cannabis.
Prolonged penile erection (Priapism)
Most common in white males ages 15-30 y.o.
* Findings: testicular nodule/s that are fixed,
“heaviness”, aching, one testicle larger,
tenderness on one side. Can be painless and
asymptomatic when early. Hydrocele common.
Diagnostics:
* US= solid mass
* Biopsy= gold standard
Tx:
* Referral to urologist for orchiectomy.
* Chemotherapy.
Testicular Cancer
Most common cancer in men. Slow growing.
Risk factors
* Age >50
* African American
* Obesity
* + Fam Hx
Findings
* PSA >4.0 ng/mL
* DRE: Fixed hard nodule or indurated area on gland
* Dx: Biopsy
Tx
* Antiandrogens (Proscar)
* Hormone blockers (Lupron)
Prostate Cancer
Usually school age boy.
* Abrupt onset of a blue-colored round mass. (blue dot sign)
* Necrosis of the appendix testis due to
torsion.
Torsion of the Appendix Testis
Usually adolescent.
* Abrupt onset of extreme testicular pain.
* N&V.
* Affected testicle is higher than non-affected.
* Cremasteric reflex missing
testicular torsion
* emergency!
risk factors associated with benign prostatic hyperplasia
Family hx
obesity
HTN
risk factors associated with benign prostatic hyperplasia
Family hx
obesity
HTN
What patient education is important when the patient is prescribed Hytrin?
Take med at night as it decreases BP (is an alpha blocker)
