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mens health Flashcards

1
Q

what is epididymitis?

A

Epididymitis is inflammation of the epididymis

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2
Q

what is epididymo-orchititis?

A

Epididymo-orchitis is usually the result of infection in the epididymis and testicle on one side.

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3
Q

what can cause epididymis orhidits?

A

Escherichia coli (E. coli)
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps

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4
Q

how long would epidid-orch take to present?

A

gradual over hours

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5
Q

how would epidid-orch present?

A

Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Tenderness on palpation, particularly over epididymis
Urethral discharge (should make you think of chlamydia or gonorrhoea)
Systemic symptoms such as fever and potentially sepsis

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6
Q

what is akey differential of epi-och?

A

testicular torsion - should treat like that until proven otherwise

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7
Q

what would increase risk of STI being cause of epi-orch?

A

Age under 35
Increased number of sexual partners in the last 12 months
Discharge from the urethra

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8
Q

what investigations are needed for epi-och?

A

rine microscopy, culture and sensitivity (MC&S)
Chlamydia and gonorrhoea NAAT testing on a first-pass urine
Charcoal swab of purulent urethral discharge for gonorrhoea culture and sensitivities
Saliva swab for PCR testing for mumps, if suspected
Serum antibodies for mumps, if suspected (IgM – acute infection, IgG – previous infection or vaccination)
Ultrasound may be used to assess for torsion or tumours

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9
Q

how should epi-orch be managed?

A

unwell - admission - IV ABx
GUM if STI
anti-biotics if enteric cause

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10
Q

what antibitoics would help e.coli by enteric cause of epi-orch?

A

Ofloxacin for 14 days
Levofloxacin for 10 days
Co-amoxiclav for 10 days (where quinolones are contraindicated)

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11
Q

what is empirical therapy for STI cause of epi-orch?

A

Intramuscular ceftriaxone (single dose)
Doxycycline
Ofloxacin

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12
Q

what supportive/ conservative measures to manage epi-orch?

A

Analgesia
Supportive underwear
Reduce physical activity
Abstain from intercourse

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13
Q

what side effects may be seen with quinolone ABs eg ofloxacin, levofloxacin, cipro?

A

Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy

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14
Q

what are complications of epi-orch?

A

Chronic pain
Chronic epididymitis
Testicular atrophy
Sub-fertility or infertility
Scrotal abscess

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15
Q

what is testicular torsion?

A

testicular torsion refers to twisting of the spermatic cord with rotation of the testicle.

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16
Q

why is testicular torsion an emergency?

A

It is a urological emergency, and a delay in treatment increases the risk of ischaemia and necrosis of the testicle, leading to sub-fertility or infertility.

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17
Q

what age is most common for torsion?

A

teens - but can be any age

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18
Q

what is intermittent torsion?

A

can untwist itself
history of recurrent symptoms

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19
Q

what can trigger torsion?

A

activity, such as playing sports

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20
Q

how does torsion present?

A

acute rapid onset of unilateral testicular pain, and may be associated with abdominal pain and vomiting. Sometimes abdominal pain is the only symptom in boys, and testicular examination to exclude torsion is essential.

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21
Q

what would be seen on examination if torsion is suspected?

A

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

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22
Q

what is bell clapper deformity?

A

the testicle is fixed posteriorly to the tunica vaginalis. A bell-clapper deformity is where the fixation between the testicle and the tunica vaginalis is absent. The testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position. It is also able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.

more at risk of torsion

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23
Q

what do you do if torsion is suspected?

A

immediate senior urology opinion

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24
Q

what is management of torsion?

A

Nil by mouth, in preparation for surgery
Analgesia as required
Urgent senior urology assessment
Surgical exploration of the scrotum
Orchiopexy
orchidectomy

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25
Q

what is orchidectomy?

A

removing testicle if surgery is delayed or necrosis

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26
Q

what is orchiopexy?

A

correcting the position of the testicles and fixing them in place)

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27
Q

what investigation can confirm diagnosis?

A

scrotal ultrasound - but this may delay going to theatre - not recommended

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28
Q

what would US show for positive torsion?

A

whirlpool sign, a spiral appearance to the spermatic cord and blood vessels.

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29
Q

what are key differentials of testicular lumps?

A

Hydrocele
Varicocele
Epididymal cyst
Testicular cancer
Epididymo-orchitis
Inguinal hernia
Testicular torsion

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30
Q

what is a hydrocele?

A

hydrocele is a collection of fluid within the tunica vaginalis that surrounds the testes.

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31
Q

how does hydroceles present?

A

hydrocele is a collection of fluid within the tunica vaginalis that surrounds the testes.

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32
Q

what are key examination findings of hydroceles?

A

The testicle is palpable within the hydrocele
Soft, fluctuant and may be large
Irreducible and has no bowel sounds (distinguishing it from a hernia)
Transillumination

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33
Q

what is transillumination?

A

can shine a torch through skin and into fluid - testicle floats within fluids

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34
Q

what can cause hydroceles?

A

idiopathic
secondary to testicular cancer, torsion, epi-orch, trauma

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35
Q

how do you manage hydrocele?

A

Management involves excluding serious causes (e.g., cancer). Idiopathic hydroceles may be managed conservatively. Surgery, aspiration or sclerotherapy may be required in large or symptomatic cases.

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36
Q

what is a varicocele?

A

A varicocele occurs where the veins in the pampiniform plexus become swollen

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37
Q

how common are varicoceles?

A

common - affecting 5% of men

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38
Q

why can hydroceles cause impaired fertility?

A

due to disrupting the temperature in the affected testicle.

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39
Q

what may a left sided varicocele indicate?

A

indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.

40
Q

what are complications of hydroceles?

A

testicular atrophy - reduction in size and function

41
Q

what exam findings would you see with varicoceles?

A

A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle

42
Q

how may varicoceles present?

A

Throbbing/dull pain or discomfort, worse on standing
A dragging sensation
Sub-fertility or infertility
bag of worms sensation

43
Q

what happens if a varicocele does not disappear when lying down?

A

varicoceles that do not disappear when lying down raise concerns about retroperitoneal tumours obstructing the drainage of the renal vein. These warrant an urgent referral to urology for further investigation.

44
Q

what investigations should be considered

A

ultrasound with Doppler imaging can be used to confirm the diagnosis
Semen analysis if there are concerns about fertility
Hormonal tests (e.g., FSH and testosterone) if there are concerns about function

45
Q

how should varicocele be managed?

A

uncomplicated - conservatively
surgery/ endovascular embolisation for pain, atrophy or infertility

46
Q

what are epidymal cysts?

A

Epididymal cysts occur at the head of the epididymis (at the top of the testicle). A cyst is a fluid-filled sac.

47
Q

what is a spermatocele?

A

epididymal cyst that contains sperm is called a spermatocele

48
Q

how common are epi cysts?

A

Epididymal cysts are very common in adults, occurring in around 30% of men

49
Q

how may epi cysts present?

A

Most cases are asymptomatic. Patients may present having felt a lump, or they may be found incidentally on ultrasound for another indication.

50
Q

how would an epi cyst present on examination?

A

Soft, round lump
Typically at the top of the testicle
Associated with the epididymis
Separate from the testicle
May be able to transilluminate large cysts (appearing separate from the testicle)

51
Q

what is the management of epi cysts?

A

harmless and are not associated with infertility or cancer. Occasionally, they may cause pain or discomfort, and removal may be considered. Exceptionally rarely, there may be torsion of the cyst, causing acute pain and swelling.

52
Q

where does testicular cancer arise from mainly?

A

testicular cancer arises from the germ cells in the testes

53
Q

what do germ cells produce?

A

Germ cells are cells that produce gametes - sperm

54
Q

what rare tumours can cause testicular cancer?

A

non-germ cell tumours and secondary metastases.

55
Q

when is the highest incidence for testicular cancer?

A

testicular cancer is more common in younger men, with the highest incidence between 15 and 35 years.

56
Q

what are the two types of testicular cancers?

A

Seminomas
Non-seminomas (mostly teratomas)

57
Q

what are RF for testicular cancer?

A

Undescended testes
Male infertility
Family history
Increased height

58
Q

how does testicular cancer present?

A

painless lump on the testicle. Occasionally it can present with testicular pain.

59
Q

how would a lump feel if it is likely to be testicular cancer?

A

Non-tender (or even reduced sensation)
Arising from testicle
Hard
Irregular
Not fluctuant
No transillumination

60
Q

what unusual sign may be seen in rarer types of testicular cancer?

A

gynaecomastia

61
Q

what testicular cancer is most likely to present with gynaecomastia?

A

Leydig cell tumour

62
Q

what investigations are used for testicular cancer?

A

scrotal ultrasound
tumour markers
staging CT - will check for mets also

63
Q

what are the tumour markers seen in testicular cancer?

A

Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas)
Beta-hCG – may be raised in both teratomas and seminomas
Lactate dehydrogenase (LDH) is a very non-specific tumour marker

64
Q

what grading scale is testicular cancer graded with?

A

royal marsden staging system
1-4

65
Q

what are the 4 stages of testicular cancer according to the royal marsden staging system?

A

Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs

66
Q

what may be included within testicular cancer management?

A

Surgery to remove the affected testicle (radical orchidectomy) – a prosthesis can be inserted
Chemotherapy
Radiotherapy
Sperm banking to save sperm for future use, as treatment may cause infertility

67
Q

where does testicular cancer commonly metastase to?

A

Lymphatics
Lungs
Liver
Brain

68
Q

what are long term complications of testicular cancer?

A

Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Lasting kidney, liver or heart damage
Increased risk of cancer in the future

69
Q

what is the prognosis of testicular cancer?

A

prognosis for early testicular cancer is good, with a greater than 90% cure rate. Metastatic disease is also often curable. Seminomas have a slightly better prognosis than non-seminomas.

70
Q

what is erectile dsyfunction - ED?

A

inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners

71
Q

how common is ED?

A

globally between 13.1% and 71.2%

72
Q

what can cause ED?

A

frequently multifactorial - mixed organic and psychogenic
vascular
neuro
hormonal
drug-induced
systemic disease
structural
psychogenic

73
Q

what vascular issues can cause ED?

A

hypertension, atherosclerosis, hyperlipidemia, smoking

74
Q

what neurological conditions can cause ED?

A

Parkinson’s disease, multiple sclerosis, stroke, spinal cord injury, peripheral neuropathy

75
Q

what hormonal causes can cause ED?

A

hypogonadism, hyperprolactinaemia, thyroid disease, Cushing’s disease

76
Q

what drugs can induce ED?

A

antihypertensives, beta-blockers, diuretics, antidepressants, antipsychotics, anticonvulsants, recreational drugs

77
Q

what systemic conditions are linked to ED?

A

DM, renal failure

78
Q

what structural pathologies are linked to ED?

A

pelvic trauma, penile trauma, Peyronie’s disease

79
Q

what psychogenic conditions can cause ED?

A

depression, anxiety, performance anxiety, schizophrenia

80
Q

what would impaired nocturnal erections indicate?

A

organic rather than psychogenic

81
Q

what should be explored within a ED Hx?

A

Onset of sexual dysfunction (i.e. short, gradual)
Duration of sexual dysfunction (i.e. lifetime or acquired)
Difficulties with arousal
Rigidity of erections
Duration of sexual stimulation
Difficulties with ejaculation
Difficulties with orgasm
Presence/absence of morning erections

81
Q

what is the usual primary complaint of ED?

A

difficulties initiating or sustaining an erection.

82
Q

what scoring system can be used for ED ?

A

International Index of Erectile Function (IIEF-5) is an objective 5-item questionnaire frequently used by urologists to assess the severity of a patient’s ED.

83
Q

apart from HPC what else should be explored within ED Hx?

A

Past medical history: previous sexual dysfunction, cardiovascular disease and previous pelvic surgery.
Medication history: antihypertensives, beta-blockers, diuretics, antidepressants, antipsychotics, and anticonvulsants.
Psychiatric history: current or previous psychological problems (e.g. depression, anxiety)
Social history: smoking, alcohol consumption, illicit drug use, diet, exercise
Sexual history: current sexual partner(s), relationship status, partner’s reaction to ED

84
Q

what blood tests should be done fro ED?

A

FBC
LFTs
U&Es
TFTs
Lipid profile
Fasting glucose and/or HbA1C
Serum total testosterone: if testosterone is reduced, serum prolactin will then be checked to screen for secondary hypogonadism

85
Q

how is ED managed?

A

primary care physicians are managing ED with medical therapies alone.6 However, depending on the cause of ED, surgery may be warranted in specific cases.

86
Q

how are ED RF managed?

A

atients should be encouraged to adopt healthy lifestyle behaviours, including smoking cessation, minimal alcohol intake, and weight loss
If a medication is suspected to be the cause of the ED, consider substitution or withdrawal of this substance for 2 weeks and review the effect.

87
Q

when may pts get psychosexual counselling in ED?

A

patients may be referred for specialist counselling services if the cause of ED is considered to have a psychogenic component (either stand-alone or mixed)

88
Q

what medications can be used for ED?

A

Phosphodiesterase-5 inhibitors (PDE-5 inhibitors). These drugs arrest PDE-5, allowing for the prolongation of cGMP and subsequent relaxation of penile blood vessels (sildenafil, vardenafil, avanafil).

89
Q

how long do PDE-5 inhib last once taken correctly?

A

The drug is intended to last for roughly 4 hours (if an erection lasts longer than 4 hours, the patient should seek urgent care for risk of priapism)

90
Q

when should PDE-5 inhib be taken for ED?

A

take on an empty stomach 30 minutes prior to intercourse, avoid alcohol and fatty meals as it reduces drug absorption.

91
Q

what are contra-indications of PDE-5inhib?

A

PDE-5 contraindications include concurrent nitrate use. Caution is required when treating patients with cardiovascular or cerebrovascular disease in the previous 6 months (hypo/hypertension).

92
Q

what are side effects of PDE-5 inhib?

A

PDE-5 side effects include headache, flushing, dizziness, dyspepsia and rhinitis

93
Q

what surgical options are available for ED?

A

ailed previous trials of management. Prosthetic options are inflatable implants vs. semirigid rods

94
Q
A

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