Mens health Session 3 Flashcards
what is phismosis ?
Prepuce cannot be fully retracted in adult
‘Normal’ - physiological
non-retractability up to adolescence
– 50% at 1 year
– 10% at 3 years
Phimosis - sequelae
Poor hygeine, risk of STDs • Pain on intercourse, splitting / bleeding • Balanitis (inflamed glans) • Posthitis (inflamed foreskin/prepuce) • Balanitis Xerotica Obliterans (BXO) • Paraphimosis • Urinary retention • Penile cancer
what is paraphimosis ?
3 common causes
Paraphimosis
The painful constriction of the glans penis
by the retracted prepuce proximal to the
corona
Commonest Causes
Phimosis
Catheterisation (esp. Elderly)
Penile cancer
Phimosis
– In adulthood may be associated with other pathologies
– Beware the elderly man with a phimosis and‘balanitis’
– Circumcision is probably the best treatment
• Paraphimosis
– Needs reduction
• This is usually achieved manually
• Occasionally dorsal slit may be necessary
bonus info
penile cancer is what type of cancer ?
a squamous cell carcinoma - SCC
why circumcise
peadiarics - recurrent blantits
Adult – Recurrent balanitis – Phimosis – Recurrent paraphimosis – Balanitis xerotica obliterans – Penile Cancer
a patient presents with acute scrotal pain
this can be an emergency
what are the possible causes, which is the emergency ?
Testicular torsion -
Unilateral pain; may be nauseated/vomit; often no LUTS
Examination
• Testis is very tender
• Lying high in scrotum with horizontal lie
If you suspect testicular torsion, the patient needs emergency scrotal exploration
Do not waste time getting investigations such as ultrasound
• Epididymitis / Orchitis / Epididymo-orchitis
– Urinary tract infection (UTI)
– Sexually transmitted infection (STI)
– Mumps
- Torsion of hydatid of Morgagni
- Trauma
outline key facts about the condition - Epididymo-orchitis
investigations
treatment
an infected epididymis (testicle)
Age – 20-40/50 – STI (esp Chlamydia) – 40/50+ - UTI (esp. E. Coli) • Gradual onset • Usually unilateral • Often recent history of – UTI – Unprotected intercourse – Catheter/urethral instrumentation – Check for mumps history
upon examination May be pyrexial; can be septic • Scrotum erythematous • Testis/epididymis enlarged, tender • Fluctuant areas may represent abscess • May have reactive hydrocoele
• Rarely – necrotic area of scrotal skin (Fournier’s Gangrene)
– Fournier’s
• High mortality rate (approx 50%)
Epididymo-orchitis - Investigation • Bloods – FBC / U&E’s / Cultures if septic • Urine - MSU for MC&S • Radiology – Scrotal USS if suspect abscess or not settling Treatment •Epididymo-orchitis – Antibiotics •Abscess – Surgical drainage and antibiotics
testicular tumours - info
Germ cell tumours (Seminoma/Teratoma) usually in men aged <45 yrs
– Risk – history of undescended testis.
•Older men (Could be lymphoma)
can get above it - not hernia
send for ultrasound
• Testicular tumour
– Inguinal orchidectomy
what is a hydrocele
Slow/sudden onset • Uni/bilateral scrotal swelling • = imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis On Examination •Testis not palpable separately •Can usually ‘get above’ •Transilluminates
Adult hydrocele
– If normal testis on ultrasound
• Reassure; Surgical removal if large/symptomatic
what is an epididymal csyt ?
Usually painless On examination •Separate from testis •Can‘get above’ mass •Transilluminates
Epididymal cyst
– Reassure; Excise if large
what is a varicocele
Varicocele • Dull ache, at end of day • Lt > Rt • May be associated with reduced fertility (esp.if bilateral) On examination • “Bag of worms” above testis • NOT tender
• Varicocele – Reassure – Radiological embolisation • Symptomatic • Infertility (slow motility of sperm) • If present in adolescent and growth of testis affected
what is a lump that you cant get above?
if you cant get above the lump, it may be a inguinal scrotal herina
if this becomes strangulated then it can get ischaemic
emergency surgery
urinary retention - what is it ?
what are the causes ? - dont need to get all
Inability to pass urine, rather than inability to make urine
Prostatic enlargement – Benign prostatic hyperplasia (BPH) – Cancer • Phimosis/urethral stricture/meatal stenosis • Constipation • Urinary tract infection • Drugs – Anticholinergic actions • Over-distension – e.g. Too much fluids at party • Following surgery • Neurological
what are some causes of male LUTS - lower urinary tract symptoms
– Voiding (suggestive of bladder outflow obstruction)
• Hesitancy
• Poor flow
• Post micturition dribbling
– Storage
• Frequency
• Urgency
• Nocturia
could be an infection, neurological(parkinsons ect), Prostate (BPH), scarring of bladder, polyuria (uncontrolled diabetes)
