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)
if its voiding symptoms it could be a BOO - bladder outflow obstruction - some causes are ……
– Physical
• Urethra
– Phimosis
– Stricture - spraying urine
• Prostate
– Benign
– Malignant
– Neurological
• Lack of coordination between bladder and
urinary sphincter
– Upper motor neurone
• Reduced contractility
– Physical
– Neurological
• Lower motor neurone lesion
what investigations should you do if they have a BOO
- DRE
• Is the bladder palpable?
what about BPH
• Dipstick - ? UTI, blood
• Consider PSA
– Counsel before requesting
– It is not a surrogate for DRE
looking to pick up BPH and more impotantly malignant issues
list some physical causes (not mental) of erectile dysfunction
Atherosclerosis. This causes
about 40% of ED cases in men aged over 50.
Smoking cigarettes, which is implicated in up to 80% of ED cases
As many as 25% of ED cases may be caused by
drugs taken to treat other conditions.
• Prostate gland surgery (or other surgery
around the pelvis).
Spinal cord injury. Almost a quarter of men with spinal injury are affected by ED.
regular drinking - Alcohol can damage the nerves leading to the penis, reduce testosterone levels and increase levels of the female hormone oestrogen.
what are some psychological causes of ED
Stress and anxiety Depression Relationship conflicts Sexual boredom Unresolved sexual orientation
not key
here are some treatments for ED read
Oral drugs
• Injection therapy: when injected, the drug (most commonly alprostadil, commonly known as
Caverject and Viridal), causes localised vasodilatation, producing an erection within 15 minutes.
• MUSE (medicated urethral system for erection). This method also uses alprostadil, but this time it’s
administered by means of a small pellet inserted into the urethra, the opening to the penis, via a
single-dose, disposable plastic applicator
- Vacuum pumps
- Penile implants
- Therapy
LUTS
Filling vs voiding symptoms
Filling symptoms:
urinary frequency, urgency, dysuria, nocturia.
Voiding symptoms :
poor stream, hesitancy, terminal dribbling,
incomplete voiding, overflow incontinence (occurs in chronic retention).
final card - some important things to remember on mens health
Men in the UK are at considerable risk of morbidity
and mortality from diabetes, cardiovascular disease and cancer
Mental health issues in men are common and are sadly
under-recognised
Detailed lifestyle/ social history is essential to evaluate
the CVS risk- several risk tools exist
Discussion of risk with a patient is essential to help
modify relevant risk factors
