Mens Health - Urology Flashcards
What is phimosis
•Prepuce cannot be fully retracted in adult •Incidence – 1% adult non-circumcised population
Physiological phimosis:
‘Normal’ non-retractability up to adolescence – 50% at 1 year
– 10% at 3 years
– 1% at 17 years
What are the sequel ae of phimosis
- Poor hygeine,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
The painful constriction of the glans penis by the retracted prepuce proximal to the corona Swollen and tender Commonest Causes Phimosis Catheterisation (esp. Elderly) Penile cancer
What are the treatments for phimosis and paraphimosis
• 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
Describe penile cancer
People lump, red patch thats not going away - red flag
• c.350 new cases/yr/UK
• 20%<50yrsold
• Risk factors
– Phimosis – hygiene - smegma
– HPV 16 & 18
Malignant
• Untreated, most †< 2yrs, almost all < 5yrs
• Important not to miss – GP may only see one in their lifetime
What are the key indications for circumcision
• Paediatric – Religious – Recurrentbalanitis/UTIs • Adult – Recurrentbalanitis – Phimosis – Recurrentparaphimosis – Balanitis xerotica obliterans – Penile Cancer
What a re teh causes of acute scrotal pain
• Testicular torsion
• Epididymitis / Orchitis / Epididymo-orchitis
– Urinary tract infection (UTI)
– Sexually transmitted infection (STI)
– Mumps Both testicular swollen and tender. Mumps can cause sterility
• Torsion of hydatid of Morgagni - Embryologyical Remnant on top of testicle can twist in young boys.
• Trauma
• Ureteric calculi (rarely) - Small stone from kidney down ureter to vuj, gets stuck. Referred pain to testicle. Pain but no tenderness. Get a dipstick.
Describe teh history and examination of testicular torsion
Testicular Torsion - History
• Usually younger patient (<30 y)
• SUDDEN onset e.g. woke from sleep
• Unilateral pain; may be nauseated/vomit; often no LUTS
Testicular Torsion - 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
What is epididymo-orchitis
• 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
Describe teh examination findings for epididymis-orchitis
• 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%) Common in diabetics. A drug that blogs reabsorption og glucose in pct - increased risk of Fournier bc gycosuris
Describe teh investigation ad treatment fo epididymo-orchitis
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
•Fournier’s gangrene – Emergency debridement & antibiotics
Describe the history and examination for scrotal lumps
History •Is it painful? •How quickly has it appeared? Examination •Can I get ‘above it’? – If not, it is likely to be a hernia •Is it in the body of the testis? – If yes, this could be a testicular tumour! •Is it separate to the testis? •Does it fluctuate and transilluminate?
Describe the presentation for different testicular lumps
Opportunistic presentations •Painless scrotal lump – Not tender – Testis tumour – Epididymal cyst – Hydrocele – Reducible inguino-scrotal hernia •Painless/Aching at end of day – Not tender – Varicocele Acute presentation with scrotal lump •Painful – Tender – Epididymitis – Epididymo-orchitis – Strangulated inguino-scrotal hernia - emergency
Desribe the history and examination of testicular tumours
History
•Usually painless
•Germ cell tumours (Seminoma/Teratoma) usually in men aged <45 yrs
– Risk – history of undescended testis. •Older men (Could be lymphoma)
On examination
•Body of testis is abnormal; can ‘get above’ Refer via 2 week wait to Urology
•Urology will
– Arrange urgent ultrasound of scrotum to confirm diagnosis
– Check testis tumour markers (aFP, hCG, LDH)
•The average GP may only see two in their lifetime!
Describe hydrocoele in an adult history and examination
• 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
