Module 7 common health concerns middle aged man Flashcards
Prostate and urethra
urethra runs through the center of the prostate
BPH s/s
urinary frequency urgency urinary difficulty nocturia difficulty starting urination/hesitancy dribbling decreased force straining WITH incomplete bladder emptying
Dx of BPH
through symptoms scores/tools
physical exam: GU including DRE
UA to exclude UTI
Bladder scan for post-void residual
BPH labs
UA
creatinine
PSA
BPH behavior modifications
dec. fluids before bed
look at current medication regimen
limit use of ETOH and caffeine
BPH Rx
alpha blockers: smooth muscle relaxers
a-adrenergic antagonist
5a reductase inhibitors
phosphodiesterase type 5 inhibitors
Etiologies of sexual dysfunction
vascular: 40%
diabetes: 30%
medication: 15%
pelvic surgery, radiation or trauma: 6%
neurological: 5%
endocrine: 3%
other: 1%
sexual dysfunction hx
onset, duration, circumstances erection quality changes to libido, curvature multiple partners? PMH
sexual dysfunction dx
Hx and physical exam
physical exam
- genital anatomy and identify any abnormalities
– testicular atrophy, gynecomastia, hyper/hypothyroidism
– pulses in BLE, vascular skin changes, femoral bruit
Diagnostic
- treat any underlining cause: hormone, A1C, testosterone
sexual dysfunction Rx
phosphodiesterase-5 inhibitors
Referral: urology, counseling
Lifestyle: no ETOH/drugs before sex
male hypogonadism s/s
Low Testosterone reduced libido/erectile dysfunction reduced muscle mass and strength inc. adiposity: around trunk osteoporosis/low bone mass depressed mood fatigue
male hypogonadism causes
Primary - injury, infection, loss of testicles - chemo or radiation - genetic: klinefelter Secondary - age - genetic conditions - pituitary tumors - medications - alcohol - corticosteroids - chronic disease
male hypogonadism dx
testosterone levels
- bound vs unbound
FSH and LH
Hypogonadism management
pharmacologic:
- injectable meds, gels, patches
Contraindications:
- breast/prostate cancer
Caution:
- BPH, LUTS, cardiac/renal/hepatic disease
- Can worsen sleep apnea
Other considerations
- expensive
- mood swings
testosterone hormone replacement
initially hormone levels will decrease because testicles stop production of testosterone
Disorders of desire
reduced libido - biologic - psychologic - sociocultural factors Testosterone, androgen, and DHEA hormones - screening for hypogonadism at 50
pathophysiology of erection
chemical mediators cause relaxation and perfusion of the corpora cavernosa and corpus spongiosum
- > vein compression to prevent venous outflow
- > maintained erection
disorders of excitement psychogenic
performance anxiety guilt strict religious constraints significant life events mood past traumas
disorders of excitement hormonal
testosterone deficiency - hypothalamic or pituitary tumors - suppressed testosterone tx: prostate cancer hyperprolactinemia hyperthyroidism hypothyroidism cushing syndrome addison disease
disorders of excitement CV
CV disorders can lead to
- failure to initiate erections
- failure to achieve erection
- failure to sustain erection
disorders of excitement pharmacologic
antiHTN
antidepressants
major tranquilizers
disorders of excitement surgical
radical prostatectomy
radical cystectomy
abdominal-perineal resection
disorders of excitement alcohol/opioid use
men with heroin addiction or who are on methadone or buprenorphine show higher rate of sexual dysfunction
Disorders of orgasm
low testosterone neurologic diseases head and spinal cord injuries Medications: - HTN - antidepressants - anxiolytics - antipsychotics Alcohol
