Paulson - Male GU Flashcards
1
Q
consistent inability to maintain an erect penis w. sufficient rigidity to allow for intercourse
A
erectile dysfunction
2
Q
mc sexual problem in men
A
erectile dysfunction
3
Q
5 things required for an erection
A
intact parasympathetic and somatic nerve supply
unobstructed arterial inflow
adequate venous constriction
hormonal stimulation
psychological desire
4
Q
rf for ED (6)
A
- sedentary
- obesity
- smoking
- medical comorbidities
- watching TV
- lower frequency of sexual activity
5
Q
comorbities associated w. ED (8)
A
DM
HTN
obesity
OSA
dyslipidemia
CVD
smoking
RLS
6
Q
sexual activity < __ / week is associated w. ED
A
once
7
Q
mc cause of ED
A
decrease in arterial flow from progressive vascular dz
8
Q
mc medication associated w. ED
A
SSRIs
9
Q
besides SSRIs, 3 common meds related to ED
A
beta blockers
spironolactone
thiazide diuretics
10
Q
psychological factors associated w. ED
A
dpn
stress
11
Q
neuro causes of ED (3)
A
stroke
SCI
MS
12
Q
sport related to ED
A
bicycling
13
Q
endocrine d.o related to ED (2)
A
testosterone deficiency
hypo/hyperthyroidism
14
Q
examples of questions to ask ED pt
A
chronic, occasional, situational?
normal erections (ex early morning)?
trauma to pelvis?
pelvic/prostate xrt?
drugs/etoh/tobacco?
15
Q
what might you see on pe for ED (5)
A
scarring
plaque formation
testicular atrophy
peripheral neuropathy
HTN
16
Q
why might you see plaque formation on ED pt
A
peyronie dz
17
Q
what labs might be helpful for ED dx (7)
A
CBC
UA
TSH
lipid panel
serum testosterone
glucose
prolactin
18
Q
what test might be helpful to dx ED (2)
A
nocturnal penile lumescence testing
direct injxn of vasoactive substances
19
Q
ex of vasoactive substance
A
prostaglandin E1
20
Q
if prostaglandin E1 does not produce erection what is next step in dx of ED (3)
A
US of cavernous arteries
pelvic arteriography
cavernosonography
studies to evaluate arterial/venous vasculature
21
Q
tx for psychogenic ED (2)
A
behaviorally oriented sex therapy
counseling
22
Q
tx options for ED (8)
A
behavior sex therapy
T replacement
wt loss
PDE-5
penile injxns
intraurethral alprostadil
vacuum erection device
surgery
23
Q
tx for low T ED
A
testosterone replacement
24
Q
how can T be administered (3)
A
injxn
gel
patches
25
s.e of T replacement
HTN
worsens BPH
worsens CHF
increased breast ca risk
hepatic toxicity
VTE
prostate ca
application site pruritis
virilization in other exposed (ex nurse, kids)
26
mainstay of ED tx
phosphodiesterase-5 inhibitors (PDE-5)
27
ex of PDE-5 (3)
sildenafil (viagra)
vardenafil (Levitra)
todalafil (Cialis)
28
when should PDE-5 be taken
45-60 min before anticipated sexual activity
29
absolute contraindication to PDE-5
nitrates
30
if a man on PDE-5 develops CP you should
delay nitrate by 24 hr
31
PDE-5 plus alpha blockers can result in
decreased bp
32
s.e of PDE-5 (2)
blue vision
sudden hearing loss
33
which PDE-5 causes blue vision
sildenafil (viagra)
34
what is a penile injection
PDE-5 injected into base of penis → causes smooth m relaxation in corpus cavernosum
35
penile injxns should be administered __ minutes before sex,
and the erection an last \> \_\_
10-20
60 min
36
what drug is used in intraurethral alprostadil
prostaglandin E1 tablet inserted into urethra → massage penis for 1 min
37
s.e of intraurethral alprostadil
penile pain and bleeding
38
contraindications for intraurethral alprostadil
SSA/sickle cell trait
leukemia
MM
any conditions that increase risk for a priapism
39
what is a priapism
prolonged erection
40
vacuum erection devices are used in conjunction w. (2)
occlusive penile rings
+/- PDE-5 inhibitors
41
vacuum erection devices may cause difficulty with
ejaculation
42
max application of vacuum erection device
30 min
43
how long does erection last w. vacuum erection device
until elastic ring is removed
44
s.e of vacuum erection device
penile bruising
45
surgical options for ED
penile prosthesis
vascular reconstruction
arterial bypass
46
2 types of penile prosthesis
rigid
inflatable
47
ejaculation that always or almost always occurs w.in or prior to 1 minute of vaginal penetration
premature ejaculation
48
3 negative consequences of premature ejaculation
distress
frustration
avoidance of sexual intimacy
49
what % of male population has premature ejaculation
~4%
*30% based on community surveys*
50
30% of men w. premature ejaculation have concurrent
ED
51
3 pharm tx for premature ejaculation
SSRIs
PDE-5 inhibitors
tramadol
52
\_\_ are first line tx for premature ejaculation
and also a major cause of \_\_
SSRIs
ED
53
SSRI suffix (2)
- tine
- pram
54
SSRI dosing for premature ejaculation
lowest dose → titrate up PRN q 3-4 weeks
55
most effective SSRI for premature ejaculation
paxil (paroxetine)
56
tx for premature ejaculation w. coexisiting ED
pde-5 inhibitors
57
last line tx for premature ejaculation
tramadol (ultram)
58
topical options for premature ejaculation
topical anesthetics → **lidocaine**
topical alprostadil cream
59
s.e of topical alprostadil cream (4)
burning and erythema
meatal/glandular pain
prolonged painful erection
vaginal burning/itching in female partner
60
behavioral therapy for premature ejaculation (5)
squeeze technique
start/stop technique
sensate focus
pelvic floor rehab
psychotherapy and/or relationship counseling
61
focusing on touch other than genitals to encourage body awareness while reducing performance anxiety
sensate focus behavioral therapy
62
what improves pharm tx of premature ejaculation
behavioral therapy
63
4 scrotal abnormalities
varicoele
hydrocele
spermatocele
testicular ca
64
sx of scrotal abnormalities
generally asymptomatic
65
dilatation of pampiniform plexus of spermatic veins
varicocele
66
varicoceles are usually __ sided
left
67
varicoceles usually appear at __ and enlarge over time
puberty
68
varicoceles are usually asymptomatic, 5 symptoms if not
dull, aching scrotal discomfort
atrophy of left testicle
decreased fertility
left sided scrotal fullness on valsalva
69
scrotal discomfort w. varicocele is worse w. \_\_
and relieved w. \_\_
standing
sitting/laying down
70
what do you think when you see: large left sided scrotal mass “bag of worms” that decompresses/disappears in recumbent position
varicocele
71
do varicoceles commonly need intervention
no
72
indications for intervention w. varicocele (2)
21 yo or younger
e.o testicular atrophy and/or abnormal semen analysis
73
intervention for younger pt w. varicocele if e.o testicular atrophy and/or abnormal semen analysis (2)
surgical ligation
or
percutaneous venous embolization
74
if semen analysis is normal in previous pt,
monitor w. semen analysis q 1-2 years
75
intervention (if any) for older pt w. varicocele (3)
semen analysis q 1-2 years to assess fertility
scrotal support
NSAIDs
76
collection f peritoneal fuid btw parietal and visceral layers of tunica vaginalis
hydrocele
77
mc cause of hydrocele
idiopathic over a long period of time
78
if not idiopathic, hydrocele can be caused by
acute reactive inflammatory conditions of scrotal contents
79
3 ex of acute reactive causes of hydrocele
epididymitis
torsion
appendiceal torsion
80
sx of hydrocele
soft small-massive collections of several liters
+/- pain/disability
81
what do you think when you see, large scrotum that transilluminates well
hydrocele
82
definitive dx for hydrocele
US
83
do hydroceles commonly need intervention
no
84
indication for surgical excision of hydrocele (2)
symptomatic w. pain/pressure sensation
scrotal irritation
85
epidermal cyst in head of epididymis that is \> 2 cm
spermatocele
86
spermatoceles have increased frequency in pt whose mom used
diethylstilbestrol during pregnancy
87
do spermatoceles commonly require intervention
no
88
surgical excision of spermatocele is indicated if pt has
chronic pain
89
what condition presents in 50% of men 40-50 yo and \>80% of men over 80 yo
benign prostatic hyperplasia (BPH)
90
what decreases risk for bph
excessive etoh
91
rf for bph (3)
obesity
heart dz
aa
92
what pt population requires tx more often for bph
aa
93
where does bph develop (2)
periurethral zone
transitional zone
94
what 2 things are needed for bph
older age
functioning lyedig cells
95
bph is generally
asymptomatic
96
2 types of lower urinary tract symptoms (LUTS) of bph
strorage
voiding
97
storage sx of bph (3)
increased daytime frequency
nocturia
urinary incontinence
98
voiding sx of bph (6)
slow urinary stream
spitting/spraying of stream
hesitancy
straining to void
terminal dribbling
99
pe for bph should include
dre
100
normal prostate is the size of a \_\_, and texture is
\_\_
and \_\_
walnut
firm, nontender
101
tender prostate suggests
prostatitis
102
mc cause of prostatitis in older men
e.coli
103
mc cause of prostatitis in younger men
chlamydia
104
nodules in prostate suggest
malignancy
105
3 dx labs for bph
ua
psa
bmp → creatinine
106
ua for bph may show
hematuria
UTI
107
elevated creatinine in bph eval may suggest
renal failure
obstruction
108
behavior mods for bph (3)
avoid fluids prior to bedtime
reduce caffeine/etoh
double voiding
109
2 pharm tx for bph
alpha-1 adrenergic antagonists
5-alpha reductase inhibitors
110
initial pharm therapy for bph
alpha-1 adrenergic antagonists
111
ex of alpha-1 adrenergic antagonists
**tamsulosin (flomax)**
terazosin
doxazosin (cardura)
silodosin (rapaflo)
112
when are alpha-1 adrenergic antagonists taken
at bedtime
113
s.e of alpha-1 adrenergic antagonists (3)
hypotn
dizziness
ejaculatory dysfxn
114
what drug do alpha-1 adrenergic antagonists interact w.
PDE-5 inhibitors
115
what pharm reduces size of prostate
5-alpha reductase inhibitors
116
tx w. 5-alpha reductase inhibitors usually lasts \_\_
before symptomatic relief is seen
6-12 mo
117
ex of 5-alpha reductase inhibitors (2)
finasteride (proscar)
dutasteride (avodart)
118
5-alpha reductase inhibitors reduce risk of
prostate ca
119
s.e of 5-alpha reductase inhibitors (3)
decreased libido
ED
ejaculatory dysfxn
120
5-alpha reductase inhibitors are dangerous for
pregnant women → *shouldn't touch tablets*
121
PSA concentrations will __ w. 5-alpha reductase inhibitors
decrease
122
tx for severe bph
combo of 5-alpha reductase inhibitors PLUS alpha-1 adrenergic antagonists
123
what tx is not recommended for bph
**herbal →**
saw palmetto, beta-sitosterol, cermilton,
pygeum africanum
124
indication for surgical intervention in bph
persistent/progressive sx **despite combo tx for 12-24 mo**
125
4 surgical options for bph
transurethral resection of prostate (TURP)
transurethral ablation
simple prostatectomy
prostatic arterial embolization
126
5 complications of bph surgery
sexual dysfxn
postprostatectomy syndrome
bleeding
urethral strictures
urinary incontinence
acute urinary retention
recurrent UTIs
hydronephrosis
renal failure
