Session 3 - Lecture 1 - Men's Health Urology Flashcards
2 - Learning Outcomes
• Men’s Health
– Penile • Foreskin – Phimosis, paraphimosis, penile cancer • Circumcision – Indications
– Scrotum • Acute scrotal pain – Torsion, epididymo-orchitis • Scrotal lumps – Testicular tumour, hydrocele, epididymal cyst, varicocele, hernia
– Urinary retention
• Acute, chronic, acute-on-chronic
– Male LUTS
• Causes, assessment, management of BPH
{3. understanding of urinary retention needed (often misunderstood in F1/2). Know the definitions for acute, chronic AoC
4. LUTS= lower urinary tract symptoms. Male lower urinary tract symptoms – v commonly indicated.}
4 - Phimosis: definition and incidence
Phimosis
•Prepuce cannot be fully retracted in adult
•Incidence – 1% adult non-circumcised population
•Famous phimotic
– Louis XVI
{Prepuce = foreskin}
5 - Physiological phimosis
Be aware of ‘Physiological’ phimosis
• ‘Normal’ non-retractability up to adolescence
– 50% at 1 year
– 10% at 3 years
– 1% at 17 years
{if you’re looking after a baby or child – it might not be abnormal
1c. adult population}
6 - Phimosis sequelae
Phimosis - sequelae
- Poor hygeine, STDs
- Pain on intercourse, splitting / bleeding
- Balanitis (inflamed glans)
- Posthitis (inflamed foreskin/prepuce)
- Balanitis Xerotica Obliterans (BXO)
- Paraphimosis
- Urinary retention
- Penile cancer
- Balanoposthitis
- BXO
{Why is it important? because it has sequelae.
- So some of these glans in elderly men haven’t seen the light of day in ages - Can often be poor hygiene in elderly men. Also linked to STD.
- In the younger person there might be
- loose glans
- scarred foreskin, probs had some infection, may have been split sometimes – scarred. Tip of penis – glans is often looking white – more scarred. And urethra – may have some strictures, the meatus (opening), bc of whiteness may have narrowing – meatal stenosis. Lichen sclerosus.
- So phimosis can have difficulty passing water, lead to urinary retention and
- penile cancer.}
7 - Paraphimosis
Paraphimosis
The painful constriction of the glans penis by the retracted prepuce proximal to the corona
Commonest Causes
Phimosis
Catheterisation (esp. Elderly)
Penile cancer
{Corona = crown, base circumference of glans
Paraphimosis – opposite of phimosis – foreskin has been retracted and can’t be retracted back over the glans and it gets swollen, tender, gets worse and worse over time - People tend not to go to the doctor’s too early because they’re embarrassed by it (younger people, older ppl may not even notice!) Causes can be intercourse, 1b - e.g. in a NH and the foreskin hasn’t been pulled back
1c. Paraphimosis can also be seen in penile cancer – raised foreskin.
Treatment: Usually what we do is put a penile block in – needle suprapubically, make the penis numb, put the foreskin back that way, or use a needle to take some of the oedema away if we can’t do that. Or actually make a slit in the foreskin temporarily to bring it back.}
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
