Session 3: Men’s Health Flashcards
What are the ways men’s urological probelms can present, especially in terms of LUTS and testicular torsion?
Urinary retention: BPH, cancer, phimosis/urethral stricture, meatal stenosis, constipation, UTI, drugs (anti-cholinergic), over distention, after surgery, neurological
‘Older men with nocturnal enuresis have chronic retention with overflow incontinence until proven otherwise
What is phimosis/paraphimosis?
Phimosis - prepuce cannot be fully retracted in adult (can be physiological but at 17 only 1%)
If remain untreated - can get STD’s, pain on intercourse, splitting/bleeding, balanitis (inflamed glans), posthitis (inflamed prepuce), balanitis xerotica obliterans, paraphimosis, urinary retention,penile cancer. If present in adulthood - usually associated with other pathologies, circumcision is best option
Paraphimosis - the painful constriction of the glans penis by the retracted prepuce proximal to the corona (usually due to phimosis, catheterisation or penile cancer). Needs manual reduction (may need dorsal slit)
What are the common causes of scrotal lumps and how can you differentiate between these differentials?
Painless, non tender: Tumour, epidiymal cyst, hydrocele, reducible inguino-scrotal hernia Painless/aching at end of day: Varicocele Acute pain, tender: Epididymitis Epididymo-orchitis Strangulated inguino-scrotal hernia
Hydrocele v epididymal cyst:
Hydrocele - testes not palpable separately, wheras cyst - testes can separaet from cyst
How do you take a history of a man presenting with lower urinary symptoms and the different ways voiding/storage problems present?
Voiding - hesitancy, flow, dribbling, blood, nocturial incomplete empyting, how often
Storage - frequency, urgency, nocturia
Prostate score - IPSS, PSA
What is the most important differential to be aware of when concerned with men with LUTS?
Urological malignancies such as testicular carcinoma. Usually painless, in older men unless germ cell tumours (seminoma/teratoma). Body of testis is abnormal, can get above Penile cancer (v unlikely) - risk factors include phimosis as this affects hygeine as well as HPV 16 and 18. If untreated - dead within 2-5 years
How do men with mental health disorders present and barriers to their health seeking behaviour and the importance of their treatment?
Embarrassed, ashamed to take time off work, think employer would think worse of them
More likely ro respond ro stress by risk taking behaviours such as alcohol use, relationship breakdowns and men don’t have a positive view on talking therapies
What are the common trends of clinical presentation for men in general practice in the UK and the importance of lifestyle modification?
Lifestyle modification - reduce longitudinal risks of CVD and CVS
1/5 men die before 65 Leading causes: Over 85: cancer (prostate) Diabetes/obesity 50-64: heart disease 20-34: suicide
What are the causes of acute scrotal pain?
Testicular torsion
Epididymitis/orchitis/epididymo-orchitis (caused by UTI, STI or mumps)
Torsion of hydatid of morgagni (embryological remenant at top of testicle)
Trauma
Ureteric calculi (referred pain)
How does testicular torsion present?
Usually young (below 30) Sudden onset Unlateral pain Associated nausea/vomit No LUTS Testis are very tender, lying high in scrotum with horizontal lie EMERGENCY (USS)
How does epididymo-orchitis present?
Causes: Age 20-40 - usually STI (chlamydia) Age 50 onwards - usually UTI (E.Coli) Gradual onset Unilateral Recent history of unprotected sex, UTI, catheter, mumps history? Can be pyrexial/septic Scrotum erythematous Testis/epididymis enlarged and tender Fluctuant areas - abscess May have reactive hydrocoele Give antibiotics Sometimes necrotic area of skin - fournier’s gangrene (high mortalitiy) - usually diabetic, can spread. Emergency dibridement
How is BPH treated?
ALpha blockers - relax smoorh muscle within prostate and bladder neck
5alpha reductase inhibitors - shrink the prostate by inhibiting androgens
Transurethral resection of prostate
What else should you investigate in prostate cancer?
Neurological deficit - metastasise to bone
What are the causes of erectile dysfunction?
Atherosclerosis Smoking Damage to blood vessels when cycling Diabetes Heavy drinking - damaging nerves in penis, reduce testosterone and increased oestrogen Spinal cord injury Stress/anxiety Depression Relationship conflicts Sexual boredom Unresolvedsexual orientation
