Urologic disorders 2 Flashcards
Phimosis
inability to retract the foreskin over the glans penis, congenital or acquired, may complain of obstructive voiding, hematuria, or pain
Phimosis treatment
no tx in asymptomatic, if symptomatic, refer for cicumcision, treat w/ BS abx, steroidal/nonsteroidal creams, check for diabetes
Paraphimosis
entrapment of the foreskin behind the glans, can be caused bu frequent catherization w/out reducing the foreskin, or by forcibly retracting a phimosis, also by vigorous sexual activity
Paraphimosis treatment
initially try manual reduction, surgery, urologic referral, circumcision highly recommended
Erectile dysfunction
consistent inability to maintain an erection with sufficient rigidity for sex, many causes, age related
normal erection requires
intact parasympathetic and somatic nerve supply, unobstructed arterial flow, adequate venous constriction, hormonal stimulation, and psychological desire
Determining the cause of ED
past med hx, meds, sex hx: timing and frequency, ejaculation and ability to masterbate, IIEF questionnaire, physical exam: look for deformities, atrophy, HTN, peripheral neuropathy
ED testing
CBC, UA, lipid profile, TSH, FT4, testosterone, glucose, prolactin, if abnormal check FSH and LH, also check nocturnal penile tumescence
ED treatment
psychogenic causes treat w/ behaviorally oriented sex therapy, PDE-5 I, sildenafil, vardenafil, tadalafil; avoid in pts taking nitrates
Hydrocele
mass of fluid filled congenital remnants of the tunica vaginalis, results from a patent processus vaginalis
Spermatocele treatment
usually not required, but large ones can be surgically removed or sclerosed
Hydrocele symptoms
soft, nontender fullness of hemiscrotum, mass transilluminates, mass may wax and wane, indirect hernia may be present
Spermatocele symptoms
painless, possible tenderness, less than 1 cm size, palpable, firm round cystic mass with distinct borders, free floatin above testicle, transilluminates
Testicular torsion
caused by testis being abnormally twisted on its spermatic cord, resulting in arterial supply and venous drainage being compromised, can lead to ischemia, most common in 12-18 yom, esp w/ hx of cryptorchidism
Testicular torsion sx
sudden onset of severe unilateral pain and scrotal swelling, testis painful to palpation, swollen testicle and scrotum, negative phrehn’s sign; doppler U/s shows dec blood flow to affected spermatic cord, radioisotope dec uptake
Testicular torsion tx
surgical emergency, if corrected within 6 hours full recovery
Varicocele
formation of venous varicosity w/in the spermatic vein, inc incidence more common w/ left spermatic vein “bag of worms”, chronic non tender, no transillumination
Varicocele dx and tx
clinical dx, but if inconclusive, doppler u/s method of choice; surgical repair if painful or cause of infertility
Benign prostatic hyperplasia
fibrostromal tissue of prostate is abnormally proliferated leading to prostatic urethra compression, urine obstruction, onset 60-65 yo, use AUA sx indec to assess sx severity
BPH sx
dec force of stream, sensation of incomplete emptying, postvoid dribbling, irritive sx, recurrent UTI, urinary retention, enlarged prostate on rectal exam
BPH labs and tx
PSA usually inc, R/O kidney, infection, ca; use a adrenergic agonists and 5 alpha reductase inhibitors, relieve obstruction, balloon dilation, microwave irradiation, stent placement, transurethral resection or incision of prostate
Prostate ca
disease of aging, rarely seen in men
Risk of prostate CA
genetic predisposition, hormonal influence, dietary and environmental factors, infectious agents
prostate CA sx
vary depending on severity, may have irritative voiding, but may have bone pain, back pain etc, usually nodular, enlarged and asymmetric, 10% with hyperplasia have malignancy
