Urology and Male Health Flashcards
What is Testicular Torsion ?
Obstruction of blood flow to the testes due to twisting of the veins and arteries in the spermatic cord
What are s/s of Testicular Torsion?
Sudden onset with unilateral scrotal pain Abdominal Pain Testis is tender Palpation: Twisted spermatic cord Scrotal edema & erythema
How is Testicular Torsion diagnosed and treated?
Doppler US: No blood flow sounds
on affected side
Emergency urological referral
Surgery: 80-100% blood flow re-established if within 6 hours of onset
What is Epididymitis ?
Inflammation of the epididymis
Most common intrascrotal infection
How is Epididymitis diagnosed and treated?
Urinalysis - Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients
Complete blood count (CBC) - Leukocytosis
Gram stain of urethral discharge, if present
Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (these tests aid in detection of N gonorrhoeae and C trachomatis)
Performance of (or referral for) syphilis and HIV testing in patients with a sexually transmitted etiology
US of the scrotum confirms diagnosis
How is Epididymitis treated (STI related)?
Treatment: Initial treatment consists of bed rest
with scrotal elevation, ice packs and appropriate antibiotic
Ceftriaxone 250 mg IM x one dose
Doxycycline 100 mg BID X 10 days
Azithomycin 1 gm
How is Epididymitis treated ( NON-STI related)?
Ciprofloxacin 500 mg BID x 10 days
Ofoxacin 200mg to 300mg PO BID
Bactrim DS one tablet PO BID
What is an indirect hernia?
Indirect Hernia
Occurs when tissue herniates through the internal inguinal ring and descends into the scrotum
Sort swelling within the internal ring
What is an direct hernia?
Direct Hernia
Hernial sac protrudes through the abdominal wall into the Hesselbach’s triangle
Usually presents as a bulge in the Hesselbach’s triangle
Usually painless
Easily reducible
What is a strangulated hernia?
Hernia in which the blood supply to the entrapped bowel is diminished which becomes an emergent surgery
Colicky abdominal pain
Abdominal distention
Nausea & vomiting
What is a incarcerated hernia?
Hernia’s contents cannot be replaced into the abdomen
What is a reducible hernia?
Hernia is easily replaced in the abdomen
What diagnostics are indicated for hernias and treatments?
Ultrasound
Refer to Surgeon for further evaluation
What is a hydrocele?
Fluid sack ( collection of peritoneal fluid within the scrotum and surrounding the testes within the layers of the tunica vaginalis
What is the difference between communicating and non communicating hydrocele?
Communicating: incomplete closure of processus vaginalis which results in temporary retention of peritoneal fluid
Non-communicating: Closure of the processus vaginalis which traps the peritoneal fluid
What are signs and symptoms of hydrocele?
Painless swelling in the scrotum Scrotum may feel heavy and is enlarged Transillumination of scrotum Hernia shows black Hydrocele shows pink or red
What is treatment of hydrocele?
Communicating: Referral to Surgeon
Especially if it is a new hydrocele
Non-communicating: Observe
What is a Spermatocele ?
Cystic dilation of the epididymis
What are signs and symptoms of Spermatocele ?
Painless cystic mass (feels like a marble in scrotum)
Circumscribed mass in scrotum
Possible tenderness with palpation
What are indicated diagnostics and treatment for Spermatocele?
Scrotal Ultrasound
No therapy necessary unless mass is uncomfortable to patient
Refer to Urologist is patient is too uncomfortable
What is a Varicocele ?
Dilation of the pampiniform plexus which is usually caused by incompetent spermatic vein valves
What are signs and symptoms of Varicocele?
Sign & Symptoms include oligospermia, pain, infertility and decreased testicular growth
What diagnostics are indicated for Varicocele?
Doppler US
Decrease Sperm count
Intravenous pyelography to R/O renal tumor or obstruction
What is clinical treatment and management of Varicocele?
Immediate evaluation for sudden appearance of left-sided varicocele to rule out renal tumor If mild, left-sided varicocele in adult, observe Consult Urologist: Right sided varicocele New onset in adult Large varicocele Painful Older males Prepubertal boys Infertility Does not disappear when supine
Testicular cancer assessment shows?
Solid firm non-tender testicular mass
Hydrocele
Mass does not transilluminate
Fullness or heaviness in scrotum
What diagnostics are indicated for probable testicular cancer?
Scrotal US ( gold standard)
What is management and treatment for testicular cancer?
Refer to oncologist for treatment
Chemotherapy
Radiation
Surgical intervention; radical orchiectomy
What is Balanitis and it s/s?
Inflammation of the glans penis Etiology Bacterial or Fungal Symptoms & Signs Pain & Discharge (Purulent exudate; ulcerations) Edema & Inflammation
What is treatment for Balanitis?
Treatment
Gentle retraction of foreskin daily and soak in warm water
Topical antifungal (Add Keflex for mixed infection), steroid cream
What is Phimosis and its cause?
a condition of the penis where the foreskin cannot be fully retracted over the glans penis.
Etiology: Congenital Defect, Yeast Infection, Poor Hygiene
What is the treatment for Phimosis?
Acute Infections
Hot compresses or soaks
Antibiotic therapy(Tetracycline or Defadroxil)
Steroid Therapy: Betamethasone Dipropionate 0.1-0.05% BID x 4-6 weeks
What is Paraphimosis and s/s?
Foreskin retracted from glans & trapped proximal to coronal edge of glans
Signs & Symptoms
Edema
Swollen prepuce & glans
What is treatment of Paraphimosis?
Treatment Reduction of foreskin (early/mild case) Dorsal slit (severe)
What is BPH and its signs and symptoms?
Noncancerous enlargement of the prostate gland Urinary frequency Increased frequency during the night Weak urinary stream Difficulty starting to urinate Possible loss of bladder control Strong urge to urinate
What are indicated diagnostics for BPH?
UA PSA US of prostate Needle biopsy IVP, CT or MRI of prostate DRE-digital rectal exam Cystoscopy Urinary flow measurement Post-void volume measurement Ultrasound & Biopsy to R/O Cancer
When to intervene in BPH?
Absolute indications urinary retention recurrent urinary tract infection renal insufficiency gross hematuria
Relative indications
Elevated post-void residual
urodynamic evidence of obstruction
What is treatment for BPH?
Mild: closely observe Treatment of Absolute Indications TURP TUIP Open Prostatectomy Transurethral Vaporization of the Prostate Trial of a-blockers
What medication are used to treat BPH?
5-a reductase inhibitor
Proscar
Avodart
a-blockers Terezosin(Hytrin) Doxazosin(Cardura) Tamsulosin(Flomax) Alfuzosin(Uroxatral)
What are signs and symptoms Acute Prostatitis?
Local
Lower back & perineum
Systemic Fever Nausea Malaise Painful intercourse or decreased libido
Signs
Enlarged tender prostate
Don’t massage
What are diagnostics for Acute Prostatitis?
UA
Urine Culture
What are treatments for Acute Prostatitis?
Bactrim DS BID for 28 days
Cipro 500mg QD for 28 days
Doxycycline 100mg BID once and then daily for 28 days
Good hydration
Sitz bath
Refrain from sexual intercourse until symptoms resolve
What are s/s for Chronic Prostatitis?
Signs & Symptoms Early a.m. penile discharge vague urinary discomfort Prostate slightly enlarged & tender No nodules
What are the indicated diagnostics for Chronic Prostatitis?
Urine Culture
CT and/or US
PSA: Elevated
Cystoscopy
What are the treatments for Chronic Prostatitis?
Sitz Bath
Good hydration
Avoid tea, coffee, alcohol and other beverages which can cause diuresis
Fluoroquinolone daily for 4-12 weeks
Floxin 300mg BID for 4-12 weeks
Cipro 400mg BID for 4-12 weeks
What are s/s of Prostate Cancer?
Prostate feels hard and may be nodular Hematuria Lymphedema Lympadenopathy Anemia Urinary retention
What are diagnostics for Prostate Cancer?
US PSA elevated but can also be normal Alkaline Phosphatase: Elevated with metastasis CT MRI Biopsy
When do PSA and DRE screenings begin for men?
Annual digital rectal exam beginning at age 40 years
Annual PSA and DRE beginning at age 50 years
Early screening at 45 years of age for high risk groups
What are treatments for Prostate Cancer?
Prostatectomy Radiation Therapy ADT Chemotherapy Cryosurgery Immunotherapy
