WALDEN Flashcards
Painful erection for 2-4 hours, ischemic form is medical/surgical emergency
Priapism
Hard fixed, nodule, heaviness or aching, one testicle larger than other,
hydrocele from tumor, painless asymptomatic until Metz,
- Dx, Gold standard testicular
biopsy, US of testes, refer to urology, for surgical removal (orchiectomy)
Testicular cancer
most common cancer in men, new onset of low back pain, rectal
perianal area, obstructive voiding symptoms, weak stream, nocturia, risk factor obese and
family history, >50 years old,
- Dx routine screening not recommended,
Prostate Cancer
blue dot sign, blue colored round mass located on
testicular surface, polyp like structure attached to testicular surface, infarction and
necrosis of the appendix due to torsion, refer to ER
Torsion of the appendix testes
Abrupt onset extremely painful and swollen red scrotum, N/V,
affected testes higher and closer to body, the cremasteric reflex is missing, >not corrected in <6 hours permanent damage, if not corrected in 24 hours becomes gangrene, common in males with bell clapper deformity
- DX call 911, US doppler preferred test, manual reduction or surgery, elevated PSA, biopsy of prostate tissue, PSA level with DRE
- TX refer to urologist, individualize screen per risk factors
Testicular torsion
Enlargement of the veins within the scrotum, bag of worms, testicular tumor, can cause infertility,
- DX US of scrotum,
- TX surgical removal of varicosities
Varicocele
Fluid filled sac around testicle, swelling of scrotum, asymptomatic
- DX will glow with transillumination, US of scrotum,
- TX refer to urologist
Hydrocele
Are found in the Hesselbachs triangle
Direct inguinal hernias
Are common on the right side internal ring
Indirect inguinal hernia
A testicle that has not moved into the bag of skin below the penis
before birth, maybe one or two, increases risk of testicular cancer
Cryptorchidism
Gradual development of urinary obstruction, weak urinary stream, postvoid dribbling, occasional urinary retention,
- Dx PSA is elevated, prostate enlarged,
- TX alpha adrenergic antagonist- terazosin/Hytrin-first for patients with HTN, Flomax, or Proscar- shrinks prostate by 50 %
BPH
> 6 weeks infection, gradual onset, asymptomatic or UTI, caused by E. coli, suprapubic or perineal pain, irritative voiding, dysuria, nocturia, frequency, boggy prostate, urine and prostatic fluid cultures, three tubes, PSA elevated, - TX Bactrim, fluoroquinolone
Chronic bacterial prostatitis
Infections ascends to urinary tract, E.coli, sudden onset of high fever, chills, suprapubic pain perineal discomfort, radiates to back to rectum, UTI, symptoms,
- DX DRE reveals tender prostate warm and boggy, CBC shows leukocytosis, pyuria, urine culture,
- TX ceftriaxone tetracycline, macrolide, fluoroquinolone, refer if septic shock
Acute prostatitis
Bacteria ascend the urethra, urethritis, reaching epididymis, rule out testicular torsion, E.coli, swollen red scrotum, unilateral testicular tenderness with urethral discharge, hydrocele with symptoms of UTI, fever, green colored purulent or serous clear discharge, Prehn’s sign positive with relief of scrotal elevation
- DX leukocytosis pyuria, hematuria, Urine culture, test for gonorrhea/chlamydia
- TX ceftriaxone, doxycycline, or fluoroquinolone
Acute bacterial epididymitis
Due to vascular insufficiency, neuropathy, medications, smoking,
alcohol
- TX first line phosphodiesterase type 5 inhibitor, Viagra Levitra
Erectile dysfunction
