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METABOLIC > UROLOGY - ANDROLOGY > Flashcards

UROLOGY - ANDROLOGY Flashcards

1
Q

What is andrology?

A

medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men

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2
Q

What are some common conditions that andrologists deal with>

A

Erectile dysfunction
Peyronie’s disease
Sub-fertility

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3
Q

What causes lack of libido?

A

In some instances this is due to low serum testosterone levels, but more commonly the testosterone is normal and reduced libido is attributed to psychological factors or lifestyle stresses

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4
Q

What is erectile dysfunction?

A

the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

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5
Q

What causes erectile dysfunction?

A

Vascular, e.g. complicating peripheral vascular disease, especially in smokers and the obese; often associated with systemic cardiovascular disease
• Neurogenic, e.g. in diabetic neuropathy or spinal cord lesions
• Anatomical
• Hormonal, e.g. in hypogonadism or hyperprolactinaemia
• Drug-induced, e.g. beta-blockers
• Psychogenic

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6
Q

How is erectile dysfunction pharmacologically managed?

A

PDE5 inhibitors such as sildenafil
Topical and intra-urethral alprostadil application

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7
Q

What lifestyle changes can a person make to improve erectile dysfunction?

A

Regular exercise
Reduction in body mass index
Smoking cessation
Reducing alcohol consumption

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8
Q

How do PDE5 inhibitors work?

A

They competitively bind to PDE5 and inhibit cGMP hydrolysis, thus enhancing the effects of NO. This leads to lowered calcium levels in the cytoplasm which causes vasodilation and smooth muscle relaxation which increases penile arterial blood flow

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9
Q

What are the contraindications for PDE5 inhibitors?

A

If SBP is <90
Patients in whom vasodilation or sexual activity are in advisable
Recent unstable angina/MI/stroke/life-threatening arrythmia in past 6 months
Hypertension
Severe congestive HF

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10
Q

What non-pharmacological option is there first-line for managing erectile dysfunction?

A

Vacuum erectile device - provides passive engorgement of the corpora cavernosa

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11
Q

What are second line therapies for erectile dysfunction?

A

Intracavernous alprostadil injections (prostaglandin E1)
Surgical implantation of prenile prosthesis - third-line

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12
Q

What is phimosis?

A

a condition in which the contracted foreskin has a tight, narrow orifice and cannot be retracted over the glans of the penis
A physiological phimosis is present at birth, but through penile growth, erection and accumulation of smegma under the foreskin, separation occurs, enabling the foreskin to be retracted. By the age of 17, only 1% of boys will have a pathological phimosis.

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13
Q

What causes pathological phimosis?

A

Poor hygiene and recurrent episodes of balanitis or balanoposthitis

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14
Q

What is balanitis?

A

Pain and inflammation of the glans penis

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15
Q

What is balanoposthitis?

A

Inflammation of the glans penis and foreskin

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16
Q

How is phimosis treated?

A

Circumcision
Corticosteroid cream and antibiotics - treats underlying balanitis and softens the phimosis.

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17
Q

What is paraphimosis?

A

an inability to return the retracted foreskin to its resting position

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18
Q

Why is paraphimosis a medical emergency?

A

Prolonged retraction can cause venous congestion, oedema, arterial occlusion and eventually necrosis

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19
Q

How is paraphimosis managed?

A

Manual pressure to the glans
Application of dextrose-soaked gauze
The Dundee technique
Dorsal slit - incision
Emergency circumcision

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20
Q

Why can applying dextrose-soaked gauze treat paraphimosis?

A

It has an osmotic effect, drawing fluid out of the glans and reducing the oedema

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21
Q

What is the Dundee technique?

A

The use of needle punctures into the glans penis, squeezing the area to allow drainage of oedematous fluid, before attempting reduction of the glans using other methods

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22
Q

What is testicular torsion?

A

The lateral to medial twisting of the spermatic cord. This results in strangulation of the blood supply to the testis and the epididymis

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23
Q

What age is peak incidence for testicular torsion?

A

13-15

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24
Q

How does testicular torsion present?

A

a short history (less than 12 h) of severe, sudden-onset hemi-scrotal pain, which sometimes wakes them from sleep and can radiate to the groin, loin or epigastrium. The pain is associated with nausea and vomiting, and an altered, broad-based ‘cowboy’ gait

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25
Q

What is prehn’s sign?

A

A test where you lift Half of the scrotum and assess changes in pain levels

A negative Prehn’s sign, or exacerbation of pain upon elevation of the testicle, is one of the clinical features of testicular torsion.

A positive Prehn’s sign, or relief of pain upon elevation of the scrotum, is associated with acute or chronic epididymitis.

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26
Q

How can you diagnose testicular torsion?

A

Negative prehn’s sign
Cremasteric reflex absent

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27
Q

How is testicular torsion managed?

A

Immediate surgical exploration
Detorsion
Bilateral orchidopexy - fixation of testicular to prevent recurrent torsion is performed in both testicles

28
Q

What is epididymitis?

A

Acute or chronic inflammatory condition of the epididymis

29
Q

Whats it called when the epididymitis involves a testicle?

A

Epididymis-orchitis

30
Q

What causes epididymitis?

A

Bacterial infection that ascends from the urethra or the bladder.
In sexually active men the infective organism is usually Neisseria gonorrhoeae, Chlamydia trachomatis or a coliform bacterium.
In older men and children the infective organisms are usually common urinary tract pathogens like Escherichia coli.

31
Q

How does epididymitis present?

A

the duration of pain is usually longer than that of testicular torsion and is of gradual onset. The pain can be associated with symptoms of urethritis, cystitis or prostatitis.
On examination the patient may have a fever and appear systemically unwell. The epididymis will be tender and swollen on palpation. The hemi-scrotum is often swollen and warm to the touch, and erythematous skin changes can be seen. Urinalysis may also show signs of infection.

32
Q

How is epididymitis managed?

A

Patients should be treated for the most likely organism, and scrotal elevation is advised to reduce swelling

33
Q

What is a hydrocele?

A

an abnormal collection of fluid within the tunica vaginalis of the scrotum or along the spermatic cord
It can be caused by inflammation or injury

34
Q

How does a hydrocele present?

A

It is usually painless but the testicle is difficult to palpate due to the tense fluid collection. The superior margin of the hydrocele is palpable. The fact that the clinician can ‘get above’ the lump differentiates a hydrocele from an inguinal hernia. It is also possible to transilluminate it.

35
Q

When is surgical excision of a hydrocele indicated?

A

If its large and uncomfortable

36
Q

What is a varicocele?

A

dilation of the pampiniform plexus of veins surrounding the testis and extending up into the spermatic cord

37
Q

Why are varicoceles more common on the left side?

A

due to drainage of the gonadal vein into the left renal vein

38
Q

How can a varicocele present?

A

When symptomatic, patients describe a dragging sensation or a dull ache in the scrotum

39
Q

Rarely, what can a varicocele be a sign of?

A

Renal maliganncy

40
Q

What is cryptorchidism?

A

Undescended testes

41
Q

Outline testicular descent?

A

Testicular descent occurs in two phases:
• at 7–8 weeks’ gestation the testes descend from the genital ridge to the internal inguinal ring
• at 24–28 weeks’ gestation the testes pass through the inguinal canal into the scrotum.

42
Q

What are the rates of undescended testes in full-term vs pre-term neonates?

A

Full term - 1-4.6%
Preterm 45%

43
Q

Whats the problem with undescended testes?

A

These patients have an eight-fold higher risk of testicular cancer and a 4% life-long risk of cancer in the intra-abdominal testis. They have reduced fertility, although this improves if orchidopexy is performed before 2 years of age. They are also at increased risk of testicular torsion and inguinal hernia formation.

44
Q

What is priapism?

A

a long-lasting painful erection

45
Q

Why is priapism a medical emergency?

A

Without prompt resolution, permanent damage to the penile tissue occurs, resulting in permanent erectile dysfunction.

46
Q

Who does priapism most commonly affect?

A

people with sickle cell disease

OtherS:
People on treatment for erectile dysfunction, blood disorders
Use of recreational drugs

47
Q

How is priapism treated?

A

Penile aspiration
Lavage
Intracavernosal infection of a sympathomimetic with action on alpha adrenergic receptors CNS be given

48
Q

What is prostatitis?

A

Inflammation of the prostate gland

49
Q

How does acute prostatitis present?

A

Symptoms of a severe UTI, including dysuria, frequency, malaise, fever and genital region pain. The prostate is found to be swollen and tender on digital rectal examination.

50
Q

What organisms cause acute prostatitis?

A

Various gram negative organisms responsible for UTIs
Organisms that cause STD e.g. chlamydia trachomatis and neisseria gonorrhoeae

51
Q

How does chronic prostatitis present?

A

3 months of pain, urinary symptoms and sexual dysfunction (with pain being the main feature)
Voiding difficulties and erectile dysfunction are common

52
Q

Who does chronic prostatitis typically affect?

A

Men 30-50

53
Q

How do you manage chronic prostatitis?

A

Antibiotics
Alpha blockers
5 alpha reductase inhibitors
NSAID
Prostate manage
Dietary manipulation or stress reduction

54
Q

Who does BPE typically affect?

A

Men over 60

55
Q

How does BPE present?

A

Nocturia and increased frequency of urination
Difficulty or delay in initiate urination
Reduced stream
Post-voiding dribble
Acute retention with overflow incontinence may occur later
Occasionally severe haematuria

56
Q

How is BPE severity assessed?

A

International prostate symptom score

57
Q

How is BPE managed?

A

Temporary containment products
Bladder training
Advice on fluid intake
Transurethral resection of the prostate
Transurethral needle ablation

58
Q

What is Peyronie’s disease?

A

Peyronie’s disease is where plaques form under the skin of the penis. These plaques can cause the penis to bend or become indented during erections

59
Q

What is Peyronie’s disease associated with?

A

Dupuytrens contracture and a history of penile trauma

60
Q

Whats the pathology of Peyronie’s disease?

A

Minor injury to tunica albuginea -> trapping of fibrin and excess cytokine reaction -> disordered healing and focal loss of elasticity

61
Q

How is Peyronie’s disease managed?

A

If its preventing intercourse then surgical intervention is needed

Either:
• excision and plication of the contralateral tunica (Nesbitt procedure)
• excision and grafting at the plaque site (Lue procedure).
The Nesbitt operation causes penile shortening, while the
Lue procedure risks erectile dysfunction.

62
Q

What can cause male infertility?

A

. Endocrine disorders - Pituitary disease, Hypogonadotropic hypogonadism, Excess
of androgens
• Disorders of spermatogenesis - Chromosomal disorders, Cryptorchidism, Testicular torsion, Sertoli cell only, Infection
• Sperm delivery disorders - Congenital bilateral absence of vas deferens, Ductal obstruction, Erectile dysfunction, Ejaculatory dysfunction
• Penile anatomical disorders
• Sperm function disorders - Immunological infertility, Ultrastructural abnormalities of sperm

63
Q

What are some differentials for scrotal pain?

A

Testicular torsion
Epididymitis
Testicular cancer

Rarer..
Henoch-Schoenlein Purpura
Viral Orchitis

64
Q

Whats the most common causative organism of epididymitis in under 35s?

A

Chlamydia

65
Q

Which drug can lower PSA?

A

Finasteride

METABOLIC (43 decks)

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