4 Men's Health Urology Flashcards
(32 cards)
Define phimosis.
What is the incidence of phimosis in the adult population?
Foreskin (prepuce) cannot be fully retracted in adult
Incidence= 1% in adult non-circumcised population
At what ages is phimosis physiological?
State some of the consequences/complications of phimosis. (8)
-
Balanitis Xerotica Obliterans (BXO)
- = male version of Lichen sclerosus is a skin condition that causes itchy white patches on the genitals or other parts of the body
-
Paraphimosis
- Manage to retract foreskin but can’t get it back again
What is paraphimosis?
Give the 3 commonest causes of it.
Painful constriction of glans penis by the retracted prepuce proximal to the corona
Causes:
- Phimosis
- Catheterisation (esp in elderly)
- Penile cancer
What is the best treatment for phimosis?
Circumcision s
What is the best treatment for paraphimosis?
- Needs reduction
- This is usually achieved manually
- Occasionally dorsal slit may be necessary- to relieve oedema
- Done under local anaestetic
How prevalent is penile cancer? What are the risk factors?What is the prognosis like?
(Squamous cell carcinoma)
Prevalence: 350 new cases/yr in UK
Risk factors: Phimosis- hygiene, HPV 16 &18
If untreated most die within 2 yrs (important not to miss)
What are the key indications for circumcision? (think paediatric and adult)
Balanitis xerotica obliterans= chronic, inflammatory condition- white patches on genitals
Give some causes of acute scrotal pain.
- Testicular torsion
- Epididymitis, Orchitis
- UTIs
- STIs
- Mumps (bilateral)
- Torsion of hydratid of morgagni (remnant of mullerian duct)
- Trauma
- Ureteric calculi (rarely)
What history might you expect for a case of testicular torsion?
- Younger patient <30yrs
- Sudden onset
- Unilateral pain
- Nausea/vomiting (often NO LUTS)
State 2 examination findings for testicular torsion.
- Testis= very tender
- Testis= lying high in scrotum with horizontal lie
What needs to be done if you suspect testicular torsion in a patient?
Patient needs emergency scrotal exploration- ideally within 6 hrs
DO NOT waste time getting investigations eg ultrasound
What history might you expect for a patient who has epididymo-orchitis?
What examination findings are there likely to be with epidydymo-orchitis?
Fournier’s gangrene- high mortality- high spread rate- can spread to abdomen
What investigations can be done into epididymo-orchitis?
How is epididymo-orchitis treated? (how would it be treated if an abscess develops/fournier’s gangrene develops?)
A patient presents with a scrotal lump. What key questions should we be asking (history/examination)?
History:
- Is it painful?
- How quickly has it appeared?
Give some differential diagnoses for each of the following:
- Painless, non tender scrotal lumps
- Painless/aching at end of day, non tender lumps
- Painful, tender
- Painless, non tender scrotal lumps
- Testicular tumour
- Epididymal cyst
- Hydrocele
- Reducible inguino-scrotal hernia
- Painless/aching at end of day, non tender lumps
- Varicocele
- Painful, tender
- Epididymitis
- Epididymo-orchitis
- Strangulated inguino-scrotal hernia
What history might you expect for a patient with a testicular tumour? What are you likely to find on examination?
- Usually painless
- Men <45yrs- germ cell tumour (seminoma/teratoma)
- Older men- lymphoma?
Examination:
Body of testis= abnormal, can ‘get above’ lump
How does a hydrocele present?
- Onset
- Swelling?
- Examination?
Hydrocele:
- Slow/sudden onset
- Uni/bilateral scrotal swelling
- Examination:
- Testis not palpable separately
- Can ‘get above’ swelling
- Swelling transilluminates
Is an epididymal cyst usually painful? What is it like on examination?
How does a varicocele present? (History and examination)
History:
- Dull ache- at end of day
- Left more than right affected
- Reduced fertility
Examination:
- Bag of worms above testic
- NOT tender
- Palpable abdominal/renal mass
How are each of the following treated:
- Testicular tumour
- Epididymal cyst
- Adult hydrocele
- Varicocele
- Inguino-scrotal hernia
- Testicular tumour
- Inguinal orchidectomy
- Epididymal cyst
- Excise if large, reassure
- Adult hydrocele
- Reassure
- Surgical removal if large/symptomatic
- Varicocele
- Radiological embolisation if:
- Symptomatic
- Infertility risk (growth of testis affected is present in adolescence
- Radiological embolisation if:
- Inguino-scrotal hernia
Give some causes of urinary retention in males.
- Meatal stenosis/phimosis/urethral stricture
- Prostatic enlargement
- BPH
- Cancer
- Constipation
- UTI
- Drugs (anticholinergics)
- Over distension (too many fluids eg alcohol)
- Following surgery (anaesthetic)
- Neurological
