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Men's Health Module > BPH, Urethra & Penis Disorders, Scrotal Mass, Torsion > Flashcards

BPH, Urethra & Penis Disorders, Scrotal Mass, Torsion Flashcards

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1
Q

Function of the prostate

A
  • gland that makes fluid for ejaculation

- produces PSA protein

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2
Q

Why are glands hard to treat with antibiotic?

A

No blood flow

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3
Q

Lab to screen for prostate cancer

A

PSA

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4
Q

Causes of elevated PSA

A

enlarged prostate, infection, prostate cancer

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5
Q

Function of ejaculatory duct

A

carries sperm from testes

fluid from seminal vesicles and fluid from prostate

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6
Q

testes mainly composed of what 2 things

A

sperm and testosterone

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7
Q

vasectomy destroys what structure

A

vas deferens

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8
Q

Most common benign tumor in men

A

BPH

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9
Q

Elevated risk of BPH begins at what age?

A

40

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10
Q

Location of BPH

A

around urethra - transition zone of prostate

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11
Q

Why do rectal exam for prostate cancer?

A

cancer most commonly occurs in peripheral zone of prostate on rectal/posterior side

*may miss BPH

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12
Q

2 categories of BPH symptoms and how they are caused

A

obstructive - mechanical (BOO) or dynamic (adrenergic tone)

irritative - detrusor muscle hypertrophy and hyperplasia

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13
Q

irritative symptoms of BPH

A
  • Increased frequency
  • Urgency and difficulty postponing urination
  • Discomfort when urinating
  • Nocturia
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14
Q

obstructive symptoms of BPH

A 
Hesitation
Straining when urinating
Weak or intermittent stream
Sense that bladder hasn't emptied completely
Dribbling
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15
Q

DDX of voiding complaints in males

A

Urethral stricture/bladder neck contracture
Urinary tract infection
Carcinoma of the bladder (hematuria resistant to abx gets urology referral)
Neurologic disease
Diabetes mellitus

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16
Q

suspected BPH lab work-up

A

serum creatinine

look for infection and hematuria

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17
Q

imaging of kids with UTI

A

< 2 yrs old
any boy
any GU anomalies
any child with recurrent (>3/yr)

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18
Q

Man with hematuria needs what imaging?

A

CT urogram

Refer to urology

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19
Q

Man with elevated creatinine needs what imaging?

A

renal/bladder US

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20
Q

How to manage BPH with IPSS score 0-7 (mild sx’s)?

A

watchful waiting

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21
Q

How to manage BPH with IPSS score +7 (mod to severe sx’s)?

A

Nonselective α-Blockers
- Terazozin (Hytrin)

Selective α1a-receptor blockers
- Tamsulosin (Flomax)

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22
Q

MOA of alpha blockers in BPH

A

relaxation of prostate smooth muscle (rich in adrenergic nerve supply)

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23
Q

MOA of 5α-reductase inhibitor in BPH

A

Blocks conversion of testosterone to dihydrotestosterone (DHT)

treats prostate epithelium

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24
Q

5α-reductase inhibitor rare side effects

A

ED, decreased libido, gynecomastia

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25
Examples of 5α-reductase inhibitor
Dutasteride (Avodart) | Finasteride (Proscar, Propecia)
26
1st line therapy for BPH in man with moderate to severe symptoms
alpha blocker
27
Cons of 5-alpha-reductase inhibitors
need 6 month therapy to see maximum benefit only helpful in very large prostate (> 40 cm3)
28
When should 5a-reductase inhibitor be added to alpha blocker in BPH therapy?
Very large palpated prostates Hemorrhagic prostates
29
What plant has been claimed to treat BPH, but has no research to support?
Palmetto berry
30
Absolute surgical indications of BPH
Urinary retention refractory to medical management Recurrent urinary tract infection Recurrent gross hematuria Renal insufficiency
31
Eval of hemorrhagic prostates
- Image upper tracts | - Have urology r/o bladder cancer with cystoscopy
32
Gold standard surgery for BPH
Transurethral resection of the prostate (TURP)
33
Hypospadias
Failure of urethral folds to close at tip of penis Occurs in 1 in every 300 male children
34
When to refer hypospadias?
bothers patient | complaints of diminished stream
35
urethral stricture and meatal stenosis symptoms
Decrease in urinary stream Spraying or double stream Postvoiding dribbling.
36
2 risk factors of urethral stricture
trauma and infection
37
meatal stenosis
scarring of urethral opening at external meatus
38
phimosis and paraphimosis
problems with foreskin tight over tip is phimosis or tight farther down past glans is paraphimosis
39
Treatment of paraphimosis
Usually treated by firmly squeezing glans for 5 minutes to reduce the tissue edema; then skin drawn forward over the glans Antibiotics
40
Signs of Peyronie's Disease
Curvature of penis and painful erection No pain when penis is in non-erect state
41
Pathophysiology of Peyronie's Disease
fibrous plaque involving tunica albuginea ~Dupuytren's contracture
42
Peyronie's Disease treatment and management
- Observation; spontaneous remission occurs in about 50% - Vit E may be tried but generally don't work - Refer if unable to perform intercourse
43
What is Priapism?
prolonged erection
44
Main concern of priapism?
impotence
45
2 types of priapism?
ischemic: obstruction of venous drainage; painful; emergency! non-ischemic: too much blood flow to penis; not painful; no treatment
46
Drug that causes ischemic priapism
Trazodone
47
Treatment of priapism in sickle cell patient
treat sickle cell and priapism will go away massive blood transfusions, exchange transfusions, or both
48
Causes of ischemic priapism
30-50% idiopathic Meds for ED Psychotropic drugs - Trazodone! Sickle cell disease
49
Causes of non-ischemic priapism
Trauma Pelvic arteriovenous malformations (AVMs) Acute spinal cord injury
50
Treatment of ischemic priapism
MEDICAL EMERGENCY Narcotic analgesia Initial tx with Terbutaline (adrenergic agonist) Corporal irrigations Surgical shunt
51
collection of peritoneal fluid between layers of tunica vaginalis
hydrocele
52
Always get _____ to eval scrotal mass.
U/S
53
Hydrocele may be reaction as a result of what?
testicular cancer, torsion, epididymitis
54
Transillumination of hydrocele differentiates scrotal mass from _______.
varicocele
55
What differentiates a complex hydrocele from a simple one?
septations on US
56
Treatment of hydrocele
NO ASPIRATION simple - observe complex - refer for surgery
57
What is epididymis cyst and spermatocele?
Painless fluid accumulation on sup/post to testes clear fluid -> epididymis cyst clear fluid + dead sperm -> spermatocele
58
Treatment of epididymis cyst and spermatocele?
No treatment unless bothersome
59
Male comes in with no sx's but unable to have children. On palpation of scrotum feels like "bag of worms"
varicocele
60
In what position should patient be in to eval for varicocele?
Both supine and upright Perform Valsalva maneuver while standing to accentuate dilation
61
Right testicular vein drains into ________ and left testicular into ________.
vena cava renal vein
62
Get _____ for all right sided varicoceles.
CT scan
63
"bellclapper deformity"
testicular torsion in which testis rotates freely within tunica vaginalis
64
Risk factors for testicular torsion
trauma increased testicular volume associated w/ puberty testicular tumor history of cryptorchidism
65
What PE most sensitive to testicular torsion?
absence of cremaster reflex
66
Testicular torsion occurs most commonly in what age group?
men younger than 25
67
Testicular pain with "blue dot sign" and 2-3 mm nodule
torsion of appendix testis
68
How soon should testicular torsion be treated to salvage testicle?
< 6 hrs from sx onset
69
Testicular torsion treatment
Immediate surgical exploration and testicular salvage or orchiectomy Manual detorsion is quick and non-invasive (rotate away from midline, 25% success rate)
70
DDX painful testicular swelling
``` Epididymitis Orchitis/Mumps Testicular torsion Torsion of Appendix testes Incarcerated Inguinal Hernia ```
71
DDX painless testicular swelling
``` Hydrocele Varicocele Unincarcerated Inguinal Hernia Nephrotic Syndrome Testicular Tumors Fragile-X syndrome Klinefelter Syndrome ```

Men's Health Module (10 decks)

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