How much calcium consumption per day is linked to prostate cancer?
Over 1000mg/day
What is increased PSA indicative of?
Prostatitis
BPH
Adenocarcinoma of Prostate
Does Saw Palmetto increase PSA?
No
What age group is recommended to have a PSA and DRE routinely?
50 and above
Earlier with symptoms or risk factors
What ethnicity group is recommended to have a PSA and DRE routinely?
Hispanic
African American
What risk group is recommended to have a PSA and DRE routinely?
Smokers
Obese
Ejaculation 4x qw
What are the risk factors for prostate disease?
Age > 50 Race Fam Hx Diet (high fats, sedentary lifestyle, obese) Vasectomy smoking
What are the symptoms of BPH?
-85-90% w/o Sx
-Difficulty initiating urine stream
-Interruption of stream
-Urinary frequency
-Urinary urgency
-Nocturia
Rectal exam -Non tender, soft, boggy
What are the symptoms of prostate cancer?
- Often silent
- 15-20% found in transurethral resection that is done for BPH
- Blood in urine or semen
- Pain/stiffness in back/hips/upper thigh/pelvis
What are the risk factors for prostate cancer?
- Age > 50
- Race
- Fam Hx
- Diet (high fats, sedentary lifestyle, obese)
- Vasectomy
- smoking
How do you manage prostate cancer?
A) Tx determined by stage - Hormone therapy 1) Antiandrogens -Suppress estradiol and testosterone production 2) Viadur -Medicated implant B) If bone mets - Fosamax C) Radiation Therapy D) Surgery
What values are considered low risk for prostate cancer?
PSA < 10
Gleason < 6
Stage T1c, T2a
What values are considered intermediate risk for prostate cancer?
PSA 10-20
Gleason 7
Stage 2b
What values are considered High risk for prostate cancer?
PSA > 20
Gleason 8-10
Stage T2c
What is the etiology of prostadynia?
- Unknown
- May be due to muscle spasm
- Like nerve entrapment
What is the treatment for prostadynia?
Finestride
Are all scrotal masses cancerous or precancerous?
Usually benign
Are testicular or scrotal masses more malignant?
testicular
How do you evaluate scrotal/testicular masses?
Palpation
Transillumination
What are the different scrotal masses?
- Hydrocele
- Varicocele
- Inguinal Hernia
- Epididymitis
- Orchitis
- Testicular Cancer
Which of the testicular/scrotal masses transilluminate?
Hydrocelle
What is the function of the testes?
- Produce sperm
- Secrete hormones such as testosterone
What are the common symptoms of testicular cancer?
- Unilateral enlargement or change in way it feels
- Painless lump or swelling or collections of fluid
- Dull ache in back, groin or lower abdomen
- Gynecomastia &/or mastalgia
- Testicular discomfort/pain or feeling of heaviness
- Occasionally, initial Sx related to METS to lungs, abdomen, pelvis or brain
- Sometimes no Sx at all
What are the risk factors of testicular cancer?
- Cryptorchidism
- Genetic (ie: Kleinefelters)
- Caucasian – 5 times incidence
- Family Hx
- HIV
How related to penile cancer is circumcision?
Circumcision decreases chance for penile cancer but since penile cancer has low incidence it is not a routine procedure and up to the parents
How related to penile cancer is HPV?
Low risk factor, only certain strains of HPV
How related to penile cancer is testicular cancer?
Cannot find information, but do not believe they are related
How related to penile cancer is prostate cancer?
Cannot find information, but do not believe they are related
What age group is most affected by penile cancer?
> 50 y/o
What are the AAP recommendations about male circumcision?
Medical benefits not sufficient to recommend routine circumcision
What is leukoplakia?
Hyperkeratotic, scaly, white patches of penile epithelium, biopsy necessary
What is condyloma?
A painless, enlarging, warty-like growth in HPV
What are squamous cell cancers of the penis?
Skin cancer
What is Bowen’s Dz?
An intraepidermal (pre)cancerous indurated erythematous plaque; ulcerated center; development of pinkish or brownish papules covered with a thickened horny layer; biopsy is necessary
What is priapism?
Neurotic sustained painful erection with acute onset
What is Peyronie’s?
Plaque’s /strands of dense fibrous tissue surrounding the corpus cavernosum -> deformity & painful erection; impotence
What is Posthitis?
Inflammation of the prepuce
What is Phimosis?
Condition where the male foreskin cannot be fully retracted from the head of the penis
What are the causes of male sexual dysfunction?
- Drugs
- Blood flow abnormalities
- Nerve abnormalities
- Hormonal abnormalities
- Psychological
- Depression
- Stress
- Performance anxiety
- Misinformation about sexuality
What is andropause?
Low androgen levels
- Testosterone
- Dehydroepiandrosterone
- androstenedione
What is low in androgen deficiency?
- Testosterone
- Dihydrotestosterone
- Low DHEA
What is androgen deficiency not associated with?
Low FSH
What has an antiaromatase effect and decreases symptoms of andropause?
Zinc
What are the risk factors of UTI?
- Sexual Activity
- Hygiene
- Hormones
- BMI
- Low fluid intake
- Delayed voiding
- GU anomalies, stones, BPH
- Catheterization
How do you prevent UTI’s in Women?
- Cranberry
- Hydration
- D-mannose
- Lactobacillus
- Topical E3
How do you prevent UTI’s in Men with BPH?
- Urinate frequently
- Saw palmetto
- Cranberry
- Hydration
- Lactobacillus
What is the treatment for UTI?
Antibiotics:
- Macrobid,
- Septra ds
- ciprofloxacin
What is the treatment for cystitis?
- Bladder distention
- Pentosan polysulfate sodium
- Aspirin/ibuprofen
- Tricyclic antidepresants
- Antihistamines
- Narcotic analgesic
- Calcium channel blockers
- Immune suppression
- Heparin
- Hyaluronic acid
What UA results are expected with a UTI?
A) Dipstick -RBC -Proteinuria -Leukocyte Esterase -Nitrites B) Microscopic ->10 wbc/hpf -Too numerous to count bacteria
What causes interstitial cystitis?
A)No known cause B)Theories -Infectious -Autoimmune -Mechanical injury -Mast cell activation -Alteration in bladder lining
Is surgery recommended for interstitial cystitis?
No
Do diet changes help some patients with interstitial cystitis?
A) Yes, but there is no scientific evidence linking diet to IC
B) Sx increased possibly by
-Artificial sweeteners
-Alcohol, Tomatoes, Spices, chocolates, caffeinated, citrus beverages, acidic foods
What are the risk factors for urinary tract cancer?
-***Smoking
-Age
-Chronic bladder inflammation
(Recurrent, UTI, urinary stones)
-Consumption of aristolochia fangchi
(Botanical for weight loss)
-High saturated fat diet
-External beam radiation
-Fam Hx of bladder cancer
-Gender (male)
-Infection with Schistosoma Haematobium
-Race (caucasian)
-Tx with certain drugs (cyclophosfamide – to tx cancer)
What are the symptoms of UT cancer?
- Hematuria
- Frequent urination
- dysuria
What are the symptoms of pelvic prolapse?
- Menstrual cramps
- Pulling in pelvis
- Constipation
- Urinary incontinence
- Low back pain
- Decrease in symptoms when lying
What hormone deficiency predisposes a person to pelvic prolapse?
Estrogen
What are the causes of incontinence?
Neurologic disorders from CNS, spinal cord & peripheral nerves
Which age groups does pelvic prolapse affect?
Postmenopausal
What conditions can a UA be used to screen?
- Kidney dz
- UTI
- Bladder Dz
- Diabetes
- Liver Dz
- Starvation/diet
- Illness/infection
- Hepatitis
What does a UA detect?
- Color
- pH
- Specific gravity
- Leukocyte Esterase
- Ketones
- Nitrite
- Protein
- Blood
- Glucose
- Bilirubin
- Urobilinogen
How do u detect proteinuria?
UA
What is the next step after a single positive test for proteinuria?
- Wait two weeks and perform again, if confirmed then:
- CMP (Comprehensive metabolic panel), BUN, Creatinine, Albumin
What are the DDx’s for proteinuria?
A) Renal
-UTI, nephrolithiasis, acute kidney failure, glomerulonephritis, nephrotic syndrome, renal METS
B)Functional
-Fever, exercise
Is proteinuria present with UTI’s?
sometimes
Hematuria is ________ unless proven otherwise.
cancer
If hematuria is found, when should you retest?
-2 weeks?
-Further work up
Microscopic
Cystoscopy
IVP
CT/US
Hematuria is a symptom of what conditions?
- Stone
- Infection
- Trauma
- Tumor
- Medications
Urinary casts are associated with?
Kidney infection of some sort – there are many types and many casts
What are the stages of chronic renal disease?
1) Stage 1
- Kidney damage w/ normal GFR
2) Stage 2
- Kidney damage w/ mild
- decrease GFR (60-89)
3) Stage 3
- Moderate decrease GFR (30-59)
- Anemia & bone problems
4) Stage 4
- Severe decrease GFR (15-29)
- Dialysis or transplant
5) Stage 5
- Kidney Failure (GFR <15)
- Dialysis/transplant
What are the symptoms of chronic renal disease?
- Fatigue
- Poor concentration
- Poor appetite
- Insomnia
- Nocturnal muscle cramping
- Peripheral & periocular edema
- Dry, itchy, skin
- Increased frequency, nocturia
What are the UA findings in chronic renal disease?
- Proteinuria
- Hematuria
- Creatinine clearance f’d up
- GFR decreased
How is GFR calculated?
Via creatinine clearance
What systemic disease can cause kidney damage?
- DM
- Hypertension
What hormones are produced by the kidney?
- Erythropoietin
- Renin
- Calcitriol
What are the diet/lifestyle changes required for kidney disease?
- Limit protein
- Limit cholesterol
- Decrease smoking
- Decrease sodium
- Decrease potassium
What are the dietary recommendations for patients with kidney stones?
- Low purine diet
- Low oxalate diet
- Increase fluids
What is the treatment for kidney stones?
- Ultrasound
- Wait (which sucks)
- Surgery
What increases the risk of urinary stones?
- Pregnancy
- Urinary tract abnormalities
- Southern US Diet
- Foods
- Weight
- Stress
- Bedridden
What are the differences between male and female in reference to urinary stones?
1) Men DDx
- Testicular torsion, pyelonephritis, acute prostatitis, appendicitis, pancreatitis,
2) Female
- Ovarian cyst, ovarian torsion, ectopic pregnancy, pyelonephritis, appendicitis, pancreatitis
Do all urinary calculi require emergency intervention?
No
What are the symptoms of urinary calculi?
- Sudden onset acute pain, flank pain radiating to groin, back flank pain
- Location travels with stone
- Local pain w/o rebound tenderness
- Dysuria, urinary urgency & increased fq
- CVA tenderness
- Hematuria
- Diarrhea, nausea/vomit, diaphoresis
What imaging is used for urinary calculi?
- KUB (supine abdomen)
- Non contrast Spiral CT
- IVP
What is a KUB used for with calculi?
Determine size, shape and location
