GU Survey Exam 3 Flashcards
(268 cards)
1
Q
What are the 2 functions of the testes?
A
- produce sperm
2. secrete hormones (testosterone)
2
Q
What is in the scrotum?
A
testicles
3
Q
What is the function of the scrotum?
A
- contains the testi at a lower temperature to allow for optimal sperm production
- prone to injuries
4
Q
Testicular or Scrotal mass? firm solid and 1. painless 2. do not transilluminate 3. usually malignant
A
testicular mass
5
Q
Testicular or Scrotal mass?
- painful
- transilluminate
- usually benign
A
scrotal mass
6
Q
Are testicular masses usuaslly painful?
A
no, painless
7
Q
Will testicular masses transilluminate?
A
no, do not transilluminate
8
Q
are testicular masses usually benign or malignant?
A
usually malignant
9
Q
are scrotal masses and those in the epididymiss or spermatic cord usually painful?
A
yes painful
10
Q
Will scrotal masses and those in the epididymiss or spermatic cord transilluminate?
A
yes
11
Q
are scrotal masses and those in the epididymiss or spermatic cord usually malignant or benign?
A
benign
12
Q
what tissue/part of the penis is the erectile tissue?
A
corpora cavernosa
13
Q
What tissue/part of the penis contains the urethra?
A
corpus spongiosum
14
Q
what layer of tissue surrounds the erectile tissue?
A
tunica albuginea
15
Q
define circumcision
A
surgical removal of the foreskin of the penis
16
Q
is the american academy of pediatrics in support of circumcision?
A
Yes, as a result of emerging evidence that found links between circumcision and decreased risk of urinary tract infection, rare penile cancer, HPV, HIV and other STIs, the AAP is in more support of the procedure
17
Q
Does the AAP recommend routine circumcision for all newborn males?
A
no, “What remains unchanged is that the AAP still holds that the
health benefits are not great enough to recommend routine
circumcision for all newborn males,”
18
Q
what are 3 non medical reasons PRO circumcision?
A
- religious/faith
- aesthetics
- hygiene
19
Q
what are 2 possible medical advantage of circumcision?
A
- less UTI, STI/HIV
2. less risk of penile cancer
20
Q
What are 5 cons/surgical risks to infant of circumcision?
A
- hemorrhage
- infection
- pain/trauma
- diminshed sensation
- > mother/child bonding
21
Q
where are the seminal vesicles located?
A
out-pocketing of vas deferens: extend from base of bladder
22
Q
what does the seminal vesicles and vas deferens form?
A
ejaculatory duct
23
Q
what is the order of sequency from the seminal vesicles?
A
- extend from base of bladder, out pocketing of vas deferens –> forms ejaculatory duct –> thru prostate –> to urethra
24
Q
what is secreted from the seminal vesicles?
A
70% of fluid components of semen = energy/fluidity for sperm
25
secretions from where supply 70% of fluid for semen and provide the energy for sperm?
seminal vesicles
26
HPO axis for tesis?
hypothalamus > GnRH > pituitary > LH and FSH
27
what does LH in the testis stimulate?
leydig cells to produce testosterone
28
what cells produce testosterone?
leydig cells/interstitial cells
29
testosterone + FSH =>
spermatogenesis
30
how many sperm does a male produce each day?
70-100 million each day!
31
length of time for production of spermatogenesis in the testes?
approx 70 days
32
length of time for maturation of sperm in the epididymis?
= 2 weeks
33
what 3 components occurs as part of the maturation of sperm in the epididymis?
acquisition of
1. motility
2. capacity to bind to an ovum
3. capacity to penetrate the zona pellucida
34
after what age should FOBT x3 be used as lab work up for preventative health?
after age 50
35
what is the peak age for tumors for penile conditions?
60 YO
36
what parts to the penis are tumors likely to involve (2)?
prepuce or glans
37
dx?
| painless, enlarging wart-like growth
HPV, conyloma acuminata
38
dx?
| hyperkeratotic, scaly, white patches of penile epithelium, yes for biopsy?
leukoplakia
39
is a biopsy necessary if you suspect leukoplakia?
yes
40
```
dx?
an intraepidermal (pre)cancerous indurated erythematous plaque, ulcerated center, development of pinkish or brownish papules covered with a thickened horny layer
```
Bowen's dz
41
is a biopsy necessary for bowen's dz?
yes
42
what are 2 skin cancers of the penis?
squamous cell carcinoma, SCC
and
melanoma
43
what is balanitis
inflammation of glans
44
Causes of balanitis? (8)
```
1. Uncircumcised w/ poor hygiene
or over hygiene
2. Diabetes
3. Chemical irritants
4. CHF, cirrhosis, nephrosis
5. Drug allergies
6. Obesity
7. Infections: candida, HPV,
anaerobes, treponema,
gardnerella, tichomonas
8. Penile cancer
```
45
what is phimosis?
In ability to retract the distal foreskin.
-at birth the foreskin is adherent to the glans penis. These adhesions usually spontaneously separate and allow the foreskin to become retractible.
46
what is paraphimosis?
Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus. Paraphimosis is a disease of uncircumcised or partially circumcised males.
47
where is the urethral opening with hypospadius
urethral opening on the ventral surface
48
which side is the ventral surface of the penis?
under
49
which is more common hypospadius or epispadius?
hypospadius
50
what is it called when the urethral opening is on the dorsal surface of the penis?
epispadius
51
which side is the dorsal surface of the penis?
upper
52
What are 3 causes of hypospadius and epispadius?
1. exposure to PG hormone, finesteride
2. lack of T in utero
3. inherited
53
what is hypo and epispadius often associated with? (2)
1. inguinal hernias
| 2. cryptorchidism
54
what is priapism?
non-erotic sustained painful erection with acute onset
55
why does the glans remain soft with priapism?
glans remains soft because involves the corpora cavernosa but not the spongiosum
56
Etiology of priapism?
- unknown in most cases
- possible associated w/ leukemia, metastatic carcinoma, local trauma, sickle cell dz, spinal cord trauma, circulatory distrubances, medications like viagra
57
tx for priapism? (5)
1. spontaneously resolve in few hours
2. ice water
3. enema
4. pharmaceutical intervention
5. drainage is rare cases
58
dx?
| plaques/strands of dense fibrous tissue surrounding the corpus cavernosum --> deformity and painful erection, impotence
peyronie's dz
59
what are the s/sx of peyronie's dz?
1. hardened tissue
2. pain during erection
3. curvature with erection
4. distortion (indentation, shortening)
60
most common age for peyronie's dz?
45-60 YO
61
etiology/risk factors for peyronie's dz? (5)
1. unknown
2. trauma (surgery, injury)
3. HLA-B7 (SLE. Scleroderma)
4. 30% of ppl will develop fibrotic tissue in other areas like dupuytrens contracture
5. diabetics
62
how do you dx peyronie's dz?
exam and vasoactive injection to cause erection
63
tx for peyronie's dz? (3)
1. watch and wait 1-2 years, often resolves
2. non surgical tx within 6 mnths of dx: ca+ channel blockers, collagenase, cortisone
3. surgery
- severe/persistent
- can cause partial loss of erectile function, penis length, urethral damage, infection, sensation loss
64
penile cancer incidence?
1/100k USA
65
what percentage of malignancies in men is d/t penile cancer?
0.2%
66
how much higher is cervical cancer incidence than penile cancer?
10x higher
67
how much higher is prostate cancer incidence than penile cancer?
100x
68
how much higher is fatal heart attack incidence than penile cancer?
200x
69
what are 3 sx of penile cancer?
1. penile growths or sores
2. abnormal penile d/c
3. bleeding
70
what area is the most common site for penile cancer?
glans and foreskin
71
Risk factors for penile cancer? 4)
1. intact/non-circumcised male (high risk factor, low incidence)
2. HPV infection (only certain strains, low risk factor)
3. smoking
4. age: majority >50 YO (40% <40 YO)
72
chance for penile cancer in uncircumcised vs circumcise?
un- 1/600
| circumcised- 1/1500
73
what are the 3 main tx for penile cancer?
1. surgery: excision, laser, circumcision, partial to complete penectomy, nodal dissection
2. radiation
3. chemotherapy: topical, oral/IV
74
What are some examples of surgical procedures for treatment of penile cancer?
1. excision
2. laser
3. circumcision
4. partial to complete penectomy
5. nodal dissection
75
what is the most common reason for visit to a urologist?
scotal masses
76
define a scrotal mass?
painless or painful lump or swelling
77
can scrotal masses be solid or cystic?
yes
78
can you develop a scrotal mass at any age?
yes
79
how are scrotal masses evaluated?
via US
80
how do most men discover scrotal masses?
most men discover scrotal masses themselves
81
Describe a testicular exam
1. stand in front of mirror
2. examine each testicle with both hands
3. gently roll the testicle between the thumbs and fingers
4. if palpable lump, refer for US and/or a urologist
82
what are 5 causes of scrotal masses?
1. cysts
2. infection
3. inflammation
4. hernia
5. tumors
83
what is cryptorchidism?
undescended testicles
84
what is a 30% risk with preterm infants?
undescended testicles
85
what are 3 risks associated with crytorchidism ?
1. testicular cancer
2. infertility
3. torsion
86
what are the two location for the testicle for cryptorchidism?
1. abdominal testicle
| 2. pubo-scrotal testicle
87
what are the two location for ectopia undescended testicle?
1. femoral
| 2. perineal
88
ddx?
| worse with lifting the testicle
testicular torsion
| ddx epididmyitis- pain lessens
89
describe the sx of testicular torsion?
1. sudden severe pain, swelling, erythema
| 2. lower ab pain, N/V
90
```
dx?
1. sudden severe pain,
swelling, erythema
2. lower abdominal pain,
N/V
3. worse with lifting the
testicle
```
testicular torsion
91
Is testicular torsion considered a medical emergency?
yes
92
within how many hours should surgery for testicular torsion occur?
6-8 hrs to prevent atrophy, 80% good prognosis
93
after how many hours is preservation of the testicle doubtful in relationship to testicular torsion?
24 hrs
94
what type of surgery is advised if delayed beyond 48 hr?
orchiectomy
95
does pain get worse or better with lifting of testicle with epididymitis?
pain lessens
96
what is a hydrocele?
collection of fluid in the sheath (tunica) that holds the testicle
97
Cause of hydrocele?
excess fluid production or decreased fluid absorption
98
is a hydrocele painful?
often painless
99
will hydrocele be transilluminated?
yes
100
describe a hydrocele?
often painless, swollen, soft, unilateral or bilateral, that will transilluminate
101
what is the ddx for hydrocele?
varicocele
102
younger or older men more likely to have hydrocele?
older
103
can hydrocele develop rapidly?
yes
104
causes of hydrocele?
1. trauma
2. radiation therapy
3. inflammation
4. congenital
105
"bag of worms"
varicocele
106
what causes a varicocele?
blood backs up in the veins leading from the testicles d/t valve dysfunction
107
varicocele painful or painless?
painless
108
which side is more likely to have a varicocele?
more common on the left side
109
which vein does left spermatic vein empty into?
left renal vein
110
Which vein does the right spermatic vein empty into?
inferior vena cava
111
sx/s of varicocele?
may feel heavy, better with lying down, achy, testicular atrophy, infertility, visibly enlarged vein, *will not transilluminate*
112
will a varicocele be transilluminated?
nope
113
typical age for varicocele?
15-25 YO
114
why is varicocele associated with 40% infertile men?
increased testicular temperature
115
what are 4 big risk factors for varicocele?
1. pelvic floor stress (constipation, heavy lifting)
2. vascular damage
3. hereditary
4. tumor
116
2 dx evaluation procedures for varicocele?
US and venogram (dye/xray)
117
tx for varicocele?
1. scrotal support (atheletic supporter, tighter underwear)
2. surgical ligation "varicocelectomy"
3. embolization
4. laparscopy
118
what is a varicocelectomy
surgical ligation for a varicocele
119
what % of varicocele reoccur?
5-20% reoccur
120
what % of those with varicocele develop a hydrocele?
2-5%
121
what is an inguinal hernia?
protrusion of abdominal contents, usually the small bowel, thru a weak point of the abdominal wall, where the vas deferens passes
122
sx/s of inguinal hernia?
1. bulge in the groin area that may extend into the scrotum
| 2. painful or uncomfortable
123
tx for inguinal hernia
surgical repair
124
define epididymitis
infection in the tubular coil, epididymis
125
what is the function of the epididymis?
collects sperm from the testes
126
where is pain with epididymitis?
produces pain in the top and rear of the scrotum
127
what organisms are often associated with epididymitis?
often a complication of *gonorrhea/chlamydia*
| - may be enterobacteriacae or pseudomonas (w/prostatitis)
128
s/sx of epididymitis?
- pain is generally severe and insidious
| - fever and swelling are common
129
tx (2) for epididymitis?
1. antibiotics
| 2. STI screen
130
what is inflammation of the testes called?
orchitis
131
what is the causative agent of orchitis?
often d/t bacterial infection or mumps virus
132
can spermatogenisis be affected by mumps?
spermatogensis is irreversible damaged in 30% of mumps cases
133
if the patient has orchitis, what might they are have or be experiencing?
prostatitis or epididymitis
134
s/sx of orchitis?
1. pain and swelling
| 2. heaviness
135
can orchitis cause permanent damage to testicles?
yes
136
orchitis can cause permanent damage to testicles resulting in what 3 things?
1. diminished size
2. inadequate hormone production
3. infertility
137
what are 6 scrotal mass ddx?
1. epididymitis
2. hydrocele
3. varicocele
4. hernia
5. orchitis
6. cancer
138
is testicular cancer highly treatable when detected and treated early?
YES, 95%
139
what is the most common cancer in men 15-34 YO?
testicular cancer
140
what is the common age for testicular cancer?
15-34 YO
141
what are 5 main testicular cancer risk factors?
1. cryptorchidism
2. genetic (klinefelter's and chromosome 12 abnormality)
3. caucasion (4-5x)
4. family hx
5. HIV
142
how much higher risk of testicular cancer does a male have if his crytorchidism is untreated?
3-17x higher risk
143
what are two genetic abnormality that are risk factors for testicular cancer?
klinefelters and chromosome 12 abnormality
144
is there an increased risk of testicular cancer with injury or vasectomy
no increased risk
145
sx/s of testicular cancer?
1. unilateral enlargement or change in the way it feels
2. painless lump or swelling or collection of fluid (recommend monthly self-screening)
3. dull ache in back, groin or lower abdomen
4. gynecomastia &/or mastalgia
5. discomfort/pain or feeling in heaviness
146
can a male experience gynecomastic or mastalgia with testicular cancer?
yes
147
might there be no symptoms with testicular cancer?
yes
148
what is secondary testicular cancer?
cancer metastasizes from primary (i.e. hodgkins)
149
T/F: testicular lymphoma is more common than testicular cancer in men over 50
T
150
what are 4 cancers that can metastasize to testicles
1. hodgkins
2. prostate
3. lung
4. skin
151
Where is stage 1 testicular cancer?
confined to testicles
152
where is stage II testicular cancer?
mets to nodes
153
where is stage III testicular cancer?
mets above diaphragm or to visceral organs
154
5 yr survival rate for stage I testicular cancer?
98%
155
5 yr survival rate for stage II testicular cancer?
97%
156
5 yr survival rate for stage III testicular cancer?
72%
157
what are some sx that may be noted especially during a testicular self exam?
1. lump on testicle
2. slight enlargement of one of the testes
3. heavy sensation in testicles or groin
4. dull ache in lower abdomen or groin
158
what are 3 PE findings to dx testicular cancer?
1. firm, non-tender testicular mass that does not transilluminate"
2. fluid collection
3. regional lymphadenopathy
159
will testicular cancer transilluminate?
nope
160
what is the first imaging step in Dxing testicular cancer?
1. US
2. CXR
3. abd CT
161
are there any blood screening tests for testicular cancer?
nope
162
what are some blood tests to monitor the response to treatment?
1. AFP: alpha-fetoprotein
2. beta HCG
3. LHD: lactic dehydrogenase
163
what test might a MD perform in diagnosing testicular cancer if other tests are inconclusive?
biopsy
164
what are 5 main testicular cancer tx?
1. radical inguinal orchiectomy
2. retroperitoneal lymph node dissection with metastatic dz
3. testicular prosthesis available
4. radiation- adjunct tx to orchiectomy
5. chemotherapy
165
what might a man do prior to testicular cancer treatment in terms of family planning?
sperm banking before tx
166
what is the 2nd leading cause of urinary tract problems in males?
prostate related
167
sxs of prostate related complaints?
1. pain
2. discomfort
3. sexual problems
168
define prostatitis?
inflammation of the prostate
169
what % of all visits regarding GU concern in young to middle aged men is related to prostatitis?
25%
170
is prostatitis contagious?
not contagious, not STI unless d/t NG/CT
171
what are 6 main sx of prostatitis?
1. tender/swollen prostate
2. fever/chills (in acute)
3. dysurina, nocturia, urgency, hesitancy, frequency, hematuria
4. pelvic/abdominal pain
5. LBP, joint/mm pain
6. painful ejaculation
172
7 risk factors for prostatitis?
1. medical procedure- catheterization
2. unprotected vaginal &/or rectal intercourse
3. abnormal urinarytract
4. enlarged prostate (BPH)
5. diabetes
6. immunocompromised
173
dx?
- sudden onset
- chills
- fever
- LBP
- body aches
- dysuria/freq/urgency/nocturia
- perineal pain
acute bacterial prostatitis
174
cause of acute bacterial prostatitis?
overgrowth of bacteria normally found in prostatic fluid (E. coli) or STI
175
tx for acute bacterial prostatitis?
ER referral, tx with antibiotics
176
PE findings of acute bacterial prostatitis?
tender, swollen, indurated prostate*
- purulent prostatic secretions if obtained
- often accompanied by *bacteriuria*
177
what is the pathogenesis of chronic prostatitis?
variable causes
- CT
- ureaplasma urealyticum
178
what are the sx of chronic prostatitis?
1. suprapubic pain
2. LBP
3. dysuria
4. nocturia
5. intermittent
6. waxing/waning
7. bacterial chronic- often assoc w/ recurrent UTIs
179
what might longstanding prostatitis be associated with?
underlying prostate defect= harbors persistent bacteria (BPH, anatomical variant)
180
what type of chronic prostatitis is more common?
non bacterial
181
sx of chronic non bacterial prostatitis?
similar to CBP w/o fever
182
what are some theories of pathogenesis of chronic non-bacterial prostatitis?
1. infectious agents undetected by standard lab tests
2. heavy lifting causing urine retention
3. physical acitivity may irritate/inflame prostate
4. pelvic mm spasm may lead to increased prostate pressure
5. structural abnormalities; urethral narrowing = pressure
183
how is the dx for chronic non bacterial prostatitis made?
made by excluding other causes
184
4 diagnostic prostatitis lab procedures
1. prostatic stripping and culture discharge (expressed prostatic secretion- EPS)
2. WBCs in EPS, (assoc w/ non bacterial prostatitis, urethritis, prostatic stones, recent ejaculation)
3. pH of prostatic fluids rises when infection is present 6.5 to > 8.0
4. PSA levels often elevated (collect pre-DRE)
185
is WBCs in expressed prostatic secretions associated with bacterial prostatitis?
nope
186
when should PSA level be collected?
collect pre-DRE, repeated testing 6 weeks after resolution of prostatitis
187
when performing a DRE in prostatits what are you checking for?
1. size
2. symmetry
3. consistency
4. lumps/nodules
5. *discomfort/pain*
188
what is the classic presentation (3) for DRE in prostatitis?
1. sx patient
2. enlarged, soft/boggy gland
3. mod-severe tender on palpation
189
what may you palpate during a DRE in prostatitis?
prostatic stones
190
can prostatic stones cause recurrent infections?
YES
191
ddx acute prostatitis with lab work?
WBCs and bacteria in urine/prostate fluid w/ acute onset and systemic sxs
192
ddx chronic bacterial prostatitis with lab work?
WBCs and bacteria in urine/prostate fluid w/ insidious onset
193
ddx chronic non-bacterial prostatitis with lab work?
may see WBC in urine or prostate fluid
| - no evidence of infection
194
tx of acute prostatitis?
Antibiotics 7-10d, repeat if symptoms do not resolve
195
tx of chronic prostatitis?
- Antibiotics 4-12 wks 60% will clear up
- NSAIDs to palliate symptoms
- Sitz baths may provide symptomatic improvement
196
tx for non infectious prostatitis?
- reduce inflammation: NSAIDs, natural COX2 inhibitors
| - relax tissue, decrease congestion
197
what % of american men have sx of prostadynia?
11%
198
what % of men dx'd as chronic prostatitis have no evidence of bacterial infection or inflammatory cells in the prostatic fluid
95%
199
another name for prostadynia?
chronic pelvic pain syndrome (CPPS)
200
sx of prostadynia?
Pain in pelvis or perineum, can extend to penis, testes, rectum
May cause voiding or sexual dysfunction
201
define prostadynia
prostatitis sx w/o inflammation or bacterial infection
202
what is the cause of prostadynia?
Cause = unknown; pain may be due to muscle spasms or
| musculoskeletal conditions, like nerve entrapment
203
what might be helpful in decreasing sx and is routing rx'd for prostadynia?
Finesteride
204
3 causes for pudendal nerve entrapment?
1. impact trauma
2. surgery
3. congenital malformation
205
sx of pudendal nerve entrapment?
1. pain in penis, scrotum, or anorectal area
2. prostatitis-like pain and voiding/sexual dysfunction are the hallmark of PNE
3. aggravated by sitting, relieved by standing, lying
206
what is the hallmark of pudendal nerve entrapment
prostatitis-like pain &
voiding/sexual
dysfunction
207
where is the pudendal nerve predisposed to entrapment?
at level of ischial
| spine and within pudendal canal:
208
what are some mechanisms of injury for pudendal nerve (4)?
1. At ischial spine, nerve can be compressed between
sacrotuberous and sacrospinous ligaments.
2. Nerve may be ensheathed by ligamentous expansions
that form a perineural compartment.
3. At pudendal canal, nerve can be compressed by falciform
process of the sacrotuberous ligament
4. If thickened, duplication of obturator fascia may act as an
entrapment site
209
is imaging helpful in Pudendal NE?
not necessarily
210
what should you r/o with pudendal NE?
R/O causes of prostatitis (urology referral)
211
what type of surgery may help with pudendal NE?
decompression surgery
212
which ethnicity has increased incidence of BPH?
african americans
213
is BPH precancerous?
nope!
214
what percentage of men over 80 have BPH?
90%
215
Etiology of BPH?
uknown, condition of aging
216
What is the hormonal influence of BPH?
1. combo of decreased testosterone and increased estrogen
| 2. increased sensitivity to DHT in the prostate
217
Where does hyperplasia in BPH typically occur?
Hyperplasia nearly always occurs in *transitional zone* beginning around prostatic urethra & extending peripherally
218
what % of males with BPH have sx?
20%
219
what are sx of BPH? (5)
1. difficulty initiating urine stream (hesitancy)
2. interruption of steam
3. frequency
4. urgency
5. nocturia
220
what are the rectal exam findings of of BPH?
non-tender, soft, boggy
221
what are the rectal exam findings of cancer?
rock-hard
222
what are the rectal exam findings of prostatitis?
painful
223
What are 3 complications of BPH?
1. decreased QOL, ADLs
2. increased risk of UTI and acute urinary rentention, but ER referral (d/t residual urine)
3. complete obstructuion requires surgery
224
does complete obstruction d/t prostate require surgery?
YES
225
does BPH increase the risk of developing prostate carcinoma?
NOPE
226
what are two Hx/PE procedures for BPH?
1. DRE
| 2. AUA sx index questionnaire
227
4 things PSA is elevated in?
1. BPH
2. prostate cancer
3. recent ejaculation/DRE (~2 days)
4. prostatitis
228
is PSA elevated in BPH?
yes
229
what are DRE screening for?
colorectal cancer and prostate cancer
230
what is the normal consistency of the prostate?
normal= rubbery, walnut size, 4 cm, symmetrical and absent of any nodules or polyps
231
what is the recommended starting age for DRE?
50 YO, earlier with sx or risk factors
232
what should the rectal wall feel like in a DRE?
smooth without abnormalities or unusual lumps, swelling or tenderness
233
where are PSA produced?
by cells of prostate capsule and periurethral gland
234
what is a normal PSA level?
0-4.0 ng/mL
235
does PSA normally increase with age?
YES
236
when should you refer in regards to PSA and DRE?
1. PSA 4-10 ng/mL w/ abnormal DRE
2. PSA >10
regardless of DRE
3. palpable nodule on DRE, regardless of PSA
4. pts w/ UTI, prostatitis or recent biopsy should have PSA test deferred to avoid a potential unnecessary biopsy
237
should patients with recent UTI, prostatitis, or recent biopsy have a PSA test?
no, PSA test deferred to avoid a
| potentially unnecessary biopsy.
238
what is the typical conventional tx for BPH?
watchful waiting and regular follow up
239
what are 2 medications used to tx BPH?
1. 5-alpha-reductase inhibitors: finasteride (proscar)
| 2. alpha blockers
240
how does 5 alpha reductase inhibitors work for BPH?
finasteride inhibits peripheral conversion of testosterone to DHT, block growth effect of DHT
- clinical trials show its effective in reducing size and sx
- assoc w/ lower risk of acute urinary retention and need for sx common with placebo 4y trial in 3040 men with mod-severe BPH sx and enlarged prostate
241
do alpha blockers change prostate size?
no, relaxes smooth mm, do not decrease prostate size
242
what are 3 surgical tx for BPH?
1. TURP- transurethral resection of the prostate (core out middle part of prostate to open lumen
2. laser/thermoablation
3. prostatectomy
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what are 2 goals of complementary care for BPH?
1. reduce hyperplasia by inhibiting conversation of T to DHT
| 2. prevent estrogen from binding to estrogen r/c
244
what is saw palmetto used to tx
BPH
245
according to research is saw palmetto good for tx of BPH?
research is mixed "may be beneficial"
246
side effects of saw palmetto?
HA, nausea, dizziness
247
how might saw palmetto tx BPH?
may improve urine flow and decrease sx while avoiding negative SE of conventional tx
248
Will saw palmetto effect PSA?
nope, does not affect PSA like medications
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what are 6 supplements for tx of BPH?
1. amino acids
2. beta-sitosterol
3. zinc picolinate
4. pygeum
5. nettles (urtica diocia)
6. saw palmetto
250
what % of men over age of 40 have sexual dysfunction?
>50%
251
what are 3 common ways male sexual dysfunction presents?
1. decreased libido
2. ejaculatory disturbances
3. erectile dysfunction
252
what is the most common presentation of sexual dysfunction?
erectile dysfunction
253
4 physical causes of male sexual dysfunciton?
1. drugs
2. blood flow abnormalities
3. nerve abnormalities
4. hormonal abnormalities
254
how might hormonal abnormalities contribute to male sexual dysfunction?
andropause
1. tesosterone levels decline
- about 2-3%/y b/w 40-70, SHBG increases as well
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what are 4 psychological causes of male sexual dyfunction?
1. depression
2. stress
3. performance anxiety
3. misinformation about sexuality
256
What is ADAM?
androgen decline in aging men
257
sx of ADAM (5)
1. mood dysfunction
2. sexual dysfunction (libido loss, erectile dysfunction)
3. osteoporosis
4. mm atrophy
5. cognitive changes
258
What are some lab tests to run with ADAM?
free and total testosterone (diurinal variation)
| and LH, PRL
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5 factors that may compound testosterone?
1. stres: physical and psychologica;
2. obesity
3. diabetes
4. pituitary tumor
5. drugs: cimetidine, digoxin, spironolactone
260
What should you R/O for ADAM?
1. hypothyroid
2. depression
3. anemia
4. prolactinoma
261
what is the most common type of cancer in MEN in the US?
prostate cancer
262
what is the second leading cause of cancer death in men?
prostate cancer
263
incidence of prostate cancer?
1/6 will get prostate cancer
264
cause of prostate cancer?
cause is uknown, genetic, hormonal and environmental factors may play a role
265
what can prostate cancer growth be inhibited by?
1. orchiectomy or use of estrogen therapy
| 2. decrease/eliminate testosterone which feeds prostate cancer cell growth
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6 major risk factors for prostatic cancer?
1. age > 50
2. race or ethnicity, African american
3. family hx, testing should begin at age 40 if so
4. diet: high fat,, sedentary lifestyle & obesity
5. vasectomy
6. smoking
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annual DRE and PSA screening guideline?
baseline screening at 50 for those w/o risk factors
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annual DRE and PSA screening guideline for AA and men w/ 1st degree relative?
at 40 YO for baseline screening
