Male disorders Flashcards by Cassidy Ruocco

Cannot readily retract foreskin to the corona of the glans (turtle head stuck inside)

Phimosis

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Tight foreskin around the head of penis. (Can’t get the turtle head back in)

Paraphimosis

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inherited varicose veins of scrotum
“bag of worms”

always on left side

Varicocele

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Water on testicle
Dx thru ultrasound
Illumination

Tx usually reassurance

Hydrocele

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Common SE of phosphodiesterase type 5 inhibitor (i.e. viagra)

headache!

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Cannot use nitrates or alpha blockers

PDE 5 inhibitors (ie viagra)

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Often seen in young
Usually sudden onset
Often E. coli or Klebsiella

*can be seen in men who ride bikes

Prostatitis

acute

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Chronic infection or inflammation of prostate, can be seen in men who sit for long periods

Chronic prostatitis

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Testicular cancer tx

Orchiectomy

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Proliferation of fibrostromal tissue of the prostate can lead to compression of the prostatic urethra, creating an obstruction of the urinary outlet leading to LUTS

benign prostatic hyperplasia (BPH)

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Disease of older men (avg 60-65 yo)

Symptoms= obstruction and irritation, decreased force of urinary stream, hesitancy and straining, postvoid dribbling, sensation of incomplete emptying

Benign prostatic hyperplasia (BPH)

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Increased frequency, nocturia, urgency
Recurrent UTIs
Urinary retention
Digital rectal exam reveals an enlarged prostate

*PSA may be slightly elevated

BPH

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Slow growing, malignant neoplasm of the adenomatous cells of the prostate gland that can lead to urinary obstruction and metastatic disease

Prostate cancer

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Disease of aging….cause is unknown

*many cases not clinically apparent. Symptoms of urinary obstruction or irritative voiding may occur if tumor has invaded into urethra, bladder neck or trigone of bladder

Prostate cancer

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In advanced disease, pts may present with bone pain from metastases, possible spinal cord impingement if vertebral bodies involved

Prostate cancer

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Prostate may be enlarged, nodular and asymmetric

PSA usually elevated

Biopsy confirms diagnosis of adenocarcinoma

Prostate Cancer

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The Gleason grading system adds together the primary and secondary grades of the tumor, resulting in a final score of 2-10. Total score can be used for prognostic purposes, with a higher score indicating a worse prognosis

This is used for…..

Prostate cancer

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Inability to retract the foreskin over the glans penis

*may be congenital or acquired

Phimosis

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If congenital, identified in children and adolescents and usually is physiologic

If acquired, seen in adults and caused by poor hygiene and chronic balanitis

Phimosis

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Erythema with tenderness and possible purulent discharge

Inability to retract the foreskin over the glans penis

Obstructed urinary stream, hematuria, or pain of prepuce

Phimosis

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If asymptotic and congenital, leave it alone.

If symptomatic, consider circumcision

If infection also present, broad spectrum abx

Phimosis

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Entrapment of foreskin behind the glans penis

can be caused by frequent catheterization
forcibly retracting a constricted foreskin for cleaning or catheterization can lead to

also can be caused by vigorous sexual activity

Paraphimosis

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Pain, edema, tenderness and erythema of the glans and foreskin

ID of any encircling foreign bodies, such as hair, clothing rubber bands or metallic objects is important

Paraphimosis

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Tx= reduced emergently

*manual reduction should be tried initially. If this fails, surgical reduction

Paraphimosis

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Consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse

Normal erections require intact parasympathetic and somatic nerve supply, unobstructed arterial inflow, adequate venous constriction, hormonal stimulation and psychological desire. Disorders of any of these may result in...

impotence

HTN, diabetes, hyperlipidemia and CV disease are all predictors of...

erectile dysfunction

The testis is abnormally twisted on its spermatic cord, thus compromising arterial supply and venous drainage of the testis, leading to testicular ischemia

Testicular torsion

Most common age group for testicular torsion?

Prepubertal and post pubertal young males (12-18 yo), especially with hx of cryptorchidism (late descent of testis)

Sudden onset of severe unilateral pain and scrotal swelling Testis is painful to palpation; testicle and scrotum are edematous NO RELIEF WITH ELEVATE OF TESTICLE (NEGATIVE PREHN SIGN)

Testicular torsion

Does testicular torsion have a positive or negative Prehn sign?

negative! (there is no relief with elevation of testicle)

Diagnosis is made clinically *doppler ultrasonography demonstrates decreased blood flow to affected spermatic cord and testis

Testicular torsion

Tx= mild analgesics may be given once the diagnosis is made. SURGICAL EMERGENCY!! try to get into surgery within 6 hours

Testicular torsion

Formation of venous varicosity within spermatic vein (pampiniform plexus) -left spermatic vein has an increased incidence of varicosity because the vein is longer than the right and joins the left renal vein at right angles

Varicocele

A chronic, non tender mass that does NOT transilluminate (usually on left side) "bag of worms" feeling, increases in size with Valsalva and decreases in size with elevation of scrotum or supine position

Varicocele

What happens to the Varicocele size with valsalva?

increases in size!

What happens to size of varicocele with elevation of scrotum or lying supine?

Decreases in size!

If diagnosis is inconclusive, doppler sonography is diagnostic method of choice tx=surgical repair if painful or seems to be causing infertility

Varicocele

Abrupt onset of scrotal, inguinal or lower abdominal pain (usually less than 6 hours) +/- N/V MC in boys 10-20

Testicular torsion

MC cause under 35= chlamydia can also be caused by gonorrhea, ureaplasma, E.coli

Epididymitis

MC cause of Epididymitis in kids is...

mumps

Gradual (over a few days) onset of scrotal pain, erythema and swelling PE shows POSITIVE PERHN'S SIGN (relief of pain with elevation of effected scrotum) and POSITIVE CREMASTERIC REFLEX

Epididymitis

Which two exam tests are positive in Epididymitis

Positive Perhn's sign (relief with elevation of effected scrotum) and positive Cremasteric reflex

Symptomatic tx= bed rest, scrotal elevation and cool compresses; NSAIDs also tx underlying cause

Epididymitis

PE shows: swollen, tender, retracted testicle * negative Perhn's test (no relief with elevation of testicle) * absent/negative Cremasteric reflex

Testicular torsion

Which 2 test can distinguish between Epididymitis and testicular torsion?

Perhn's test (pos in Epididymitis, neg in torsion) Cremasteric reflex (pos in Epididymitis, neg in torsion)

"Blue dot sign"** at upper pole indicates torsion of _____ of testis

appendix | seen in testicular torsion

What is the best INITIAL*** test for testicular torsion (not gold standard)

Testicular doppler (there will be a decrease in blood flow)

What is the GOLD STANDARD** diagnostic in testicular torsion?

Radionuclide scan!!

Detorsion and orchioplexy within 6H is management for...

testicular torsion

If the testicle is not salvageable in torsion, what is done?

Orchiectomy

Cystic collection of fluid in testicle leading to a testicular mass *MC cause of painless scrotal swelling

Hydrocele

Communicating: peritoneal fund between the parietal and visceral layers from a patent processus vaginalis Noncommunicating: Fluid from the mesothelial lining of the tunica vaginalis (no connection to the peritoneum)

Hydrocele

Infants: congential, due to incomplete obliteration of the processus vaginalis (usually will close within first year)

Hydrocele

Adults: usually acquired, represents injured, infection or inflammatory etiology *painless scrotal swelling!! can be transilluminated on exam

Hydrocele

Usually no tx needed. may aspirate fluid if compressive

Hydrocele

Cystic testicular mass of varicose veins MC on left side. MC surgically correctable cause of infertility

Varicocele

"bag of worms" superior to testicle **dilation worse when pt is upright or with valsalva (dilation increases when pt is supine or with testicular elevation)

Varicocele

Undescended testicle (MC right sided) Increased risk in...premature infants, low birth weight

Cryptorchidism

Empty, small scrotum can increase risk of cancer, infertility, testicular torsion and inguinal hernia

Cryptorchidism

Tx of choice for cryptorchidism as early as 6 months of age and before 1 years old

Orchiopexy | observation can be done only if less than 6 months

MC solid tumor in young men 15-40 yo Risk factors: cryptorchidism**, frequent UTIs, renal lithiasis, uncircumcision, multiple sex partners MC in right side

Testicular cancer

Germinal cell tumors usually malignant (Seminoma is MC. also can be Nonseminomatous)

Testicular cancer

Painless testicular nodule, solide mass or enlargement (may have hydrocele present) *gynecomastia may be present also

Testicular cancer

Dx made with scrotal ultrasound and serum studies (alpha-fetoprotein, HCG, LDH)

Testicular cancer

with testicular cancer, HCG may cause...

gynecomastia

Seminomatous germ cell tumors

Less aggressive Radiosensitive and lack tumor markers

Non-seminomatous germ cell tumors

Increase serum alpha-fetoprotein increase beta-HCG *RadioRESISTANT

Foreskin become trapped being the corona of glans and forms a tight band, constricting penile tissues UROLOGIC EMERGENCY (must manual reduct or use pharm therapy)

Paraphimosis

Prostate gland inflammation secondary to ascending infection MC cause= E coli, psueodomas (or gonorrhea/chlamydia if under 35)

Prostatitis

Fever, increased frequency, urgency, dysuria, poor or interrupted stream, starring to void, incomplete emptying if chronic, may present with recurrent UTIs/intermittent dysfunction

Prostatitis

Dx made thru UA (if chronic, may be negative and prostatic massage recommended to increase bacterial yield on UA) **avoid massage in acute cases!

Prostatitis

Tx= fluoroquinolones, Bactrim | if caused by STI, tx appropriately

Prostatitis

Prostate hyperplasia (periurethral/transitional zone) that leads to bladder outlet obstruction *increase in dihydrotestosterone production

BPH

Frequency, urgency, nocturia, hesitancy, weak/intermittent stream, incomplete emptying, incontinence digital rectal exam: uniformly enlarged, firm, rubbery prostate

BPH

Firm, rubbery prostate vs hard, nodular prostate

Firm, rubbery= BPH Hard, nodular= Cancer

Tx= observation if mild (AVOID ANTIHISTAMINES AND ANTICHOLINERGICS) Can also use... 5 alpha reductase inhibitors, alpha 1 blockers, surgery (trans urethral resection of prostate)

BPH

SLOW growing tumor! Risk factors= age, genetics, high fat intake diet, obesity, african american

Prostate cancer

Often asymptomatic until invasion of bladder, urethral obstruction or bone involvement *with urethral obstruction, increased urinary frequency, urgency, decreased stream, urinary retention back/bone pain= METS

Prostate cancer

Dx: screening via DRE and PSA done if over 50 (but if african american or am hx, done when over 40)

Prostate cancer

Tx for local dz= radical prostatectomy Tx for advance dz= External beam radiation therapy, Androgen deprivation

Prostate cancer

Male disorders Flashcards

(81 cards)