Male GU Issues

Question 1

Erectile Dysfunction

Answer 1

failure to achieve erection suitable for sex or dissatisfaction w/ size, rigidity or duration

Question 2

What are the 2 most common underlying causes of ED?

Answer 2

• organic: problem w/ vascular, nervous or hormonal system

- psychogenic: interference w/ perception of psychological stimuli

Question 3

Tx Options for ED

Answer 3

-PDE5 inhibitor: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)

• lifestyle modifications
• alprostadil
• psychotherapy
• vacuum erection device, surgery

Question 4

What is BPH and how does it happen?

Answer 4

• nonmalignant enlargement of prostate gland
• leads to bladder outlet obstruction
• testosterone conversion causes prostate enlargement and growth

Question 5

Signs and Sxs of BPH

Answer 5

• weak strain
• straining to void, hesitancy
• post-void residual urine, sense of incomplete void, urinary retention
• overflow or urge incontinence
• enlarged prostate (DRE)
• gross hematuria

Question 6

Dx of BPH

Answer 6

• DRE
• PSA
• post void residual

Question 7

Tx of BPH (3 different levels)

Answer 7

• watchful waiting for mild
• alpha 1 and 1A blockers for moderate (terazosin or tamsulosin); or 5 alpha reductase inhibitor (finasteride)
• surgery if more severe sxs

Question 8

What is prostatitis?

Answer 8

• inflammation of prostate gland and surrounding tissues due to infx
• can be acute or chronic

Question 9

Most Common Causative Organisms of Acute Bacterial Prostatitis

Answer 9

• E.coli 75%

- also Klebsiella, Pseudomonas, Enterobacter, Serratia

Question 10

Most Common Causative Organisms of Chronic Bacterial Prostatitis

Answer 10

• E. coli

- other gram negatives (EKP)

Question 11

Sxs of ABP

Answer 11

• high fever
• perineal pain
• frequency, urgency, dysuria
• obstructive sxs
• nocturia
• retention

Question 12

Sxs of Chronic BP

Answer 12

• vague sxs
• recurrent UTI or prostate infx
• voiding difficulties
• prostatic enlargement

Question 13

Dx of ABP

Answer 13

• clinical presentation
• significant bacteriuria (UA)
• midstream urine culture

Question 14

Dx of CBP

Answer 14

• urinary tract localization studies critical

- sequential cultures

Question 15

Tx of ABP <35 yo

Answer 15

• ceftriaxone 250 mg IM then
• doxycycline 100 mg po bid x10 days
• treat partners!

Question 16

Tx of ABP >35 yo

Answer 16

-cipro ER 500 mg po qd or 400 mg IV bid

Question 17

Tx of CBP

Answer 17

• cipro 500 mg po bid x4 wks

- may be longer or need surgery

Question 18

What is the cause of epididymitis?

Answer 18

• can be trauma, but usually 2/2 infx

- 35 yo or MSM: Enterobacteriaceae

Question 19

Sxs of Epididymitis

Answer 19

• unilateral pain and swelling of scrotum
• hydrocele formation
• urethral discharge
• elevation of testes improves discomfort
• signs and sxs or UTI or prostatitis

Question 20

Dx of Epididymitis

Answer 20

-culture voided urethral and midstream specimens to get specific organism

Question 21

Tx of Epididymitis <35 yo

Answer 21

• ceftriaxone 250 mg IM then
• doxycycline 100 mg po bid x10 days
• scrotal elevation, analgesics

Question 22

Tx of Epididymitis >35 yo

Answer 22

• cipro ER 500 mg po qd or 400 mg IV bid

- bedrest, scrotal elevation, analgesics

Question 23

What is a hydrocele?

Answer 23

• fluid-filled sac surrounding testicle

- results in swelling of scrotum anterior to testicle

Question 24

What is a communicating hydrocele?

Answer 24

-has an associated indirect inguinal hernia

Question 25

Sxs of Hydrocele

Answer 25

- painless - swelling - changes size - sense of a heavy scrotum

Question 26

Dx of Hydrocele

Answer 26

- transillumination - cremaster reflex intact - don't aspirate! - US if large to rule out tumor

Question 27

Tx of Hydrocele

Answer 27

-observation: should be rapid recovery

Question 28

What is a spermatocele?

Answer 28

-diverticulum of the epididymis (posterior to testicle)

Question 29

Dx of Spermatocele

Answer 29

- may transilluminate - cremaster reflex intact - can be separated from testes on exam - almond size/shape

Question 30

Tx of Spermatocele

Answer 30

-surgical removal if painful

Question 31

What is a varicocele?

Answer 31

- dilations of pampiniform venous plexus | - "bag of worms"

Question 32

On which side does a varicocele occur?

Answer 32

- almost 100% on left (drains to renal vein) | - right side warrants further investigation

Question 33

Sxs of Varicocele

Answer 33

-painless

Question 34

Tx of Varicocele

Answer 34

-surgery for relief of sxs and cosmetic concerns

Question 35

What is testicular torsion?

Answer 35

- SURGICAL EMERGENCY - twisting of testis and spermatic cord - leads to acute ischemia and impeded venous/lymphatic drainage - lack of normal attachments to scrotum

Question 36

Signs and Sxs of Testicular Torsion

Answer 36

- acute scrotal pain - enlarged, red, edematous, tender scrotum - testes "riding high" - N/V - fever may occur - ABSENT cremaster reflex

Question 37

Dx of Testicular Torsion

Answer 37

- Prehn sign: elevation of testis does not relieve pain | - US reveals reduced blood flow

Question 38

Tx of Testicular Torsion

Answer 38

- surgical urology consult indicated! - manual reduction: untwist right clockwise and left counter-clockwise - orchidoplexy to tack down

Question 39

What is phimosis?

Answer 39

-foreskin too tight to retract

Question 40

What is paraphimosis?

Answer 40

- foreskin too tight to get back | - may need emergent circumcision

Question 41

In which male GU issues is the cremaster reflex intact?

Answer 41

- hydrocele | - spermatocele

Question 42

In which male GU issues is the cremaster reflex ABSENT?

Answer 42

-testicular torsion

Question 43

Which male GU issues are painless?

Answer 43

- hydrocele | - varicocele

Question 44

Which male GU issues have acute severe pain?

Answer 44

testicular torsion

Question 45

Which male GU issues are NOT associated with infertility?

Answer 45

- hydrocele | - spermatocele

Question 46

Which male GU issues may cause infertility?

Answer 46

- varicocele | - testicular torsion

Question 47

What is Prehn sign and which male GU issue is it a sign of?

Answer 47

- elevation of testis does not relieve pain | - testicular torsion