MDT's Part 2 Flashcards
(48 cards)
Normal male erection is a neurovascular event that relies on what?
- Intact autonomic and somatic nervous system
- Arterial blood flow
- Smooth and striated musculature of corpora cavernosa and pelvic floor
Erection is caused and maintained by?
- Increase in arterial flow
- Active relaxation in smooth muscle
- Increase in venous resistance
What is a key neurotransmitter that initiates and sustains erections?
Nitric oxide
What is Peyronie disease?
A fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity
What is anejaculation?
inability to ejaculate
What are signs and symptoms of ED?
- History
- Lifestyle factors
- Sexual orientation
- Quality of relationship
- Alchohol
- Tobacco
- use of porn
- Medication
What may be the first sign of endothelial dysfunction?
Ability to achieve but not maintain an erection
Physical exam for erectile dysfunction?
- Vitals
- Obesity?
- Cardio
- Neuro
- Genitalia
Treatment of ED?
- Lifestyle modification and reduction of cardiovascular risk factors
- If psychogenic component, therapy or counseling
- Hormonal replacement
- Oral agents (Sildenafil, Vardenadil, Tadalafil)
Refer to Urology for ED?
- Priapism (MEDEVAC)
- Initial oral therapy
- Inadequate response to medication
- Unable to tolerate side effects
- Peyronie disease
- Hx of pelvic/perineal trauma, surgery, or radiation
What are some general considerations for benign prostatic hypertrophy?
- Hyperstatic process = increased number of cells
- Most common benign tumor in men
- At 55 yrs, approx 25% of men report obstructive voiding Sx
- At 75, 50% report decreased force and caliber of urinary system
- Risk factors are poorly understood
Obstructive symptoms associated with benign prostatic hypertrophy?
- Hesitancy
- Decreased force and caliber of stream
- Sensation of incomplete bladder emptying
- Double voiding (urinating twice within 2 hours)
- Straining to urinate
- Postvoid dribbling
Irritative symptoms associated with benign prostatic hypertrophy?
- Urgency
- Frequency
- Nocturia
What is the most important tool and should be calculated for all patients before starting benign prostatic hypertrophy?
American Urological Association (AUA) index
- Seven questions that quantify severity of Sx’s on a 0-5 scale
Treatment for benign prostatic hypertrophy?
- Watchful waiting (for mild Sx, AUA scores 0-7)
- Medical Therapy ( Alpha blockers, 5-alpha-reductase inhibitor)
Absolute surgical indications for benign prostatic hypertrophy?
- Refractory urinary retention
- Large bladder diverticula
- Sequela of benign prostatic hyperplasia
When to refer to urology for benign prostatic hypertrophy?
- AUA score greater than 7
- Urinary retention
- Hematuria
- Recurrent UTI
- Evidence of kidney disease
What is the most common non-cutaneous cancer in American men and second leading cause of cancer related death in men?
Prostate Cancer
What are risk factors for prostate cancer?
- African American
- Family Hx of prostate cancer
- Hx of high dietary fat intake
- Known or likely to have BRAC1 or BRAC2 mutations
Signs and symptoms of prostate cancer?
- Most cases detected due to elevated serum PSA
- May manifest as focal nodules or areas of induration on DRE
- Can cause obstructive symptoms
- Lymph node metastases (axial skeleton most common)
Lab finding for prostate cancer?
- PSA > 4.0 ng/mL
- Prostate biopsy
- Misc labs:
- BUN and creatinine
- Alkaline phosphate and calcium
- CBC
Imaging for Prostate cancer?
- Transrectal U/S
- MRI
- Bone scan (eval for bony metastases)
What is the screening for prostate cancer?
- DRE
- PSA testing
- Transrectal U/S
What is the treatment for prostate cancer?
- As dictated by urology and oncology
- Active surveillance
- Radical Prostatectomy
- Radiation therapy
- Cryosurgery
- Androgen deprivation therapy for advanced disease
