Men's Health

Question 1

What is phimosis?

Answer 1

When the foreskin cannot be fully retracted in an adult, physiological phimosis is normal up until adolescence.

Question 2

What is paraphimosis?

Answer 2

When the foreskin can be retracted but can’t be pulled back over the glans, can cause painful constriction of the glans.

Question 3

Name some causes of paraphimosis.

Answer 3

• phimosis
• penile cancer
• catheterisation (especially in elderly)

Question 4

What is balanitis?

Answer 4

Inflammation of the glans, can be caused by phimosis or paraphimosis.

Question 5

What type of cancer is penile cancer?

Answer 5

Squamous cell carcinoma

Question 6

State some consequences of phimosis.

Answer 6

• pain, splitting or bleeding on intercourse
• balanitis (inflammation of glans)
• posthitis (inflammation of foreskin)
• balanitis xerotica obliterans (BXO, scarring of foreskin)
• paraphimosis
• penile cancer
• increased risk of STDs due to poor hygeine
• urinary retention

Question 7

What is smegma?

Answer 7

Sebaceous secretions under the fold of the foreskin.

Question 8

What strains of the HPV virus increase the risk of penile and cervical cancer?

Answer 8

HPV 16+18

Question 9

What is balanitis xerotica obliterans?

Answer 9

Scarring of the foreskin, can be caused by phimosis or paraphimosis.

Question 10

List some reasons for circumcision.

Answer 10

• religious practice
• recurrent balanitis
• phimosis
• recurrent paraphimosis
• penile cancer
• balanitis xerotica obliterans

Question 11

Name some causes of acute scrotal pain.

Answer 11

• testicular torsion
• ureteric calculi - can get referred pain to the testes
• epididymo-orchitis (inflammation of epididymis and testes)
• trauma

Question 12

What is Founier’s gangrene?

Answer 12

Rare condition where area of scrotal skin becomes necrotic due to an anaerobic infection - emergency debridement is needed and ABX treatment - can be fatal.

Question 13

Name some risk factors for epididymo-orchitis.

Answer 13

• STI (especially chlamydia)
• UTI (especially E.coli)
• mumps
• recent catheter insertion

Question 14

If someone has a scrotal lump that fluctuates and illuminates, what is it likely to be?

Answer 14

Hydrocoele, collection of fluid in the tunica vaginalis.

Question 15

If someone has a scrotal lump that you can’t get above, what is it likely to be?

Answer 15

Inguinal hernia

Question 16

What is the lymphatic drainage of the testes?

Answer 16

Para-aortic lymph nodes

Question 17

What is the treatment for a cryptorchid/undescended testicle?

Answer 17

Orchiopexy - moves the undescended testicle down into the scrotum and fixes it.

Question 18

Name 3 tumour markers for testicular cancer.

Answer 18

• beta hcg
• alpha fetoprotein (AFP)
• lactate dehydrogenase (LDH)

Question 19

What is hydrocoele?

Answer 19

Swelling of scrotum unilaterally or bilaterally due to collection of fluid in the tunica vaginalis, caused by imbalance of fluid production and resorption.

Question 20

What is varicocoele? Which side is it more common?

Answer 20

Scrotal swelling due to enlargement of the pampiniform plexus in the scrotum, caused by venous blockage higher up.
It is more common on the left side due to longer venous drainage (testicular vein drains into left renal vein).

Question 21

What is an inguino-scrotal hernia?

Answer 21

When part of the intestines descend down through the embryological remnant of the gubernaculum.

Question 22

What is urinary retention?

Answer 22

Inability to pass urine.

Question 23

What is nocturnal enuresis?

Answer 23

Bed wetting at night, commoner in older men who have chronic retention and overflow incontinence.

Question 24

Name the 4 types of urinary incontinence.

Answer 24

• urge
• stress
• mixed
• overflow

Question 25

What is the difference between acute and chronic urinary retention?

Answer 25

Acute - painful, no kidney insult, residual volume <1000ml | Chronic - less painful, kidney insult, residual volume >300ml

Question 26

What is acute-on-chronic urinary retention?

Answer 26

When someone with chronic urinary retention suddenly develops acute urinary retention, can be painful and may have kidney insult, residual volume >1000ml.

Question 27

List some causes of urinary retention.

Answer 27

- prostatic enlargement e.g. BPH or cancer - phimosis/urethral strictures/meatal stenosis - UTIs - neurological - drugs e.g. Anticholinergic drugs calm the bladder - over-distension due to too many fluids

Question 28

What are male LUTS (lower urinary tract symptoms)?

Answer 28

Can be: - voiding - hesitancy, dribbling, poor flow - storage - frequency, urgency, nocturia

Question 29

What examinations would you do for male LUTS?

Answer 29

- DRE - neurological examination is suggestive history - dipstick - check for UTIs - PSA test

Question 30

What is the international prostate symptom score (IPSS)?

Answer 30

Score used to assess male LUTS.

Question 31

Name some causes of male LUTS.

Answer 31

- obstruction e.g. Phimosis, urethral stricture, enlarge prostate - neurological e.g. UMN lesion or LMN lesion - increased smooth muscle tone at alpha-1 receptors

Question 32

Name 2 drugs that can be given for management of male LUTS.

Answer 32

1) alpha blockers e.g. Tamsulosin | 2) 5-alpha reductase inhibitors (5ARIs) e.g. Finasteride, dutasteride

Question 33

What is the MOA of alpha blockers? What are some side effects?

Answer 33

- relax smooth muscle sphincter mediated by alpha-1 | - side effects: postural hypotension, nausea, oedema

Question 34

What is the MOA of 5ARIs and are there any side effects?

Answer 34

- given for enlarged prostate - block dihydrotestosterone, blocking testosterone production and shrinking prostate - side effects: reduced libido

Question 35

What is a TURP and when would it be done?

Answer 35

Transurethral resection of the prostate, surgical procedure that can help male LUTS, especially problems with voiding.

Question 36

What is the biggest cause of death in men under 45?

Answer 36

Suicide

Question 37

Name some causes of erectile dysfunction.

Answer 37

- physical e.g. Diabetes, atherosclerosis, smoking, cycling - psychosexual e.g. Stress, anxiety, guilt, loss of sex drive, relationship problems - prostate surgery - drugs e.g. Those used for hypertension, CVD, depression - regular heavy drinking

Question 38

Name some treatments for erectile dysfunction.

Answer 38

- oral drugs - injected therapies - vacuum pumps - penile implants - MUSE (pellet inserted into urethra)