Men's Healthy - Urology Flashcards
(28 cards)
What is phimosis, how common is it?
Inability to retract the foreskin back over the glans
1% adult non-circumcised population
50% at 1yr old
Problems with phimosis and treatment
Poor hygiene, increased STDs
Balanitis (inflamed glands)
Posthitis (inflames foreskin/ prepuce)
Balanitis xerotica obliterans
Paraphimosis
Urinary retention
Penile cancer
✅circumcision
What is paraphimosis? Common causes and treatment
Painful constriction of the glans penis by the retracted prepuce proximal to the corona
Phimosis
Catheterisation esp elderly
Penile cancer
✅needs reduction, manually
✅occasionally dorsal slit needed
Risk factors of penile cancer - squamous cell carcinoma. Mortality
20% <50yrs old
Risk factors: phimosis, poor hygiene-> smegma, HPV 16 & 18
Untreated leads to death <2yrs, almost all <5yrs
Key paediatric and adult indications for circumcision
Paediatric:
Religious
Recurrent balanitis/ UTIs
Adult: Recurrent balanitis Phimosis Recurrent paraphimosis Balanitis xerotica obliterans Penile cancer
Causes of acute scrotal pain - emergency presentation
Testicular torsion
Epididymitis/ orchitis/ epididymo- orchitis
UTI
STI
Mumps
Torsion of hydatid morgagni
Trauma
Ureteric calculi - rare
History of testicular torsion and examination, investigations
Usually younger <30yrs Sudden onset (awoken) Unilateral pain May nausea/ vomiting Often no LuTs
Examination:
Testis v tender
Lying high in scrotum with horizontal line
✅emergency scrotal exploration, emergency
Epidiymo- orchitis history
Age 20-50/50 - STI (chlamydia)
40/50+ UTI (E.coli)
Gradual onset
Usually unilateral
Often recent history UTI/ u protected sex/ catheter/ urethral instrument
Check for mumps history
Epididymo- orchitis examination
May be pyrexial, can be septic
Scrotum erythematous
Testis/ epididymis enlarged, tender
Fluctuate areas may represent abscess
May relative hydrocoele
Necrotic area skin (Fournier’s Gangrene) - rare, high mortality 50%
Epididymo - orchitis investigations and treatment
Bloods - FBC/ U&Es/ cultures if septic
Urine - MSU for MC&S
Radiology - scrotal USS if suspect abscess
✅antibiotics, abscess = surgical drainage/ antibiotics, Fourier’s gangrene = emergency debridement & antibiotics
History to find out for scrotal lumps and examination
Is it painful? (How quickly has it appeared?
Can I get above it (if not= hernia) Is it in body of testis (yes= tumour) Separate to testis Does it fluctuate/ trans illuminate? (=hydrocele/ cyst) Feel like bag of worms = varicocele
Causes of painless/ painful and aching scrotal lumps
Not tender:
Testis tumour, epididymal cyst, hydrocoele, reducible inguinal-scrotal hernia
Painless but aching at end of day:
Varicocele
Acute presentation, painful:
Epididymitis, epidiymo-orchitis, strangulated inguinal-scrotal hernia (emergency)
History of testicular tumour, examination, treatment
Usually painless
Germ cell tumours (seminoma/ teratoma) usually <45yrs, risk factor = history of undescended testis (either side of tumour)
Lymphoma - older men
Examination:
Body of testis abnormal, can get above
✅refer 2week wait to urology then they:
- ultrasound to confirm
- check testis tumour markers (aFP,hCG, LDH) = doesn’t rule out of normal, if abnormal v likely
- inguinal orchidectomy
History of hydrocele, what is it, examination, treatment
Slow/ sudden onset
Uni/bilateral scrotal swelling
Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis
Testis not palpable separately, usually can get above, trans illuminates
✅in adult - if normal on ultrasound reassure, surgical removal if large or symptomatic
Epididymal cyst examination, treatment
Usually painless
Separate form testis
Can get above mass
Transilluminates
✅reassure, excise if large
Varicocele symptoms, examination, treatment
Dull ache at end of day
Let>Rt
May be associated reduced fertility
‘Bag of worms’
Not tender
Palatable abdo/ renal mass
✅reassure, radiological embolisation, only treat: adolescent and growth of testis affected/ symptomatic/ infertility - slow motility of sperm
Treatment of inguinal-scrotal hernia
Surgery
emergency if strangulated
Causes of urinary retention
- prostatic enlargement, BPH/ cancer
- phimosis/ urethral stricture/ meatal stenosis
- constipation
- UTIs
- drugs (anticholinergic e.g. schizophrenia)
- over distension (too much fluids at party)
- following surgery (not linked e.g anaesthetic, linked e.g cholecystectomy)
- neurological *
Types of urinary retention and treatment
Acute
Painful - relieved by catheter, residual volume <1000ml, no kidney insult ✅trial without catheter after addressing exacerbating factor
Chronic
- painless/ less painful, May notice abdo swelling, residual volume >300ml, May kidney ✅learn to self catheterise
Acute on chronic
- painful, residual volume >1000ml, usually have kidney insult ✅TWOC (not if kidney insult), long term catheter or surgical intervention
Diagnosis of older men with nocturnal enuresis
Chronic retention with overflow incontinence until proven otherwise
History of LUTs
Voiding (suggestive bladder outflow obstruction), hesitancy, poor flow, post micturition dribbling
Storage - frequency, urgency, nocturia
Causes of storage LUTS (other than prostate)
- irritating (bladder infection/ inflammation, bladder stone, bladder cancer
Overactive bladder - idiopathic, neuropathic e.g. CVA, Parkinson’s, Ms
Low compliance of bladder (scarred) e.g. after TB/ schistosomiasis/ pelvic radiotherapy
Polyuria (making too much urine) - global eg uncontrolled diabetes
- nocturnal e..g venous stasis, sleep apnoea
Causes of voiding symptoms?
Bladder outflow obstruction
- physical urethra (phimosis, stricture - spraying urine), prostate (benign, malignant, bladder neck)
- dynamic prostate, bladder neck (sympathetic smooth muscular tone mediated alpha 1 receptors)
- neurological lack of coordination bladder & urinary sphincter =upper motor neurone
Reduced contractility:
- physical
- neurological (LMN lesion)
International prostate symptom score
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