Mens Health - Urology

Question 1

What is a phimosis?

Answer 1

prepuce (foreskin) cannot be full retracted

(can be physiological up to around 3 years of age)

Question 2

Name 3 potential complications that can result from phimosis

Answer 2

Poor Hygiene

Pain / Splitting During Intercourse

Balanitis

Urinary Retention

Penile Cancer

Question 3

What is a paraphimosis?

Answer 3

painful constriction of gland penis by the retracted prepuce (foreskin), proximal to the corona

Question 4

What are two potential causes of paraphimosis?

Answer 4

Phimosis

Cateterisation

Question 5

Why may paediatric and adult males have circumcision performed?

Answer 5

Relgious Reasons

Recurrent Balanitits

Recurrent Paraphimosis

Question 6

What are 2 potential causes of acute scrotal pain?

Answer 6

Testicular Torsion

Epididymitis / Orchitis / Epididymo-orchitis

Trauma

Ureteric Calculi

Question 7

What typical history and physical examination findings may be present in a male with testicular torsion?

Answer 7

History

sudden onset, unilateral pain, nauseated/vomiting

Examination

testis very tender, lying high in scrotum, horizontal lie

Question 8

Patients with suspected testicular torsion should be referred for immediate ultrasound imaging?

True / False

Answer 8

FALSE!

patients with suspected torsion should be referred for immediate scrotal exploration

Question 9

What is epididymo-orchitis?

Answer 9

inflammation of the epididymis ± testis

Question 10

What is a common cause of epidiymo-orchitis in 20-40 year olds and name 2 additional risk factors?

Answer 10

Sexually Transmitted Infection

Catether / Urethral Instrumentation

Urinary Tract Infection

(esp. chlamydia)

Question 11

What findings may be seen on physical examination of a patient with epididymo-orchitis?

Answer 11

scrotum erythematous

testis / epididymis enlarged + tender

reactive hydrocele

± pyrexia

Question 12

What is Fournier’s Gangrene?

Answer 12

necrotic area of scrotal skin

(a type of necrotising fasciitis of the scrotum)

Question 13

What is the likely underlying cause of a scrotal lump that you ‘cannot get above’?

Answer 13

Scrotal Hernia

Question 14

What condition may present with a scrotal lump that is painless and aches at the end of the day?

Answer 14

Varicocele

Question 15

What physical examination technique could be used to help identify a hydrocele?

Answer 15

Transillumination

Question 16

Why are varicoceles more commonly associated with the left testicle, compared to the right?

Answer 16

left testicular vein drains into the left renal vein rather than inferior vena cava

Question 17

Name 4 potential causes of urinary retention in males?

Answer 17

Prostatic Enlargement

Phimosis / Meatal Stenosis

Drugs - Anticholinergic

Neurological

Question 18

What is the difference between acute and chronic urinary retention?

Answer 18

Acute

sudden inability to pass urine > painful > volume (<1000ml)

Chronic

incomplete emptying of bladder over prolonged period of time > volume (<300ml) > may have LUTS - voiding or storage

Question 19

Think of 2 conditions that could cause storage LUTS in a male patient, other then prostate pathology

Answer 19

Bladder Infection
(irritating bladder)

Poor Compliance
(scarring secondary to readiotherapy/TB)

Question 20

How long after a UTI should you wait before performing a PSA test?

Answer 20

4-6 weeks

may be falsely raised with a UTI

Question 21

How do alpha blockers (e.g. tamsulosin) help patients with BPH?

Answer 21

relax smooth muscle within prostate and bladder

provides rapid symptom relief (e.g. able to urinate)

Question 22

What is the mechanism of action of finasteride in the treatment of BPH?

Answer 22

shrinks the prostate by reducing the amount of androgens

(5 alpha-reductase inhibitors)