Paulson Male GU

Question 1

This is the mc sexual problem in men and is the consistent inability to maintain an erect penis with sufficient rigidity to allow for intercourse

Answer 1

Erectile dysfunction

Question 2

The most common cause of ED is…

Answer 2

Decrease in arterial flow from progressive vascular disease

Question 3

What are a few meds that can cause ED?

Answer 3

SSRIs, beta blockers, spironolactone

Question 4

What diagnostics are ordered for ED?

Answer 4

• depends on what you think the underlying cause is
• can do nocturnal penial tumescence testing which differentiates b/t organic and psychogenic cause
• Can also do direct injection of prostaglandin E1 into penis and erection if vascular system intact (if no erection, will need to vascular studies)

Question 5

If psychogenic cause, what is the tx for ED?

Answer 5

Behaviorally oriented sex therapy and counseling

Question 6

If low testosterone cause, what is the tx for ED?

Answer 6

testosterone replacement

Question 7

S/e of testosterone?

Answer 7

HTN (may inc CV events), worsen BPH or CHF

Question 8

What is the mainstay of ED treatment?

Answer 8

Phosphodiesterase-5 inhibitors (PDE-5)

• Sildenafil (Viagra)
• Vardenafil (Vevitra)
• Tadalafil (Cialis)
• *Take 45-60 min prior to anticipated sexual activity
• Avanafil (taken 15-30 min prior to sexual activity)

Question 9

PDE-5 are contraindicated in who?

Answer 9

Patients who are on nitrates

Question 10

A combo of these two meds and result in decreased BP

Answer 10

PDE-5 and alpha blockers

Question 11

Side effects of PDE-5?

Answer 11

Blue vision (sildenafil), hearing loss

Question 12

This ED treatment involves an injection of prostaglandin E1 injected into the base of the penis –> smooth muscle relaxation in the corpus cavernosum

Answer 12

Alprostadil (Caverject)

**inject 10-20 minutes before sex

Question 13

This is a prostaglandin E1 where you insert a tablet into urethra –> massage penis for one min to equally distribute medication

Answer 13

Intraurethral alprodastil

Question 14

This uses vacuum pressure to encourage increased arterial inflow (draws blood into penis) and limit venous blood loss from the corpora cavernosa by holding blood in the penis

Answer 14

vacuum erection device

Question 15

Varicocele is typically ______ sided

Answer 15

left

Question 16

an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum)

Answer 16

varicocele

Question 17

Bag of worms

Answer 17

varicocele

Question 18

These are symptoms of what?

Dull, aching, scrotal discomfort often worse with standing and relieved by sitting/laying down, atrophy of left testicle

Answer 18

varicocele

Question 19

Treatment for varicocele?

Answer 19

Most dont need innervention

• If <21 and evidence of test atrophy and abnormal semen analysis, surgery
• If semen analysis normal, monitor semen q1-2 years

Older men:
-if fertility desired then semen analysis q1-2 years otherwise scrotal support & NSAIDs

Question 20

a type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle.

Answer 20

hydrocele

Question 21

Clinical symptoms of hydrocele

Answer 21

• soft, small to massive collections of several liters where patients can’t wear pants.
• Transilluminates
• may have pain depending on the size

Question 22

If dx is uncertain for hydrocele, what diagnostic should we do?

Answer 22

ultrasound

Question 23

Treatment for hydrocele?

Answer 23

• No treatment typically

- if symptomatic, surgery (excision of hydrocele sac)

Question 24

is an abnormal sac (cyst) that develops in the epididymis — the small, coiled tube located on the upper testicle that collects and transports sperm >2 cm

Answer 24

Spermatocele

Question 25

Treatment for spermatocele?

Answer 25

no tx but surgery if causing pain

Question 26

Symptoms of this disease cause increase in daytime frequency, nocturia, urinary incontinence, voiding symtpms

Answer 26

BPH

Question 27

How to detect BPH on PE?

Answer 27

-DRE to assess prostate size & consistency

Question 28

A normal prostate is the size of a _________

Answer 28

walnut and should be firm and non-tender

Question 29

Diagnostics for BPH?

Answer 29

UA, PSA, BMP

Question 30

What are some behavioral modifications for BPH?

Answer 30

- Avoid fluids prior to bed - Reduce caffeine and alcohol consumption - double voiding

Question 31

This med is good for initial symptomatic BPH and relaxes smooth muscle to allow urine to flow out

Answer 31

Alpha blockers - "Osins" - Tamsulosin (flomax) MC - Terazolsin, doxazosin * *given at bedtime

Question 32

Side effects alpha blockers

Answer 32

hypotension, dizziness, ejac dysfxn

Question 33

This BPH med reduces the size of the prostate and decreases the incidence of prostate cancer

Answer 33

Finasteride, dutaseride "asterides"

Question 34

For those with severe BPH symptoms what is the tx?

Answer 34

5-alpha reductase inhibitors + alpha blockers

Question 35

These are NOT recoemmended for people with BPH?

Answer 35

Herbal therapies (Saw palmetto)

Question 36

For persistent or progressive symptoms despite combo BPH therapy for 12-24 months what is the tx?

Answer 36

TURP (transurethral resection of the prostate) which is basically chipping away at pieces of the prostate

Question 37

Complications of surgical BPH options?

Answer 37

Sex dysfxn is the mc significant complaint