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Integration for Clinical Application > Session 3: Men's Health - Urology > Flashcards

Session 3: Men's Health - Urology Flashcards

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1
Q

What is phimosis?

A

When the prepuce (foreskin) cannot be fully retracted over the glans in adults.

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2
Q

Is phimosis common?

A

Phimosis can be physiological and then it is common in young ages.

50% at 1 year

10% at 3 years

1% at 17 years.

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3
Q

Complications/effects of phimosis.

A

Poor hygiene

Increased risk of STDs

Balanitis

Pain on intercourse where foreskin might split or bleed

Posthitis

Balanitis Xerotic Obliterans (BXO)

Paraphimosis

Urinary retention

Penile cancer

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4
Q

What is balanitis?

A

Inflamed glans

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5
Q

What is posthitis?

A

Inflamed foreskin

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6
Q

What is paraphimosis?

A

Painful constriction of the glans penis by the retracted prepuce proximal to the corona.

This means that the foreskin cannot be protracted after once being retracted.

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7
Q

Commonest causes of paraphimosis.

A

Phimosis

Catheterisation especially in elderly

Penile cancer

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8
Q

Best treatment of phimosis.

A

Circumcision

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9
Q

Treatment of paraphimosis.

A

Needs reduction and this is usually achieved manually.

However a dorsal slit might be necessary.

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10
Q

Most common type of penile.

A

Squamous cell carcinoma.

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11
Q

Epidemiology of penile cancer.

A

Very rare with around 350 new cases per year in the UK.

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12
Q

Risk factors of penile cancer.

A

Phimosis

Hygiene

Smegma

HPV 16&18

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13
Q

Prognosis of penile cancer.

A

If untreated most patients die within 2 years.

Almost all will die within 5 years.

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14
Q

Causes of circumcision in paediatrics.

A

Religious reasons

Recurrent balanitis and UTIs.

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15
Q

Causes of circumcision in adults.

A

Recurrent balanitis

Phimosis

Recurrent paraphimosis

Balanitis Xerotica Obliterans

Penile cancer

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16
Q

Causes of acute scrotal pain.

A

Testicular torsion (Most important to rule out)

Epididymitis

Orchitis

Epididymo-orchitis

Torsion of hydatid of Morgagni

Trauma

Ureteri calculi

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17
Q

Common presentation/history of testicular torsion.

A

Usually younger patient (<30 years)

Sudden onset which can commonly wake them up from sleep

Unilateral pain and may be associated with nausea

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18
Q

What would be found on examination on testicular torsion?

A

Testis is very tender

The testis is lying high in the scrotum and with a horisontal lie.

If you suspect testicular torsion, the patient needs emergency scrotal exploration.

Do not waste time with USS etc..

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19
Q

Common presentation of epididymo-orchitis.

A

Age around 20-40 years with an STI

Or 40/50+ with UTI.

It has a gradual onset compared to testicular torsions acute onset.

There is often a recent history of UTIs, unprotected intercourse, catheterisation or mumps.

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20
Q

Examination findings of epididymo-orchitis.

A

May be pyrexial and even septic

Scrotum erythematous

Can have enlarged and tender tesis/epididymis

Can have abscess

May have reactive hydrocoele.

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21
Q

What is a rare but serious complications of epididymo-orchitis?

A

Fournier’s gangrene.

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22
Q

What is Fournier’s gangrene?

A

Necrotic area of scrotal skin with a high mortality rate of around 50%.

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23
Q

Investigations of epididymo-orchitis.

A

Bloods like FBC, U&Es, cultures

Urine dipstick

Radiology if suspect abscess

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24
Q

Treatment of epididymo-orchitis.

A

Antibiotics (anaerobic)

If abscess then surgical drainage and antibiotics

If Fournier’s gangrene then emergency debridement and antibiotics.

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25
Key history from scrotal lumps.
Is it painful? How quickly did it appear?
26
Key examinations.
Can you get above it? Is it in the body of the testis? Is it separate to the testis? Does it fluctuate and transilluminate?
27
If you can't get above the lump, what is it likely to be?
A hernia
28
If it is in the body of the testis, what is it likely to be?
A testicular tumour
29
Give examples of painless non-tender lumps.
Testis tumour Epididymal cyst Hydrocoele **Reducible** inguino-scrotal hernia
30
Likely diagnosis if the lump is painless during the day but get's achy at the end of the day.
Varicocoele
31
Give examples of painful/tender scrotal lumps.
Epididymitis Epididymo-orchitis **Strangulated** inguino-scrotal hernia
32
General history of testicular tumour.
Usually painless Germ cell tumours such as seminomas or teratomas are usually in men aged \<45 years. If in older men could be a lymphoma
33
Common risk factor of testicular tumours.
Cryptorchidism
34
Findings on examination of testicular cancer.
**Body** of testis is abnormal Can get above
35
Investigations of testicular cancer.
Urgent USS of scrotum Tumour markes such as aFP, hCG, LDH
36
Clinical presentation of hydrocoele.
Slow/sudden onset Can be either unilateral or bilateral.
37
Cause of hydrocoele.
Imbalance of fluid production and resorption between tunic albuginea and tunica vaginalis.
38
Findings on examination of testis in hydrocoele.
Testis not palpable seperately Can usually get above the testis **Transilluminates**
39
Clinical presentation of epididymal cyst.
Usually painless
40
Findings on examination of epididymal cysts.
Separate from testis. Can get above the mass **Transilluminates**
41
Clinical presentation of varicoele.
Dull ache at the end of day. May be associated with reduced fertility. Left testicle more commonly affected than right.
42
Findings on examination of varicoele.
Bag of worms above testis. Not tender
43
What is important to consider and examine in a varicocoele?
If there is any palpable abdominal/renal mass because varicocoeles can be secondary to renal disease.
44
Tx of testicular tumour.
Inguinal orchidectomy
45
Tx of epididymal cyst.
Reassurance but excision if large and symptomatic.
46
Tx of hydrocoele.
Reassure and excise if large/symptomatic
47
Tx of varicocoele.
Reassurance Radiological embolisation if symptomatic, if infertile, if present in adolescent and growth of testis is affected.
48
Tx of inguino-scrotal hernia.
Surgery
49
Causes of urinary retention.
BPH and prostate cancer Phimosis/urethral stricture or meatal stenosis Constipation UTI Drugs Over-distension Following surgery Neurological
50
What kind of drugs can lead to urinary retention?
Anti-cholinergics Alpha-1 agonists
51
Why would anticholinergic cause urinary retention?
Anti-cholinergics inhibit the parasympathetic system. The parasympathetic system is needed in order to void.
52
Why would alpha1-agonists cause urinary retention?
Because they act on alpha-1 receptors in the prostate and the IUS and constrict the IUS. This causes urinary retention.
53
Type of urinary retention.
Acute painful Chronic painless/less painful Acute on chronic which is painful
54
Features of acute painful UR.
Pain relieved by drainage Residual volume less than 1000 ml No kidney insult
55
Tx of acute painful UR.
Trial without catheter (TWOC) after addressing the exacerbating factors.
56
Features of chronic painless/less painful UR.
May just notice abdominal swelling Residual volume \>300 ml and may go up to extremely high numbers such as 5L. May have kidney insult.
57
Tx of chronic painless/less painful UR.
Learn to self-catheterise.
58
Features of acute on chronic painful UR.
Residual volume \>1000 ml Usually have kidney insult.
59
Tx of acute on chronic painful UR.
Long-term catheter or surgical intervention as TWOC is usually not successful.
60
What is the clinical diagnosis of older men with nocturnal enuresis?
Chronic retention with overflow incontinence until proven otherwise.
61
What can LUTS in men be divided into?
Voiding problems Storage problems
62
Give voiding symptoms
Hesistancy Poor flow Post-micturition dribbling
63
Give storage symptoms.
Frequency Urgency Nocturia
64
Give causes of storage LUTS.
Bladder infection/inflammation Bladder stone Bladder cancer Overactive bladder that is idiopathic or neuropathic Scarred bladder with low compliance. Polyuria either global or nocturnal
65
Causes of overactive bladder
CVA Parkinson's MS
66
Causes of low compliance of bladder
TB Schistosomiasis Pelvic radiotherapy
67
Causes of global polyuria.
Uncontrolled diabetes
68
Causes of nocturnal polyuria.
Venous stasis Sleep apnoea
69
Causes of voiding LUTS.
Bladder outflow obstruction Reduced contractility of bladder
70
Give examples of physical BOOs.
Urethra such as phimosis or strictures. Prostate such as BPH or cancer
71
Give causes of reduced contractility.
Neurological such as lower motor neurone lesion.
72
Explain dynamic BOO.
Where there is increased sympathetic smooth muscular tone leading to constriction and possible stasis.
73
Assessment of LUTS in primary care.
IPSS (international prostate symptom score)
74
Examination of LUTS.
DRE Palpable bladder? Neurological if history suggest it
75
Investigations of LUTS.
Dipstick looking for UTI or blood. Consider as PSA
76
Management of BPH in primary care.
Lifestyle interventions such as reduce caffeine intake, avoid fizzy drinks and don't drink excessive amounts of fluid.
77
Medicinal management of BPH in primary care.
Alpha blockers 5alpha-reductase inhibitors
78
Explain the action of alpha-blockers.
Acts by relaxing the smooth muscle in the prostate and also the IUS. This gives rapid symptom relief.
79
Explain the action of 5ARIs.
Shrinks the prostate by inhibiting 5alpha-reductase which is supposed to convert testosterone to dihydrotestosterone (DHT).
80
How does 5ARIs differ to alpha-blockers.
5ARIs have slower symptoms relief and also slows progression and reduces the risk of retention.
81
Give examples of alpha-blockers.
Tamsulosin
82
Give examples of 5ARIs
Finasteride Dutasteride
83
Management of BPH in secondary care (if lifestyle and medication fails)
Flow rate done before considering surgery. Surgery.
84
When is surgery done?
When lifestyle and medical management fails. When there is urinary retention that needs intervention.
85
What surgical procedure is used in BPH?
TURP (Transurethral resection of prostate)
86

Integration for Clinical Application (11 decks)

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