Urology and Male Health Flashcards by Cornelius Ware

What is Testicular Torsion ?

Obstruction of blood flow to the testes due to twisting of the veins and arteries in the spermatic cord

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What are s/s of Testicular Torsion?

Sudden onset with unilateral scrotal pain
Abdominal Pain
Testis is tender
Palpation: Twisted spermatic cord
Scrotal edema &amp; erythema

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How is Testicular Torsion diagnosed and treated?

Doppler US: No blood flow sounds
on affected side
Emergency urological referral
Surgery: 80-100% blood flow re-established if within 6 hours of onset

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What is Epididymitis ?

Inflammation of the epididymis

Most common intrascrotal infection

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How is Epididymitis diagnosed and treated?

Urinalysis - Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients
Complete blood count (CBC) - Leukocytosis

Gram stain of urethral discharge, if present

Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (these tests aid in detection of N gonorrhoeae and C trachomatis)

Performance of (or referral for) syphilis and HIV testing in patients with a sexually transmitted etiology

US of the scrotum confirms diagnosis

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How is Epididymitis treated (STI related)?

Treatment: Initial treatment consists of bed rest
with scrotal elevation, ice packs and appropriate antibiotic
Ceftriaxone 250 mg IM x one dose
Doxycycline 100 mg BID X 10 days
Azithomycin 1 gm

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How is Epididymitis treated ( NON-STI related)?

Ciprofloxacin 500 mg BID x 10 days
Ofoxacin 200mg to 300mg PO BID
Bactrim DS one tablet PO BID

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What is an indirect hernia?

Indirect Hernia
Occurs when tissue herniates through the internal inguinal ring and descends into the scrotum

Sort swelling within the internal ring

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What is an direct hernia?

Direct Hernia
Hernial sac protrudes through the abdominal wall into the Hesselbach’s triangle

Usually presents as a bulge in the Hesselbach’s triangle
Usually painless
Easily reducible

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What is a strangulated hernia?

Hernia in which the blood supply to the entrapped bowel is diminished which becomes an emergent surgery

Colicky abdominal pain
Abdominal distention
Nausea & vomiting

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What is a incarcerated hernia?

Hernia’s contents cannot be replaced into the abdomen

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What is a reducible hernia?

Hernia is easily replaced in the abdomen

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What diagnostics are indicated for hernias and treatments?

Ultrasound

Refer to Surgeon for further evaluation

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What is a hydrocele?

Fluid sack ( collection of peritoneal fluid within the scrotum and surrounding the testes within the layers of the tunica vaginalis

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What is the difference between communicating and non communicating hydrocele?

Communicating: incomplete closure of processus vaginalis which results in temporary retention of peritoneal fluid
Non-communicating: Closure of the processus vaginalis which traps the peritoneal fluid

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What are signs and symptoms of hydrocele?

Painless swelling in the scrotum
Scrotum may feel heavy and is enlarged
Transillumination of scrotum
Hernia shows black
Hydrocele shows pink or red

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What is treatment of hydrocele?

Communicating: Referral to Surgeon
Especially if it is a new hydrocele
Non-communicating: Observe

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What is a Spermatocele ?

Cystic dilation of the epididymis

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What are signs and symptoms of Spermatocele ?

Painless cystic mass (feels like a marble in scrotum)
Circumscribed mass in scrotum
Possible tenderness with palpation

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What are indicated diagnostics and treatment for Spermatocele?

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Scrotal Ultrasound
No therapy necessary unless mass is uncomfortable to patient
Refer to Urologist is patient is too uncomfortable

What is a Varicocele ?

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Dilation of the pampiniform plexus which is usually caused by incompetent spermatic vein valves

What are signs and symptoms of Varicocele?

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Sign & Symptoms include oligospermia, pain, infertility and decreased testicular growth

What diagnostics are indicated for Varicocele?

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Doppler US
Decrease Sperm count
Intravenous pyelography to R/O renal tumor or obstruction

What is clinical treatment and management of Varicocele?

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Immediate evaluation for sudden appearance of left-sided varicocele to rule out renal tumor
If mild, left-sided varicocele in adult, observe
 Consult Urologist:
Right sided varicocele
New onset in adult
Large varicocele
Painful
Older males
Prepubertal boys
Infertility
Does not disappear when supine

Testicular cancer assessment shows?

Solid firm non-tender testicular mass Hydrocele Mass does not transilluminate Fullness or heaviness in scrotum

What diagnostics are indicated for probable testicular cancer?

Scrotal US ( gold standard)

What is management and treatment for testicular cancer?

Refer to oncologist for treatment Chemotherapy Radiation Surgical intervention; radical orchiectomy

What is Balanitis and it s/s?

``` Inflammation of the glans penis Etiology Bacterial or Fungal Symptoms & Signs Pain & Discharge (Purulent exudate; ulcerations) Edema & Inflammation ```

What is treatment for Balanitis?

Treatment Gentle retraction of foreskin daily and soak in warm water Topical antifungal (Add Keflex for mixed infection), steroid cream

What is Phimosis and its cause?

a condition of the penis where the foreskin cannot be fully retracted over the glans penis. Etiology: Congenital Defect, Yeast Infection, Poor Hygiene

What is the treatment for Phimosis?

Acute Infections Hot compresses or soaks Antibiotic therapy(Tetracycline or Defadroxil) Steroid Therapy: Betamethasone Dipropionate 0.1-0.05% BID x 4-6 weeks

What is Paraphimosis and s/s?

Foreskin retracted from glans & trapped proximal to coronal edge of glans Signs & Symptoms Edema Swollen prepuce & glans

What is treatment of Paraphimosis?

``` Treatment Reduction of foreskin (early/mild case) Dorsal slit (severe) ```

What is BPH and its signs and symptoms?

``` Noncancerous enlargement of the prostate gland Urinary frequency Increased frequency during the night Weak urinary stream Difficulty starting to urinate Possible loss of bladder control Strong urge to urinate ```

What are indicated diagnostics for BPH?

``` UA PSA US of prostate Needle biopsy IVP, CT or MRI of prostate DRE-digital rectal exam Cystoscopy Urinary flow measurement Post-void volume measurement Ultrasound & Biopsy to R/O Cancer ```

When to intervene in BPH?

``` Absolute indications urinary retention recurrent urinary tract infection renal insufficiency gross hematuria ``` Relative indications Elevated post-void residual urodynamic evidence of obstruction

What is treatment for BPH?

``` Mild: closely observe Treatment of Absolute Indications TURP TUIP Open Prostatectomy Transurethral Vaporization of the Prostate Trial of a-blockers ```

What medication are used to treat BPH?

5-a reductase inhibitor Proscar Avodart ``` a-blockers Terezosin(Hytrin) Doxazosin(Cardura) Tamsulosin(Flomax) Alfuzosin(Uroxatral) ```

What are signs and symptoms Acute Prostatitis?

Local Lower back & perineum ``` Systemic Fever Nausea Malaise Painful intercourse or decreased libido ``` Signs Enlarged tender prostate Don’t massage

What are diagnostics for Acute Prostatitis?

UA | Urine Culture

What are treatments for Acute Prostatitis?

Bactrim DS BID for 28 days Cipro 500mg QD for 28 days Doxycycline 100mg BID once and then daily for 28 days Good hydration Sitz bath Refrain from sexual intercourse until symptoms resolve

What are s/s for Chronic Prostatitis?

``` Signs & Symptoms Early a.m. penile discharge vague urinary discomfort Prostate slightly enlarged & tender No nodules ```

What are the indicated diagnostics for Chronic Prostatitis?

Urine Culture CT and/or US PSA: Elevated Cystoscopy

What are the treatments for Chronic Prostatitis?

Sitz Bath Good hydration Avoid tea, coffee, alcohol and other beverages which can cause diuresis Fluoroquinolone daily for 4-12 weeks Floxin 300mg BID for 4-12 weeks Cipro 400mg BID for 4-12 weeks

What are s/s of Prostate Cancer?

``` Prostate feels hard and may be nodular Hematuria Lymphedema Lympadenopathy Anemia Urinary retention ```

What are diagnostics for Prostate Cancer?

``` US PSA elevated but can also be normal Alkaline Phosphatase: Elevated with metastasis CT MRI Biopsy ```

When do PSA and DRE screenings begin for men?

Annual digital rectal exam beginning at age 40 years Annual PSA and DRE beginning at age 50 years Early screening at 45 years of age for high risk groups

What are treatments for Prostate Cancer?

``` Prostatectomy Radiation Therapy ADT Chemotherapy Cryosurgery Immunotherapy ```

Urology and Male Health Flashcards

(48 cards)