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GU General


BPH sxs Obstructive: hesitancy, decreased force of stream, incomplete voiding, straining, dribbling; irritative: urgency, frequency, nocturia
ED 50% of 40-70 yo; usually organic (vs psych); poss CV/DM/ meds
Cystitis: DDx Women: vulvovaginitis, PID; Men: urethritis, prostatitis; bladder ca, voiding dysfn
Epididymitis in men <40 yo: caused by: STI: urethritis, CT / NG / Ureaplasma
Urethritis etiology Infxn: NG (GC/CT) or NGU (most often in DM: Myco genitalium, Ureaplasma). Reactive. Posttraumatic. Induced inflammation.
Epididymitis in men >40 yo: caused by UTI or prostatitis, usually GNR; ?amiodarone
Epididymitis: Sx/Sx Gradual onset. Scrotal pain radiating via spermatic cord to flank. Firm tender scrotal mass. Possible prostate TTP. Fever, high WBC
Prostatitis: bacterial vs nonbacterial nonbac: no h/o UTI or pos cx; consider bladder ca in older men: do cytology & cystoscopy
Urethritis: DDx UTI, candida, noninfxs urethritis (FBO), stones, Reiter, chronic prostatitis
Prostatitis bugs GNR (E coli & Pseudomonas) & GPC (enterococci, seen in chronic dz). Younger men also GC/CT & Trichomonas
BPH etiology Androgen, estrogen, stromal GF dysregulation, decreased cell death, increased stem cells, genetics
BPH obstructive sxs: decreased force of urinary stream, hesitancy, postvoid dribbling, incomplete voiding
BPH irritative sxs: frequency, urgency, nocturia
Prostate cancer prevalence by site: 95% adenocarcinoma. Peripheral zone > transition zone (periurethral area: removed by TURP) > central zone (urethra + ejac ducts)
bladder cancer risk factors tobacco (esp transitional cell ca), indust chem exp; schistosomiasis; cyclophosphamide
bladder cancer: most common presenting sx painless hematuria; also bladder irritability & infxn
testicular cancer prevalence by type Most common solid tumor in young males. Risk 1 in 500. Seminoma (35%); nonseminoma (65%): mixed > embryonal > teratoma > choriocarcinoma.
entrapment of foreskin behind glans penis = paraphimosis; poss 2/2 frequent caths
Predictors of ED: HTN, DM, HLD, CVD
Hydrocele is usually 2/2: fluid filled congenital remnants of tunica vaginalis (2/2 patent processus vaginalis)
spermatocele = Painless cystic mass containing sperm, usually <1 cm. Superior & posterior to testes. Aspirate: white cloudy fluid
Varicocele = venous varicocity within spermatic vein (pampiniform plexus); L vein > R vein (bc longer)
Varicocele sx/sx chronic nontender mass, does not transilluminate; bag of worms, enlarges w/Valsalva, diminishes w/elevation
TRUS not accurate in: determining local tumor extension
Male infertility: most common etiologies varicocele (37%); idiopathic (25%)
Male factors contribute what percent to infertility cases? 40%
BPH vs prostate cancer: findings BPH: firm smooth enlarged prostate, normal PSA; cancer: firm, irregular, nodular non-tender prostate, elevated PSA
Fibrous band on lateral penis Peyronie disease
Inability to retract foreskin; erythema, TTP, poss purulence Phimosis
Inflammation of glans Balanitis
<40 yo male with high fever/chills, perineal pain, dysuria, freq/urgency, prostate swollen/TTP Acute prostatitis
>50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate; Normal PSA BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
Incontinence with straining Stress, 2/2 inc intra-abd pressure
Prostate cancer risk factors AA, age, FH, testost; high Gleason: high mets risk (usu to bone); not always high PSA
blue dot sign Testicular appendiceal torsion
BPH Pathophysiology Proliferation of fibrostromal tissue -> urethral compression; develop in periurethral or transitional zone. BPH requires older age and functioning Leydig cells
BPH Sx/Sx AUA sx score (0-35, severe >20), IPSS; LUTS (irritative & obstructive sxs). DRE: firm smoothly enlarged, non-nodular
BPH DDx overactive bladder, interstitial cystitis, prostatitis, prostate or bladder ca, UTI, neurogenic bladder, urethral stricture
NGU clinical findings Dysuria, pruritus, scant clear-white discharge
GU clinical features 2-7 day incubation. 30-40% coinfxn with CT. Burning w/serous/milky discharge. Dyspareunia.
GU sxs of disseminated dz Fever, rash, tenosynovitis, conjunctivitis, arthritis
Irritative voiding symptoms, Fever, chills, CVA tenderness = Pyelonephritis
Pyelonephritis risk factors Underlying Ur tract abnormalities, stones, DM, immunocomp, elderly F in facility, pyelo episode within past year
Testicular tumor clinical features Firm, nontender mass. Does not transilluminate. Para-aortic LN involvement resembles ureteral obstruction. R testis > left. M 20-35yo; 5% of cryptoorchidism
Testicular tumor workup HCG, a-fetoprotein, LDH
Testicular torsion sx severe testicular, scrotal, lower abd pain, N/V. Recent trauma. Cremasteric reflex absent on affected side.
Acute scrotal pain DDx Testicular torsion, Testicular appendiceal torsion, epididymitis, hernia, orchitis
Prostatitis sx/sx Perineal pain, fever/chills, irritative & obstructive voiding sx. Tender boggy prostate
Chronic prostatitis tx Bactrim: prolonged course (8-12 weeks) has moderately high cure rate. Chronic dz difficult to cure (Abx unable to diffuse into prostatic fluid)
Testicular torsion mgmt Ultrasound to dx. Complications include necrosis. Surgical emergency (attempt manual detorsion while surgery pending)
BPH mgmt Selective alpha1 blockers (prazosin, terazosin, doxazosin, tamsulosin) reduce LUTS sxs. 5-alpha-reductase inhibitor (finasteride) reduces prostate size & sxs. TURP vs TULIP
testicular cancer mgmt Inguinal orchiectomy. Retroperitoneal LN dissection. Chemo +/- XRT.
Bladder cancer types Transitional cell (90%; superficial or invasive). Squamous. Adenocarcinoma.
GU adenocarcinomas Prostate. Ovarian, endometrial
Prostate cancer screening <75 only. Rise in PSA precedes clinical dz by 5 -10 yrs. Begin at 50; 40 if AAM, FH (<65 yo), BrCa.
Screen with PSA & DRE how often? Yearly if PSA >2.5 (q 2 yrs if <2.5).
Transurethral US bx if PSA is: >3.0
Created by: Abarnard