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Men's Health Labs

Men's Health

USPSTF: prostate insufficient evidence for/vs in men <75; men >75: harms outweigh risks
USPSTF: testicular ca against routine screening in Asx
PSA elevations can precede clinical dz by: 5-10 yrs
PSA index PSA density (PSA conc divided by PSA volume); higher may be assoc w/cancer
Utility of free PSA helps distinguish prostate cancer from BPH in DRE-negative pts with borderline-high PSA
Most common formula for prostate volume ellipsoid formula
Acid phosphatase used for: Dx of prostatic ca; monitor tx w/ neoplastic drugs, esp in metastatic dz
Acid phosphatase elevated in prostate: Adenocarcinoma; Manipulation; Inflammation; Hypertrophy
Do not order acid phosphatase immediately after: DRE, TURP, or prostatic massage
Acid phosphatase: specimen 0.5ml serum separated & added to 10µl acid phosphatase preservative (pH 5) within 2 hours of collection
Cystoscopy: risks Infection, bleeding, tear/perf, urinary retention, scar tissue, allergy to anesthetic, epididymitis/ orchitis
TRUS: utility not useful as screening test; US alone cannot establish /exclude the dx; used to evaluate elevated PSA (to locate suspicious area for transrectal biopsy)
TRUS not accurate in: determining local tumor extension
Prostate bx: eval men with azoospermia to: rule out ejaculatory duct cysts or seminal vesicular cysts
Prostate bx best performed with: a spring-driven needle core biopsy device (or biopsy gun)
Complications of prostate bx hematuria, rectal bleeding, hematospermia, urosepsis, & perineal pain
Testosterone: indications Hypogonadism (loss of libido, ED, gynecomastia, osteoporosis, infertility); delayed/ precocious puberty; monitor testost replacement tx or antiandrogen tx; eval ambiguous genitalia
Hgb 3 g/dL higher in men
Uric acid 2 mg/dL higher in men
Testicular U/S: utility Inflam scrotum; epididymitis; hydrocele; absent/ undescended testicle; torsion; abnormal blood vessels; lump or tumor; most scrotal masses
If testicular mass, first do: dx U/S
Use _____ to differentiate torsion from epididymitis Doppler US
Male infertility: most common etiologies varicocele (37%); idiopathic (25%)
Male factors contribute what percent to infertility cases? 40%
Male infertility analysis: start with: semen analysis (if abnormal, look for exposure to toxins (environment, workplace, EtOH, drugs, hypogonadism)
Semen analysis: specimen 0.5 mL, room temp, no sex 2-3 (2-5?) days prior, macro & micro analysis within 1 hr
Semen analysis: normal volume volume >2 ml
Semen analysis: normal appearance: beige, opalescent
Semen analysis: normal liquefaction: liquefied within 1 hour
Semen analysis: normal pH: 7.2-7.8
Semen analysis: normal motility: ≥ 50%, >50% forward progression
Semen analysis: normal sperm concentration: ≥ 20 x 10(6)/ml
Semen analysis: normal morphology: ≥ 50%
Low sperm motility may be due to: antisperm Ab or infection
Abnormal sperm morphology: may be due to: varicocele, infection, exposure history
Low semen volume: may be due to: retrograde ejaculation or androgen insufficiency
Elevated LH: causes Testicular dysfn; primary testicular fail; CNS dysfn; precocious puberty; postviral orchitis
Decreased LH: causes Testicular tumors; secondary testicular fail; hypopituitarism; hypothalamic-pituitary dysfn
FSH normal range 1.5-14.0 mIU/mL
Elevated FSH causes primary gonadal failure, testicular agenesis, alcoholism, gonadotropin-secreting pituitary tumors
Decreased FSH causes Anterior pituitary hypofunction, hypothalamic disorders
Limitation of FSH levels Pulsatile secretion throughout day (physiologic variation within reference range)
Primary testicular failure: labs increased LH/FSH, decreased testosterone
Secondary testicular failure: labs decreased LH, FSH, testosterone
Steroid tx for: spontaneous autoimmunity; also genital infection, testicular obstruction, & IVF
Sims-Huhner test During female LH surge, examine cervical mucus 2-8 hrs post coitus to evaluate sperm & quality of mucus
Sims-Huhner test provides info about: number of sperm, progressive motility, morphology & interaction of spermatozoa with the cervical mucus
Seminal plasma fructose: to evaluate: azoospermia with ejaculate < 1 ml
Seminal plasma fructose MOA Fructose is produced in seminal vesicles (energy source); if absent in ejaculate, implies absence or obstruction of ejaculatory ducts
Seminal plasma fructose: specimen: frozen seminal plasma
Post-vasectomy testing: check sperm counts: After 20 ejaculations; 8-12 weeks post-vasectomy
Testicular cancer dx studies US (shows hyperechoic area). AFP & HCG for staging.
Bladder cancer dx studies Cystoscopy (dx & tx). Excision of small lesions. Excretory urography for large mass (eval renal pelvis / ureter). CT A/P
Created by: Abarnard