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