GU
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| 4-glass localization test for: | chronic prostatitis vs UTI (avoid in acute prostatitis); detn nidus of infxn
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| infxn 2/2 retrograde organism spread thru vas deferens = | epididymitis
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| urinary incontinence studies | UA, PVR; cystometry (H2O into bladder), stress test, US, cystoscopy
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| prostate ca studies | PSA. TR US (if PSA >4): hypoechoic lesions. Bx to dx adenocarcinoma & Gleason grading (2-10). PSA >10: radionuclide bone scan to r/o bony mets. CT unreliable to detect LN involvement
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| modalities for prostate ca staging: | abd/pelvic CT or MRI, pelvic lymphadenectomy, bone scan
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| testicular ca studies | scrotal US (intratesticular echogenic focus); CXR & chest/abd/ pelvic CT; high AFP & hCG (nonseminoma)
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| spermatocele dx studies | FNA; scrotal U/S
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| PSA elevations can precede clinical dz by: | 5-10 yrs
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| PSA index | PSA density (PSA conc divided by PSA volume); higher may be assoc w/cancer
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| Acid phosphatase used for: | Dx of prostatic ca; monitor tx w/ neoplastic drugs, esp in metastatic dz
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| Acid phosphatase elevated in prostate: | Adenocarcinoma; Manipulation; Inflammation; Hypertrophy; do not assay immediately after DRE, TURP, or prostatic massage
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| Testicular U/S: utility | Inflam scrotum; epididymitis; hydrocele; absent/ undescended testicle; torsion; abnormal blood vessels; lump or tumor; most scrotal masses
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| If testicular mass, first do: | dx U/S
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| Use _____ to differentiate torsion from epididymitis | Doppler US
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| Male infertility analysis: start with: | semen analysis (if abnormal, look for exposure to toxins (environment, workplace, EtOH, drugs, hypogonadism)
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| Semen analysis: specimen reqs | 0.5 mL, room temp, no sex 2-3 (2-5?) days prior, macro & micro analysis within 1 hr
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| Semen analysis: normal volume | volume >2 ml
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| Semen analysis: normal liquefaction: | liquefied within 1 hour
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| Semen analysis: normal pH: | 7.2-7.8
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| Semen analysis: normal motility: | ≥ 50%, >50% forward progression
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| Semen analysis: normal sperm concentration: | ≥ 20 x 10(6)/ml
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| Semen analysis: normal morphology: | ≥ 50%
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| Low sperm motility may be due to: | antisperm Ab or infection
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| Abnormal sperm morphology: may be due to: | varicocele, infection, exposure history
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| Low semen volume: may be due to: | retrograde ejaculation or androgen insufficiency
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| Elevated LH in men: causes | Testicular dysfn; primary testicular fail; CNS dysfn; precocious puberty; postviral orchitis
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| Decreased LH in men: causes | Testicular tumors; secondary testicular fail; hypopituitarism; hypothalamic-pituitary dysfn
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| FSH normal range (M) | 1.5-14.0 mIU/mL
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| Elevated FSH in men: causes | primary gonadal failure, testicular agenesis, alcoholism, gonadotropin-secreting pituitary tumors
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| Decreased FSH in men: causes | Anterior pituitary hypofunction, hypothalamic disorders
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| Limitation of FSH levels | Pulsatile secretion throughout day (physiologic variation within reference range)
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| Primary testicular failure: labs | increased LH/FSH, decreased testosterone
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| Secondary testicular failure (ie, pituitary dz): labs | decreased LH, FSH, testosterone
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| Sims-Huhner test | During female LH surge, examine cervical mucus 2-8 hrs post coitus to evaluate sperm & quality of mucus
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| Sims-Huhner test provides info about: | number of sperm, progressive motility, morphology & interaction of spermatozoa with the cervical mucus
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| Seminal plasma fructose MOA | Fructose is produced in seminal vesicles (energy source); if absent in ejaculate, implies absence or obstruction of ejaculatory ducts; exam on frozen seminal plasma specimen
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| Post-vasectomy testing: check sperm counts: | After 20 ejaculations; 8-12 weeks post-vasectomy
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| Utility of free PSA | helps distinguish prostate cancer from BPH in DRE-negative pts with borderline-high PSA
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| Most common formula for prostate volume | ellipsoid formula
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| Prostate bx: eval men with azoospermia to: | rule out ejaculatory duct cysts or seminal vesicular cysts
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| gold std test for testicular torsion | radionucleotide scan
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| intratesticular echogenic focus on scrotal US = | testicular ca
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| Positive urine cx = | >10(5) bacteria/mL (or >100 CFUs) pure growth
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| If gram stain inconclusive for GU: | Cx on Thayer-Martin plate
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| Decreased FSH, elevated LH & testosterone = | Azoospermia &/or androgen resistance
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| Infertility despite normal FSH, LH, testosterone: | ?obstruction of epididymis or vas deferens
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| Prostate cancer mgmt | If neg bone scan & low PSA: local curative tx, radical prostatectomy, XRT. Advanced dz: androgen ablation (castration or LH for med alteration). Palliative bone pain tx
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Created by:
Abarnard
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