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78 Cards in this Set
- Front
- Back
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what is erectile dysfunction?
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inability to achieve or sustain an erection for satisfactory sexual activity
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what are 4 requirements of erection?
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healthy nervous system
healthy arteries healthy smooth muscles adequate levels of NO in the penis |
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when can ED occur in terms of requirements of erection?
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when one or more requirement is not met
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what are 3 major causes of ED?
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aging
HTN CV disease |
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what are 4 minor causes of ED?
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diabetes
smoking nerve or spinal cord damage depression/anxiety |
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when is ED diagnosed?
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men who have had repeated inability to achieve and/or maintain erection for satisfactory sexual performance for at least 3 months
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what lab tests should be run for ED? (3)
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diabetes
full chemistry panel hormone levels (esp free testosterone which is easily treated) |
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why is the hormone level important in diagnosing ED?
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because low free testosterone is easily treated
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why do you want to look for vasculogenic causes of ED?
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because they are usually linked and important to treat
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what studies do you want to run on a pt presenting with ED?
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labs
UA lipid panel PSA |
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what treatment works very well for ED but is unpleasant?
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PGE1 injections
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what are 4 general treatments for ED?
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vacuum pump/tension ring
self injections oral meds surgery |
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who are oral meds contraindicated in?
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patients taking nitro
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what is the difference between oral ED meds and injections?
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injections do not require sexual stimulation like oral meds do
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why are implants the last option for ED?
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because if the implant has to be removed for any reason (infection, etc) the patient is totally impotent
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what is priapism?
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persistent, usually painful erection lasting more than 4 hours without sexual stimulation
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what causes priapsim?
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when blood in the penis is trapped and unable to drain
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what is the problem with not treating priapism immediately?
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it can lead to scarring or permanent erectile dysfunction
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who gets priapism? (2)
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boys 5-10
men 20-50 |
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how can sickle cell cause priapism?
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because of sludging of blood that gets trapped in the penis
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how can priapism spontaneously resolve? (3)
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repeated ejaculation
physical activity brisk walk |
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how can priapism be treated orally? (2)
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terbutaline or salbutamol
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what is the best way to treat priapism in the ER? (2)
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removing some of the blood from the penis
reversing agent (metaraminol) |
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how long must a patient have priapism becofre they are permanently impotent?
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24 hours
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what part of the penis does priapism affect?
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only the cavernosum
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what is peyronie's disease?
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scarring or fribosis in the tunic of the corpora
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how does a patient with peyronie's disease present?
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mass in the penis causing abnormal curvature in the penis
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what is the treatment for peyronie's disease?
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surgery
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what disease is peyronie's disease associated with?
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dupuytren's contracture
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what is the best treatment for peyronie's disease patients if it is not serious?
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reassurance
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what is the most common malignancy in US males?
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prostate cancer
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how can priapism spontaneously resolve? (3)
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repeated ejaculation
physical activity brisk walk |
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what is the second leading cause of cancer death in US males?
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prostate cancer
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how can priapism be treated orally? (2)
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terbutaline or salbutamol
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what is the best way to treat priapism in the ER? (2)
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removing some of the blood from the penis
reversing agent (metaraminol) |
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how often does prostate cancer occur?
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1 in 6 men
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how long must a patient have priapism becofre they are permanently impotent?
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24 hours
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who is prostate cancer more common in? (3)
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african americans
family history increasing age (common after 70) |
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what part of the penis does priapism affect?
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only the cavernosum
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what are 2 main things to do to diagnose/screen for prostate cancer?
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DRE and PSA
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what is peyronie's disease?
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scarring or fribosis in the tunic of the corpora
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what will raise PSA? (2)
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prostatitis and BPH
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how does a patient with peyronie's disease present?
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mass in the penis causing abnormal curvature in the penis
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when should you begin yearly PSA screenings?
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age 50
age 40 in black males or family history |
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what is the treatment for peyronie's disease?
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surgery
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who do you begin yearly PSA screenings in at the age of 40? (2)
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african americans
family history |
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what disease is peyronie's disease associated with?
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dupuytren's contracture
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what test is not used for prostate cancer anymore?
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prostatic acid phosphatase
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what is the best treatment for peyronie's disease patients if it is not serious?
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reassurance
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what 3 other things can be used for diagnosis of prostate cancer?
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biopsy
CT bone scan |
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when would you do a trans-rectal US for prostate cancer? (3)
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nodule on prostate
PSA is out of range PSA velocity (increase by more than 20%/year) |
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what is the gleason grading system?
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a way to grade how abnormal the prostate cancer cells look on a scale of 2-10 (which is a sum of primary and secondary grades)
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what gleason grade is considered highly aggresive prostate cancer?
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7-10
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what is the TNM staging system?
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T - primary tumor
N - lymph node involvement M - metastasis |
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what is the typical path of prostate cancer spread?
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prostate --> nodes --> axial skeleton
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what is the gold standard for prostate cancer?
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radical prostatectomy
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who do we usually do prostatectomies on? (3)
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younger
healthier at least 15 year life expectancy |
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what is interstitial brachytherapy?
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small needles are placed in the prostate and small radiation seeds are placed to radiate it from the inside out (generally in 70 or over)
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what is cryoablation?
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needles are places into the prostate to freeze it
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what is hormone removal?
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remove the testes or use drugs that can stop hormone production
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when is hormone removal done?
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when cancer spreads outside the prostate
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what are 3 treatment options for prostate cancer not including surgery?
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interstitial brachytherapy
cryoablation hormone removal |
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what is the key to hormone removal therapy?
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it is palliative, not curative
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what is the most common testicular cancer?
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seminoma
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who gets testicular cancer the most?
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young caucasions
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who is testicular cancer most common in? (3)
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those with:
abnormal testical development undescended testicle family history |
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what are 3 presenting symptoms of testicular cancer?
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swelling
masses in testicles or groin rapidly enlarging, non painful mass |
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anytime you see a painless mass in the testicle, what is it?
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testicular cancer until proven otherwise
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what are 3 ways to diagnose testicular cancer?
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testicular exam
US CT |
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what is the most common method to diagnose Testicular cancer?
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US
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what are 2 serum markers for testicular cancer?
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beta-hCG
alpha fetoprotein |
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when should a testicular cancer patient see a surgeon?
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within the first week of diagnosis
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what is the best way to treat testicular cancer?
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removal of the testicle
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if a testicular cancer is a seminoma, what must you do with lymph nodes?
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radiation therapy to the lymph nodes of primary drainage (iliac areas)
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if a testicular cancer is not a seminoma, what must you do with lymph nodes?
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dissect the draining lymph nodes
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what 2 things increase the risk for penile cancer?
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uncircumcised men
HPV |
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when must you consider penile cancer?
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anytime there is a lesion on the penis, especially under the foreskin
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what is the 1st treatment for patients presenting with a lesion on the penis?
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antibiotics to see if the patient improves
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