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75 Cards in this Set

  • Front
  • Back

Circumcision

Typically done during infancy



Surgical removal of the foreskin of the penis



Recently, there has been a trend towards not circumcising


- cultural thing

Potential Benefits of Circumcision

- decreased risk of STD transmission

Potential Negative Effects of Circumcision

- bleeding


- infection


- need for a repeat procedure (rare)


- decreased sexual sensitivity

Structural Abnormalities of Penis

Epispadias


Hypospadias


Phimosis


Paraphimosis

Epispadias

Opening on the dorsal shaft of the penis exposing the urethra



Does not need to be fixed unless it occurs very high up on the shaft

Hypospadias

Abnormally placed urethral meatus



Lower on the penis

Phimosis

Stenosis or narrowing of the preputial opening



Cannot pull the foreskin back off the head of the penis

Paraphimosis

Strangulation of the glans penis which needs to be fixed immediately



Cannot pull the foreskin back over the head of the penis

Congenital Abnormailties of Male Reproductive System

Kleinfelter's Syndrome


- testicular atrophy and infertility



Cryptorchism


- undescended testes


- happens more commonly in premies


- need to be surgically descended if they have not descended on their own by age 1 (risk of testicular cancer)

Infections of the Male Reproductive System

Orchitis


Epididymitis


Prostatitis


Urethritis


Balantitis


STD's

Orchitis

Not very common in US



Typically seen w/ epididymitis



Caused by viruses or secondary syphilis (uncommon in US)



Decreased incidence after vaccine for mumps



Can cause infertility

Epididymitis

Inflammation of the epididymis



Common in young males



Most common cause of swelling/ pain in the scrotum



Need to be able to differentiate from torsion!

Causes of Epididymitis

- may or may not be related to infection


* E. Coli, N. Gonorrhea


Diagnosis if Epididymitis

- cremasteric reflex intact


- pain relived w/ elevation of the testes (phrens sign)

Treatment of Epididymitis

- antibiotics


- scrotal elevation


- NSAID's


- rest

Balantitis

Inflammation of the glans penis



Localized or diffuse swelling, redness or ulceration



Viral or bacterial


- herpes: ulcers = painful


- syphilis: painless ulcers

Urethritis

Inflammation of the urethra



Types of Urethritis

Bacterial (gonococcal)


- purulent discharge


- neisseria gonorrhea



Non-gonococcal


- chlamydia trachomatis is the most common, but it can also be caused the ureaplasma urealyticum, haemophilus vaginalis and mycoplasma genitalium



Other


- viral


- parasitic


- non-infectious

Signs & Symptoms of Urethritis

- dysuria


- penile discharge


- urinary frequency

Prostatitis

Typically occurs in older men



Types


- acute or chronic


- bacterial or non-bacterial



Risk Factors of Prostatitis

- manipulation of the urinary system


- trauma


- UTI

Signs & Symptoms of Prostatitis

- pain


- dysuria


- urinary frequency


- hesitancy


- urgency


- nocturia

Diagnosis of Prostatitis

- rectal examination


- urinalysis

Treatment of Prostatitis

- antibiotics for 4 weeks (cipo or bactrim): increases risk of achilles tendon rupture


- hospitalization in serious cases


STD's

Herpes Simplex Virus - Type II


- painful ulcers


- recurrent



Gonorrhea


- purulent yellow discharge


- dysuria



Chlamydia


- often asymptomatic



HPV


- genital warts in males


- most common



Syphilis


- primary: painless ulcers (chancre)


- secondary: fever, chills, rash, condyloma latum


- tertiary: latent phase; gummas, multiple symptoms; NO treatment

Scrotal Masses

Vericocele


Hydrocele


Spermatocele


Vericocele

Mass of enlarged and ligated veins in the spermatic cord



Most common of the scrotal masses



Easily diagnosed



85% are left sided b/c blood drains at a 90 degree angle to the renal vein (not as good as the right side)




Symptoms, Diagnosis and Treatment of Vericocele

Symptoms


- typically asymptomatic


- may have an ache


- can cause fertility issues



Diagnosis


- exam


- u/s



Treatment


- support


- surgery


- embolization

Hydrocele

Collection of fluid around the testicle



Typically painless


Causes of Hydrocele

- congenital


- injury or trauma


- radiation therapy

Diagnosis and Treatment of Hydrocele

Diagnosis


- transillumination


- u/s to confirm



Treatment


- none


- surgery in extreme cases

Spermatocele

Cyst develops in the epididymis



Blockage of sperm



Usually asymptomatic



May cause infertility

Testicular Torsion

Torsion - acute onset of severe testicular pain



Twisting of the spermatic cord leading to the testicle causing a loss of blood supply


- testicle can also slightly ascend



Common in adolescent men

Signs & Symptoms of Testicular Torsion

- severe acute testicular pain


- not much swelling

Risk Factors of Testicular Torsion

Ball Clapper Deformity

Diagnosis of Testicular Torsion

- clinical exam


- confirm w/ u/s


- absent cremasteric reflex

Treatment of Testicular Torsion

- emergent surgery!!


- if treated within 6 hrs 90% chance of saving testicle


- if treated after 24 hrs 0% change of saving the testicle

Disorders of the Penis

Peyronies Disease


Priapism


Fracture


Erectile Dysfunction

Peyronies Disease

Connective tissue disorder causing abnormal curvature


- fibrosis pulls penis into curved shape



Can be mild or severe



Treatment of Peyronies Disease

Tricky to treat


- medications


- injections


- surgery

Priapism

Erection lasting longer than 4 hours



Happens more commonly in patients w/ sickle cell

Fracture

Rupture of the tunica albuginea


- muscles of the penis



Can be caused from trauma during sex


- girl on top



Fix via surgical repair

Types Erectile Dysfunction

Organic


- most common


- caused by a medical issue (hypertension)



Non-organic


- psychological causes


Treatment of Erectile Dysfunction

- medications


- injections


- vacuum device (also used in post prostate surgery)


- prosthesis

Prostate

Walnut-sized gland located between the bladder and the penis



Lies in front of the rectum



Urethra runs through the center of the prostate


- from the bladder to the penis



Secretes fluid that nourishes and protects sperm



During ejaculation, the prostate squeezes this fluid into the urethra, and it's expelled w/ sperm as semen

Prostate Diseases

Benign Prostatic Hyperplasia (BPH)


Infertility

Benign Prostatic Hyperplasia

Enlargement of the prostate



Typically > age 50



Very common



Pathology of Benign Prostatic Hyperplasia

Changes in hormones w/ aging

Signs & Symptoms of Benign Prostatic Hyperplasia

- urinary frequency


- urgency hesitancy


- decreased stream


- dribbling


- nocturia



In more extreme cases:


- overflow incontinence


- urinary retention


- UTI's


- hematuria

Diagnosis/Tests of BPH

- symptoms of prostate significant antigen (PSA)


- DRE


- flow studies (measures amount and how fast they pee)


- urodynamics


- Cr


- imaging studies

Treatment of BPH

- meds (alpha blockers)


- surgery: to clean out the prostate


- catheterization

Infertility

Unprotected intercourse for a 12 month period without a pregnancy


- 15% of those in reproductive age



Causes of Infertility

- hypothalamic diseases


- pituitary diseases


- varicocele


- epispadias


- antisperm antibodies


- obstruction


- testicular failure


- SCI


- crypotorcism

Diagnosis of Infertility

- H&P


- hormone test


- semen analysis

Male Reproductive Cancers

Prostate cancer


Testicular cancer


Penile cancer

Prostate Cancer

Most common cancer in males



3rd most common cause of cancer related deaths in men


- people die w/ prostate cancer not from it



Genetic component



Related to testosterone



African Americans have a higher risk (screen at age 40)



Asians have a lower risk

Signs & Symptoms Prostate Cancer

Often asymptomatic therefore routine screening is necessary



IF symptoms are present they are similar to BPH

Diagnosis of Prostate Cancer

- elevated prostate specific antigen (PSA)


* screened by prostate cancer cells


- Digital rectal exam


- U/S guided prostate biopsy

Prostate Cancer Pathology

Originates in the peripheral zone (cannot feel on rectal exam)



Spreads adjacent organs via the lymphatics



Mets --> vertebral bones, lungs, liver



Gleason staging

Treatment of Prostate Cancer

- active surveillance


- radiation therapy


- cryotherapy


- hormone therapy (chemical castration)


* testosterone feeds prostate cancer, but this takes away testosterone


- surgery (prostatectomy; open, robotic)


* robotic surgery has a slightly faster recovery time


* make sure you don't cut the nerves (erectile dysfunction)


- immunotherapy

Testicular Tumors

1% of neoplasms in men



Most common neoplasm in men age 20-34



Treatable w/ early detection



Grows rapidly



Testicular lump


- refer to urologist

Rule of 90's of Testicular Cancer

- peak incidence in 25-45 yr old men (90%)


- germ cell origin (90%)


- most malignant (90%)


- curable (90%)


Risk Factors of Testicular Cancer

- cryptorcisim


- Kleinfelder's


- estrogen


- family history


- HIV

Signs & Symptoms of Testicular Cancer

- lump in testicle (may or may not have pain)


- swelling


- ache in lower abdomen


- gynecomastia in 10% (increased breast tissue)


Diagnosis of Testicular Cancer

- scrotal u/s


- tumor markers


* helps to determine seminoma vs. non-seminoma

Treatment of Testicular Cancer

Based on staging criteria


- orchiectomy plus additional treatment (lymph node dissection, radiation, chemo)


Types of Testicular Cancer

Seminomas


Nonseminomas

Seminomas

- firm intramuscular mass


- no typical serologic tumor markers


- peak at age 40


- good prognosis


Nonseminomas

- testicular masses


- younger men (30)


- often have mets at diagnosis


- hCGand AFP produced


- requires more aggressive treatment: surgery, lymph node dissection, chemo

Other Testicular Tumors

Lydig Cell


Sertoli Cell

Lydig Cell Tumor

- mostly benign


- secrete hormone (testosterone or estrogen)


- may cause precocious puberty, gynecomastia, decreased libido, feminization

Sertoli Cell Tumor

typically benign testicular mass

Penile Cancer

Rare in the US


- seen in Asia, South America and Africa



Peak incidence in the 6th decade



Happens in


- uncircumsized men


- poor hygiene


- smoking


- diabetes



Environmentally induced?



Tumors typically in the Glans of the penis



98% is squamous cell cancer




-

Signs & Symptoms of Penile Cancer

- lesion without pain


- thickened skin


- palpable lymph nodes

Treatment of Penile Cancer

- surgical removal of tumor