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140 Cards in this Set
- Front
- Back
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What kind of problem is Erectile Dysfunction?
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A functional Disorder
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What really is the description of erectile dysfunction?
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Inability to achieve and maintain erection
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What are the two main causes of erectile dysfunction?
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psychogenic or organic organ is most common
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What kind of problem is Erectile Dysfunction?
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A functional Disorder
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What really is the description of erectile dysfunction?
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Inability to achieve and maintain erection
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What are the two main causes of erectile dysfunction?
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psychogenic or organic organ is most common
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When the cause of erectile dysfunction is neurogenic, what does it mean?
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That there is a nerve problem. Decreasing libido or preventing initiation of erection
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Give an example of a nerogenic cause of erectile dysfunction. Remember this is an organic cause
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Parkinsons's disease, stroke, cerebral trauma
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When the cause of erctile dysfunction is hormonal, what does it mean?
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that there is a decrease in androgen levels
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When the cause of erectile dysfunction is vascular, what does that mean?
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There is arterial insufficiency
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Give an example of vascular cause of erectile dysfunction
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hypertension, hyperlidipdemia, diabetes, smoking...
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When the cause of erectile dysfunction is neurogenic, what does it mean?
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That there is a nerve problem. Decreasing libido or preventing initiation of erection
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Give an example of a nerogenic cause of erectile dysfunction. Remember this is an organic cause
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Parkinsons's disease, stroke, cerebral trauma
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When the cause of erctile dysfunction is hormonal, what does it mean?
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that there is a decrease in androgen levels
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When the cause of erectile dysfunction is vascular, what does that mean?
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There is arterial insufficiency
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Give an example of vascular cause of erectile dysfunction
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hypertension, hyperlidipdemia, diabetes, smoking...
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When discussion hyptertension as a vascular cause of erectile dysfunction, what is the pathway for this cause?
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Not an increase in blood pressure. It causes lesions that lead to erectile dysfunction.
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Most causes of erectile dysfunction in older men relate back to .....
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Metabolic syndrome
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The treatment for erectile dysfunction includes...
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careful history
lab tests to rule out organic causes (cuz they can fix the organic causes) Psychosexual counseling Androgen replacement Vascular devices Surgery |
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Where is the Tunica Albuginea?
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It is the envelope that holds the corpora cavernosa
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What is erythema?
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Redness on skin from inflammation...capulary congestion
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What is balanitis?
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Inflammation and infection of the tip of the penis
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What kind of inflammation can you have with Balanitis?
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Acute or Chronic
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Where is the inflammation with balanitis?
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on the glans penis (the tip)
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What is balanoposthitis?
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inflammation of glans and prepuce
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What is the physcial chacteristic that is a common companion to a person who suffers from balanitis?
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Phimosis (tight foreskin...)
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What are some causes of balanitis?
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Poor Hygiene
Bacteria Smegma Glandular Secretions |
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Other than having phimosis, what other physical condition would predispose one to balanitis?
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a redundant prepuce that is difficult to clean
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What is smegma?
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debris from desquamated epithelia that gets stuck under the prepuce and gets infected...causing balanitis
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When the causative agents get under the prepuce and get infected, what does it cause? And what does that lead to?
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Causes ulcerations of mucosal surface of glans...that lead to scarring of phimosis which further causes balanitis and balanoposthitis
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What are some common bacteria that are related to balanitis?
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chlamydiae & mycoplasms...could be fungal or yeast too!!!
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How do you tx for balanitis?
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there is non specific inflammation, so you need to have correct lab id...then abx
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What is different about acute superficial balanitis?
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has exudate with smell
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What is balanitis xerotica obliterans?
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a disorder of penis
inflammation and infection a specific type of balanitis |
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What is physical problem in balanitis xerotica obliterans?
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chronic white pathcy lesion that originates on the glans and progresses to involve the meatus
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What is balanitis xerotica obliterans similar to in females?
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Lichen Sclerosus
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What type of male is a common person to have balanitis xerotica obliterans ?
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diabetic, middle aged men
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What is tx for balanitis xerotica obliterans?
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topical or intralesional injections of corticosteroids
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What has localized progressive fibrosis of tunica albuginea?
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Peyronie's disease
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Where is the tunica albuginea?
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surrounds the corpus cavernosum
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How does Peyronie's Disease get the fibrous issue?
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Inflammatory process...cause is unknown
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Where is the fibrous plaque with Peyronie's Disease located?
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On Dorsal midline of shaft
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What is cause of Peyronie's Disease?
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cause unknown...but it looks like severe vasculitis
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What are some mans of Peyronie's disease?
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painful, bent erection. presence of hard mass at site of fibrosis....hard mass may resolve itself in beginning stages of disease because of remodeling
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What is dx for Peyronie's Disease?
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ultrasound, physical exam with history
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What is tx for Peyronie's disease?
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Surgery sometimes, but it is self limiting...antioxidants, or corticosteroids
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Where is the fibrous plaque with Peyronie's Disease located?
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On Dorsal midline of shaft
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What is cause of Peyronie's Disease?
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cause unknown...but it looks like severe vasculitis
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What are some mans of Peyronie's disease?
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painful, bent erection. presence of hard mass at site of fibrosis....hard mass may resolve itself in beginning stages of disease because of remodeling
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What is dx for Peyronie's Disease?
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ultrasound, physical exam with history
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What is tx for Peyronie's disease?
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Surfery sometimes, but it is self limiting...antioxidants, or corticosteroids
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What can happen if you have Peyronie's Disease?
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Erectile Dysfunction ---(vascular organic cause)b/c of veno occlusive dysfunction...failure of veins to close
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What does veno occlusive dysfunction mean?
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failure of veins to close
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What is priapism?
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involuntary, prolonged, abnormal painful erection not associated with sexual excitement
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Why is priapism a medical emergency?
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b/c of ischemia and fibrosis with risk of subsequent impotence
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What type of person can get priapism?
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Occurs at any age, but it is also common in Sickle Cell anemia sufferers
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What is the cause of Priapism?
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impared blood flow in corpora cavernosa
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What are the mechanisms for impared blood flow in corpora cavernosa (in priapism)?
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1) Ischemic (low flow)
2) Non Ischemic (continued arterial flow) |
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What are some of the characteristics of priapism that is caused by ischemic mechanism? (characteristics that would distinguish it from non ischemic)
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more painful & more rigid
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When the mechanism of priapism is considered non ischemic, what does that mean?
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Continued arterial flow.
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With non ischemic priapism, what are some characteristics of it?
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no fear of hypoxia of tissue and not a lot of permanent damage
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What is cause of the impared blood flow with priapism?
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Two ways: Primary (idiopathic) or Secondary
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What are some examples of primary cause for priapism?
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trauma, infections, neoplasms
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What are some examples of secondary cause for priapism?
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sickle cell anemia, leukemia, viagara, and testosterone steroids
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What are the tx for priapism?
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analgesics, hydration, sedation, irrigation of corpus cavernosum with saline shunt
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What is a hydrocele?
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excess fluid between the tunica vaginalis and the testes
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Where does a hydrocele actually appear on the scrotum?
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unilateral or bilateral
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What are the kinds of causes that hydrocele can come from?
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primary or secondary
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What do they describe a hydrocele as when they do an examination?
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palapable cystic mass
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Hydroceles are considered....
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benign
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What is tx for hydrocele?
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surgical correction to alleviate pain or for cosmetic reasons
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What is a hematocele?
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accumulation of blood in tunica vaginalis
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What is a visual manifestation of hematocele?
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scrotal skin is dark red
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What causes a hematocele?
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abdominal surgery, scrotal trauma, bleeding disorder or testicular tumor
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What is a spermatocele?
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painless, sperm cyst at end of epididymis
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What is dx of spermatocele?
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transilluminates and is moveable
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What is a varicocele?
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varicosites of pampiniform plexus (a network of veins in testes)
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What is cause of varicocele?
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incompetent valves
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What is dx of varicocele?
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feels like a bag of worms....
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What can a varicocele cause?
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impotence if not corrected. low sperm concentration and motility reduced
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What are testicular torsions?
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twisting of the spermatic cord
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What are the two types of testicular torsions?
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extravaginal torsion & intravaginal torsion
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What population gets extravaginal testicular torsions?
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neonates
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What population gets intravaginal testicular torsions?
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most common type....18-30 yrs old
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Where is the problem with intravaginal testicular torsions?
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testes rotate on long axis in tunica vaginalis...flips up like a light switch
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Where is the problem with extravaginal testicular torsions?
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testicle and the fascial tunicae that surrounds it rotate around the spermatic cord at the level ABOVE the tunicae vaginalis...twist around cord
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What causes testicular torsions?
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Usually there is developmental or congenital abnormalities.....so the problem would present bilaterally
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How does pt present with testicular torsion?
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severe distress, swollen scrotum
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What is important in dx of testicular torsion?
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must differentiate between epididymitis, orchitis and trauma
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What is a defining manifestation of testicular torsion?
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Usually testicle is high and in weird place, but ***cremasteric reflext is absent****
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Why is testicular torsion a medical emergency?
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to save the testicle
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What is epididymitis?
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Inflammation of the epididymitis (the sack that connects the testicle to the vas deferens...where sperm are born)
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Whar are the two types of epididymitis?
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sexually transmitted and primary non sexually transmitted
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Sexually transmitted epididymitis is associated with this condition
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urethritis
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Sexually transmitted epididymitis is usually caused by these bacteria
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chlamydia trachomatis & neisseria gonorrhoeae
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Primary non sexually transmitted epididymitis is associated with these two conditions
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UTI and prostatis
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How do bacteria get to the epididymus in primary epididymitis? How do they get all the way up there??
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Straining, lymphatics of sperm cord or rarely (by the blood)
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What are the mans of epididymitis?
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unilateral acute pain and swelling with erythema (24-48 hrs)
Maybe pus if the bacteria produce pus |
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What is dx for epididymitis?
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leukocytosis, bacteriuria and pyuria
(increase in WBC due to bacterial infection) pus in urine, bacterial in urine |
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What is orchitis?
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infection of the testes
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How does orchitis usually start?
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with an infection in genitourinary tract, blood or lymph
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What can orchitis be a complication of?
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systemic infection (mumps, scarlet fever or pneumonia)
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Can babies get orchitis?
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No, it does not happen in prepubescent boys
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What are mans of orchitis?
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fever, painful enlargment of testes with small hemorrhages in tunica albuginea
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After acute phase of orchitis, what do you get?
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****hyalization of seminoferous tubules & atrophy of testicles
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What can happen after you get orchitis?
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impared spermatogenesis (from hyalization of seminoferous tubules)
Can become sterile if both testes involved |
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What is prostatis?
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Inflammation of prostate gland
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What is primary cause of prostatis?
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caterization or instrumentation
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What else can cause prostatis?
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Secondary.....other diseases
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What are the four kinds of prostatis?
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asymptomatic inflammatory prostatis
acute bacterial prostatis chronic bacterial prostatis chronic prostatis/pelvic pain syndrome |
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What are the symptoms of asymptomatic inflammatory prostatis?
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No symptoms...detected on biopsy or examination of prostatic fluid
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What is closely related to acute bacterial prostatis?
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UTI...it is a subtype of UTI
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What is most common cause of acute bacterial prostatis?
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e-coli
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What are mans of acute bacterial prostatis?
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uti, fever, malaise, myalgia, thick prostrate discharge with lots of wbc and grows pathogens on culture ******
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How do you remember the chronic bacterial prostatis?
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that it is from recurrent UTI, from g-negs
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What is tx for chronic bacterial prostatis?
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difficult to treat because abx don't penetrate chronically inflammed prostate
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What are the two kinds of chronic prostatis (pelvic pain syndrome)
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inflammatory & noninflammatory
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Another name for: inflammatory (chronic prostatis/pelvic pain syndrome)
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non bacterial prostatis
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Another name for:
noninflammatory (chronic prostatis/pelvic pain syndrome) |
prostatodynia
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What is leukocyte count in inflammatory chronic prostatis?
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elevated
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What is leukocyte count in noninflammatory chronic prostatis?
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normal
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What is the cause of inflammatory chronic prostatis?
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unknown cause, but maybe an autoimmune disorder
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Where is the pain in inflammatory chronic prostatis?
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all over your body
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What is the cause of prostatic cancer?
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Unknown, but many many risk factors
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What are the cancers called in prostatic cancer?
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prostatic adenocarcinomas
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Where are the prostatic adenocardinomas in prostatic cancer?
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in the PERIPHERAL zones of the prostate
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What is the bladders involvement with prostatic cancer?
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b/c of location, the bladder is not involved
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Where does prostatic cancer masticisze to ?
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bones and lungs..b/c lymphatic spread thru thoracic duct
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What are the first symptoms of prostate cancer?
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asymptomatic. If you have symptoms than it is advanced
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How do you screen for prostatic cancer?
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psa and digital rectal exam
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What is PSA?
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It is a glycoprotein secreted around benign & malignant cells in the prostate. so high psa could mean cancer or not
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What type of grading do they do for prostate cancer?
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Gleason Grading system. PSA and Serum Acid phosphatase
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What is Benign prostatic Hyperplasia? (BPH)
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non malignant enlargment of prostate gland
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What is physically present with benign prostatic hyperplasia?
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large nodular lesions on periurethral region of prostate (area right around urethra)
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What do these nodular lesions on the periurethral region of the prostate cause?
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they compress the urethra and produce symptoms of dysuria
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What is cause of BPH benign prostatic hyperplasia?
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unknown cause
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What is the dx for benign prostatic hyperplasia?
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history, physical exam, symptoms with index rating PSA and serum creatine
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What is phimosis?
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tightening of prepuce that prevents its retraction over the glans
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When is phimosis a urological emergency?
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urinary stream obstructed
hematuria preputial pain is present |
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Paraphimosis is...
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entrapement of retracted foreskin behind coronal sulcus....can lead to ischemia & necrosis
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