MENS HEALTH

more common in women

type + risk factors

STRESS vaginal deliveries age pelvic floor muscle pvm,<estrogen,sneeze etc,prostate + pelvic Sx

URGE-uti, chronic cystitis, parkins, dementia, age stroke radiation bladder

MIXED

OVERFLOW over distended bladder, bladder outlet obstruction, enlarged prostate, impaired detrusor contractility

I

HYPERMOBILITY OF BLADDER NECK

INCREASED ABD PRESSURE

INTRINSIC SHPINCTER DEFICIENCY

> INTRA ABDOMINAL PRESSURE IAP CAUSES ROTATION OF BLADDER NECK + URETHRA BELOW PF MUSCLES SO THAT IAP NO LONGER TRANSMITTED TO URETHRA AND BLADDER NECK=LEAK

MOST COMMON IN OLDER

DETRUSOR OVER ACTIVITY

BLADDER PRESSURE > THAN SPHINCTER AND URETHRAL PRESSURE- BLADDER NECK OPENS = INCO

CAUSE :IDIOPATHIC:

THEORIES:

>ALPHA 1 RECEPTORS IN BLADDER

DISRUPTION OF NERVOUS SYSTEMS AND PATHWAYS

> MUSCARINIC M2 M3 RECEPTORS IN BLADDER

NEUROGENIC

SCI T11-L1

MS DM SPINA BIFIDA

POOR BLADDER COMPLIANCE => PRESSURE WITH SMALL VOLUME INCREASE IN BLADDER-

MIXED STRESS AND URGE

OVERFLOW CAUSES

INCOMPLETE EMPTYING

BLADDER OUTLET OBSTRUCTION ( BPH)

POOR DETRUSOR CONTRACTILITY

BPH

RADICAL PELVIC SX

DETRUSOR INACTIVITY

MEDS

NEUROLOGIC

D ELIRIUM

I INFECTION

A TROPHIC

P HARM

P SYCHOLOGICAL ANX DEPRESSION

E XCESS UO DIABETES INSIPIDUS, > BG, CHF

R ESTRICTED MOBILITY

S TOOL IMPACTION

SUBJECTIVE

MEDS

MENTAL STATUS

OBJECTIVE

ABD

GENITOURINARY PHIMOSIS BALANITIS

PELVIS WOMEN STRESS INC Q TIP TEST URETHRA> 30 DEGREES = POOR URETHRAL SUPPORT, VALSALVA -URINE LEAK STRESS

RECTAL STOOL IMPACTION RECTAL MASS PROSTATE NODULES

NEURO

EDEMA ASSESS

R/O UTI ? CVA

VOIDIING DIARY 3-7 DAYS

PSA > RESULT -INFLAMMATION, INFECTION MALIGNANCY

UA:

LOOK FOR PROTEIN HEMATURIA GLUCOSE WBC NITRITE AND LEUCOCYTE ESTERASE

HEMATURIA >3 W NEGATIVE CULTURE = NEED CYSTOSCOPY, ? CYTOLOGY

CULTURE IF UTI

BUN CR IF RENAL FUNCTION CONCERN

PVR

COUGH OR SUPINE STRESS TEST

DRE PROSTATE

I-PSS/AUA QUESTIONNAIRE

REFER TO UROLOGIST FOR CYSTOSCOPY

URODYNAMICS-VOIDING CYSTORURETHROGRAM, UROFLOWMETRY

TYPES OF INCONTINENCE

LUTS BLADDER CA, PROLAPSE,STRICTURE

ISD

ANATOMIC SUI

DO IDIOPATHIC OR NEURO

MEDS

STI

bph

dm

pregnancy

STRESS

TIMED DOUBLE VOIDING

WT LOSS

PFE, BIOFEEDBACK VAG WEIGHTS

PESSARIES

ALPHA ADRENERGIC AGONISTS > TONE

SX SLING ARTIFICIAL SPHINCTERS

PERIURETHRAL BULKING AGENTS

MIXED /STRESS MYRBETRIQ

URGE/OAB

REMOVE IRRITANTS CAFEEINE ETC ETOH CITRUS SPICY

VAGINAL ESTROGEN

*ANTIMUSCARINICS /ANTICHOLINERGICS

BETA ADRENERGIC MYRBETRIQ

SX NEUROSACRAL MODULATION, BOTOX, BLADDER AUGMENTATION

• Posterior tibial nerve stimulation

OVERFLOW

CIC PESSARY

ALpHA 1 BLOCKERS-< TONE

5 ALPHA REDUCTASE INHIBITORS

SX REDUCE PROLAPSE , RELIEVE OBSTRUCTION

STRESS

ALPHA 1 ADRENERGIC AGONIST SUDAFED > URETHRAL PRESSURE AND OUTLET RESISTANCE PHENYLEPHRINE, VASOCONSTRICTOR PSEUDO

ESTROGEN CREAM

IMIPRAMINE -ALPHA AGONIST AND ANTICHOLINERGIC- GOOD FOR MIXED OR SUI

URGE

ANTICHOLINERIC/ANTIMUSCARINIC

DETROL LA TOLDERODINE , DITROPAN-OXYBUTYNIN

TROSPIUM ( REMEMBER IUMS ARE MUSCARINIC ANTAGONISTS)-SANCTURA

DARIFNACIN -ENABLEX

SOLIFENACIN VESICARE

NEW :MYRBETRIQ BETA ADRENERGIC- CAN CAUSE HTN

FALLS AND SYNCOPE IN ELDERLY

MIXED

DULOXETINE ( SNRI)

OVERFLOW ESP BPH

ALPHA 1 BLOCKERS CAN CAUSE LOW BP

FLOMAX ( TAMSULOSIIN)

HYTRIN- TERAZOSIN

5 ALPHA REDUCTASE INHIBITOR 5 A REDUCTASE TESTOSTERONE TO DIHYDROTESTOSTERONE RESPNSIBLE FOR MALE SEX CHARACTERISTICS-PREVENT FURTHER BPH

PROSCAR - FINASTERIDE

AVODART- DUTASTERIDE

ESCHERICIA COLI 75-95%

KLEBSIELLA PNEUMONIAE

STAPH SAPROPHYTICUS

ENTEROCOCCUS FECALIS,

STAPH AUREUS

PROTEUM MIRABILIS

GROUP B STREP

PSEUDOMONAS AERUGINOSA

FUNGUS-CANDIDA

HEMATOGANUS SPREAD IS RARE

Malodorous urine is not found to be indicative of infection.

WOMEN

DM

POST MENOPAUSE

RARE MEN <50

HIV/IMMUNOSUPPRESSION

ANAL INTERCOURSE

HYPERURICEMIA

NEW PARTNER

SPERMICIDE

VAGINAL INSTRUMENTATION ( EG DILDO)

60-90% probability of UTI exists when dysuria, frequency, fever, and back pain are present.

BURNING FREQUENCY

URGENCY

PAIN POST VOID

FEVER CHILLS

HEMATURIA GROSS OR MICROSCOPIC

LOWER ABD/SUPRAPUBIC OR BACK PAIN

COSTOVERTEBRAL ANGLE PAIN Located on your back at the bottom of your ribcage at the 12th rib. INDICATES COMPLEX UTI/PYELONEPHRITIS

VAGINITIS

STD

HEMATURIA FROM ANOTHER CAUSE eg CA, TRAUMA

PID

PROSTATITIS EPIDIDYMITIS

ENURESIS

OAB

CONSTIPATION

INTERSTITIAL CYSTITIS/SYMPTOMATIC ABACTERIURIA MIMIC UTI

PYELONEPHRITIS

PREGNANCY

ATROPHIC VAGINITIS

UA: WBC PYURIA 90SP/50SE + LEUCOCYTE ESTERASE NOT RELIABLE, POSITIVE NITRATES NOT RELIABLE

MALES : SCREEN FOR STI, CHLAMYDIA TRACHOMATIS, N. GONORRHEA

UC+S >100,OOO .USU GRAM NEG FROM STOOL FOLLOWED BY GM +

RENAL USS CALCULI MASSES HYDRONEPHROSIS STRUCTURAL ABN

KUB FOR:

KIDS

SECONDARY HTN

ABNORMAL VOIDING PATTERN

 THE PRESENCE OF MULTIPLE BACTERIA SPECIES= CONTAMINATED SAMPLE , GET CLEAN CATCH MIDSTREAM

STERILE PYURIA( + UA AND NEGATIVE CULTURE, CAUSES- NGU , RENAL TB, VAG CONTAMINATION, KINEY STONES

ASYMPTOMATIC BACTERIURIA CFU >100,000 AND ASYMPTOMATIC DONT TREAT

HAND HYGIENE, PERINEAL HYGIENE

VOID AFTER INTERCOURSE

HYDRATION

ESTROGEN CREAMS

AVOID SPERMICIDES

DM MGT

ABX PROPHYLAXIS RECURRENT UTI

DONT HOLD URINE

CIRCUMCISION-75% REDUCTION IN UTI

NO EVIDENCE FOR CRANBERRY JUICE

FIRST LINE

NITROFURANTOIN-MACROBID not an abx, used only for uti X 5 DAYS

TMP-SMX BACTRIM 160/800 BID X 3 DAYS

FOSFOMYCIN (MONURIL) 3 G X 1 DOSE

COMPLEX CASES

SECOND GEN CEPHS: CEFACLOR, CEFUROXIME

THIRD GEN: CEFPOXIDIME, CEFTIXIME

LEVAQUIN -LAST RESORT

BETA LACTAMS

β-lactam antibiotics are antibiotics that contain a beta-lactam ring in their chemical structure. This includes penicillin derivatives, cephalosporins and cephamycins, monobactams, carbapenems and carbacephems.

AUGMENTIN IN BETA LACTAMASE PRODUCING STRAINS OF ECOLI AND KLEB, ENTEROBACTER( AMOXYCILLIN, AMPICILLIN INEFFECTIVE)

PREGNANT: CEPHALEXIN ( FIRST GEN), AMOXIL, AUGMENTIN, AMPICILLIN FIRST LINE

AVOID SMP TMX AND MACROBID NEAR DELIVERY

PYRIDIUM , USE AFTER UA

RECURRENT UTI

NO PROPHYLAXIS UNTIL NEGATIVE CULTURE

ABU IS ASYMPTOMATIC BACTERIURIA - DONT RX WITH ABX UNLESS PREGNANT

MALE UTI

DOXYCLINE 100 MG BID X ? I MONTH OR 14 DAYS FOR C TRACHOMATIS

NON PHARMA

POST COITAL VOID

AVOID SPERMICIDE

FLUIDS

TOPICAL ESTROGEN

SHORT COURSE THERAPY FOLLOWED BY LO DOSE X 6 MONTHS

BACTRIM 40/200 80/400 DAILY

OR KEFLEX 125-250 DAILY

IF SEX SINGLE LOW DOSE THERAPY AFTER SEX, BACTRIM 80/400

REFER

RECURRENT UTI

PYELONEPHRITIS

F/ U

CUTLTURE ONLY IF FREQUENT UTI

EDUCATION

SEXUAL PRACTICE,

UTI- MEN ANAL INTERCOURSE

FINISH ENTIRE ABX REGIMEN ( 3 DAYS ?)

REDFLAGS

PYELONEPHRITIS/COMPLEX UTI -COSTOVERTEBRAL ANGLE TENDER, FEVER, BLOOD, N+V=

S/S SEPSIS

RENAL ABSCESS COLIC PAIN(?)

GONOCOCCAL

NON GONOCOCCAL URETHRITIS NGU =

CHLAMYDIA

UREAPLASMA UREALYTICUM

MYCOPLASMA HOMINIS

HSV

CYTOMEGALOVIRUS

WOMEN: GARDNERELLA VAGINALIS, TRICHOMONAS VAGINALIS

NON INFECTIOUS

WEGENER GRANULOMATOSIS

SJS

SPERMICIDES

ACIDIC FOODS

ASSOC WITH HIGH RISK SEX BEHAVIOR

STONES IN URINARY TRACT MADE OF CHEMICAL COMPONENTS, CA++ URIC ACID, MG, PHOSPHATE ETC

KIDNEY STONES CALCULI IN KIDNEYS, WORST STAGHORN -LARGE BRANCHING STONE

SUPER SATURATION OF URINE W STONE FORMING SALTS

OBESE EXCRETE > CA, NA,URIC ACID, CITRATE,

< URINE COMPOUNDS THAT INHIBIT STONE FORMATION

75% CA OXALATE-SHOW ON XRAY,

5-15%STRUVITE(TRIPLE PHOS)USU STAGHORN+ DONT SHOW ON XRAY

HYPEROXALURIA-LOOK UP

RISK F

MEN>WOMEN, WHITE MEN

ALKALINE URINE

FAM HX AND GENETIC DEFECTS

GOUT

THIAZIDE DIURETICS

SEDENTARY

OBESITY

DIET > NA, ANIMAL PROTEIN,PURINES ,OXALATES (COKE, CHOCOLATE)<FLUID, CALCIUM

INSULIN RESISTANT STATES

DRINKING H20 HI MINERAL LEVEL

RENAL COLIC

FLANK PAIN RADIATES TO IPSILATERAL ABD OR GROIN

,GENITALIA PAIN

COSTOVERTEBRAL ANGLE TENDERNESS TO PERCUSSION

HEMATURIA

DYSURIA

FREQUENCY

>HR>RESPS

CHILLS FEVER-ER

N+V

DIAPHORESIS

RESTLESS

HISTORY -STONE HX, FAMILY HX, GOUT, DM RECURRENT UTIS , IMMUNOSUPPRESSION

MEDS ALLOPURINOL, SULFA DRUGS THIAZIDE, LAXATIVES

ABD USU SOFT NON TENDER

PYELONEPHRITIS

UTI

CHOLCYSTITIS

HYDRONEPHROSIS

BLADDER CA

APPENDICITIS

PANCREATITIS

SALPINGITIS /GYN DISORDER

PUD

AAA

ACUTE PERITONITIS

COLITIS /DIVERTICULITIS

LABS:

UA-PH OF URINE****HEMATURIA PYURIA MAY OR MAY NOT BE PRESENT

URINE C&S

CBC

CMP BUN CREAT PARATHYROID,BICARB PHOS ,VIT D

STRAIN FOR STONE, ANALYSIS OF STONE

24 HOUR URINE( IF RECURRENT) CA MG PHOS, URIC ACI OXALATE CITRATE CREATININE

KUB XRAY FASTEST

GOLD STANDARD * LO DOSE NON CONTRAST (NCCT) SPIRAL CT

USS ALTERNATIVE -COST PREGNANCY

IV PYELOGRAM

METABOLIC TESTING IF RECURRENT 24 HR URINES

• If urine pH is <5.5, stone is likely uric acid in composition

• If urine pH is >7.5, stone is likely a staghorn calculus; usually composed of magnesium ammonium nitrate (struvite)

ADEQUATE FLUID INTAKE

BASED ON STONE , THIAZIDE OR NONTHIAZIDE DIURETIC , ALLOPURINOL

1000-1200 DAILY CALCIUM IF RECURRENT

sx

STONES >6MM

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

URETEROSCOPY

PERCUTANEOUS NEPHROLITHOTOMY

OPEN SX STONE REMOVAL

CALCIUM STONES:

HYPEROXALURIA

LOW FAT LO OXALATE DIET- COLA CHOC PEANUTS VITC

HYPERURICOSURIA

LOW PURIINE FOODS

URIC ACID STONES

EAT FRUITS VEG HYDRATE

PAIN CONTROL

NSAID: KETOROLAC 60 MG IM PENDING ER OR UROLOGY REFERRAL

NSAID <PROSTAGLANDIN AND REDUCE RENAL FLOW

MEDICAL EXPULSION THERAPY (met)

ALPHA BLOCKERS FOR EXPULSION , EG TAMSULOSIN 0.4-0.8 MG , OR CALCIUM CHANNEL BLOCKERS ( NIFEDIPINE) DAILY UNTIL STONE PASSED

ANTIEMETIC

RED FLAGS FOR HOSPITALIZATION

INFECTION

STONE >6MM STONE INVOLVES RENAL PELVIS AND RENAL CALYCES

EXCESSIVE N+V

GROSS HEMATURIA

REFER

UROLOGIST

ENDOCRINOLOGISTFOR >PTH controls calcium and phosphate levels

RD DIETARY MODIFICATION

CREATININE LEVEL WEEKLY

PA??

ABD XRAY 1-2 WEEKLY ??RADIATION LEVELS

DIET DEPENDENT ON STONE TYPE

USU:

HYDRATION

LO NA

LO animal protein

LO OXALATE

LO PURINE

Immediate referral is warranted for sudden onset of severe pain in or swelling of the scrotum, elevation or abnormally positioning of a testicular, scrotal, or testicular erythema, tender scrotal masses, evidence of increasing hematoma, absent cremasteric reflex, and testicular or scrotal trauma

VIDEO ON VARICOCELE USU ON LEFT TESTICLE

https://www.youtube.com/watch?v=wJcoRtoIk0A

PAMPINIFORM PLEXUS -LEFT TESTICLE VEIN DRAINS INTO RENAL VEIN-RENAL CELL CA -VARICELE 2/2 DRAINAGE

INTERFERE WITH TEMPERATURE CONTROL, CAN CAUSE SUB OR INFERTILITY

PE

-BAG OF WORMS

BLUE COLOR

THROBBING PAIN

FELT ON STANDING UP,

TEST

VALSALVA - GRADE 1 2 3

USS- SHOWS A DILATED PAMP PLEXUS >2-3 MM

SEMEN ANALYSIS

SERUM TESTOSTERONE

COLLECTION OF FLUID WITHIN TUNICA VAGINALIS- NOT SEALED PROPERLY FROM PERITONEUM DURING DEVELOPMENT

IF >30 YEARS CAN BE 2/2 TESTICULAR TUMOR

EXAM FINDINGS:

PAINLESS

SMOOTH TENSE.

SOFT FLUCTUANCT AND LARGE, IRREDUCIBLE LUMP W/O BOWEL SOUNDS, CAN TRANSILLUMINATE

IDIOPATHIC

TESTI CA

TORSION, TRAUMA EPIDYORCH

DIAGNOSTIC : USS

MGT

SURGERY

ASPIRATION

SCLEROTHERAPY

INFECTION

MUMPS LOOK FOR PAROTID GLAND SWELLING, PANCREATISIS AND ORCHITIS

CHLAMYDIA

GONORRHEA

ECOL,HEMOPHILUS INFLUENZAE, TB

CRYPTOCOCCI

BRUCELLA ALL MEN WITH ANAL INTERCOURSE

OTHERS:

PROSTATITIS AND UTI CAN LEAD TO EPIDIDYMITIS, USU PSEUDOMONAS AER

STRUCTURAL

INSTRUMENTATION

CAN SPREAD TO ENTIRE TESTICLE CALLED

EPIDIDYMO-ORCHITIS

SAME INFECTIOUS AS ABOVE OR URINARY REFLUX FROM STRAINING

EPIDIDYMO-ORCHITIS

SIMILAR PRESENTATION AS TORSION,

ER

IF DISCHARGE SUSPECT STD

PE :

CHECK GENITAL AREA,CREMASTERIC REFLEX

LOOKS FOR S/S MUMPS

RED

SWOLLEN

PAINFUL

PREHNS SIGN_ PAIN RELIEF W ELEVATION OF AFFECTED SIDE

FEVER, UTI TRIAD -DYSURIA URGENCY FREQUENCY

ORCHITIS -BOTH SWOLLLEN AND MORE SWOLLEN AND TENSE.THINK MUMPS

TESTS

USS DOPPLER-> INTRATESTICULAR BLOOD FLOW,HYPEREMIA,

UA

CBC

NAAT FOR GONOHORRHEA AND CHLAMDIA

SCROTAL PAIN AND HEAVINESS, NOT TESTICULAR

PAIN WITH DEFECATION

TENDER EPIDIDYMUS

TRUCK DRIVERS SUSCEPTIBLE TO NON INFECTIOUS AS SITTING FOR MANY HOURS

TWISTING SPERMATIC CORD USUALLY LEFT SIDE

TWO TYPES EXTRAVAGINAL TWISTS SPERMATIC CORD, INTRAVAGINAL -BELL CLAPPER

UROLOGICAL EMERGENCY ,DELAY IN RX LEADS TO ISCHEMIA NECROSIS + SUB/INFERTILITY

TEENAGE BOY TYPICAL

PE

SPORTS ACTIVITY TRIGGER

ACUTE RAPID ONSET UNILATERAL PAIN, ABD PAIN AND VOMITING

FIRM SWOLLEN TESTICLE HIGHER THAN THE OTHER

BLUE DOT ON SCROTUM+ TORSION OF APPENDIX TESTIS

ELEVATED

ABSENCE OF CREMASTERIC REFLEX

NEGATIVE PREHNS SIGN NO RELIEF

ABNORMAL LIE

EPIDIDYMIS ANTERIOR

NORMAL- TESTICLE ATTACHED POSTERIORLY TO TUNICA VAGINALIS, TESTICLE VERTICAL

BELL CLAPPER DEFORMITY TESTICLE HORIZONTAL TV AND TESTES NOT ATTACHED, CAN ROTATE

DIAGNOSTIC

USS - NO BLOOD FLOW ON DOPPLER

MGT

NPO

ANALGESIA

SURGERY IN 2-3 HOURS-ORCHIOPEXY OR ORCHIDECTOMY ( DELAY OR NECROSIS)

ER UROLOGIST

USS WHIRLPOOL SIGN

SAME AS EPIDYDMYITIS SEE CARD

DIFF DX TORSION

PE FINDINGS

IF DISCHARGE THINK CHLAMYDIA , GONORRH

SWELLING OF BOTH , TENDERNESS DRAGGING HEAVY SENSATION

DIAGNOSTIC TESTING:

IS IT ENTERIC OR STI ? STI <35 MULTIPLE SEX PARTNERS, DC

UA CULTURE

CHLAMYDIA AND GON NAAT TESTING( FIRST PASS URINE)

CHARCOAL SWAB OF DISCHARGE

SALIVA PCR FOR MUMPS

SERUM ANTIBODIES IGM AND IGG IF MUMPS -MUMPS AFFECT TESTICLE -SPARING THE EPIDYMUS

USS

MGT

TYLENOL, SUPPORTIVE UNDERWEAR NO SEC

IV ABX ADMIT TO ER

QUINOLONE OFLOXACIN, QUINOLONES GREAT GRAM NEGATIVE COVER. S/E TENDONITIS OR RUPTURE,REDUCED SEIZURE THRESHOLD,C DIFF

CAN LEAD TO SCROTAL ABSCESS

CYSTS IN EPIDIDYMUS , FROM RETE TESTIS , FORM FROM OBSTRUCTION OF EFFERENT TUBULES, MILKY FLUID , 30% MALES, OFTEN POST VASECTOMY

PE:

SMALL NON TENDER MOBILE MASS ABOVE AND BEHIND TESTIS

CAN TRANSILLUMINATE

SCROTAL SWELLING,

SCROTAL HEAVINESS

BULGE MAY BE PRESENT

EDEMA >STANDING AND < RECUMBENT

DIAGNOSTIC

USS SEE IF BOWEL INSIDE

MASS IN SCROTUM USU PAINLESS, FEELING OF HEAVINESS OR FULLNESS

LATER STAGE :

BACK PAIN,

ABD PAIN

ANOREXIA

NAUSEA

BLADDER /BOWEL SX

USU RETROPERITONEAL LYMPH INVOLVEMENT BY THEN

PE

INCLUDE CHEST ABDOMEN EXAM

PALPATE W BOTH HANDS

IS IT ON TESTIS OR EPIDIDYMIS

LYMPH NODES ( THIGH)

TRANSILLUMINATION - LIQUID VS SOLID

DIAGNOSTICS

HCG -HIGH

USS

REFERRED AND THEIR TESTING

CAUSE OBSTRUCTION OF LYMPH VESSELS

PE:

THICK SCROTAL LYMPHEDEMA

THICKENED SCROTAL SKIN

MAY HAVE ULCERATION

TESTS

CBC

BLOOD URINE HYDROCELE FLUID SAMPLE TESTED FOR MICROFIL

USSARIAE

INSPECTION:

SIZE CHANGES W TEMP

USU EACH TESTICLE 4-5 CM LONG 2-4 CM WIDE

USU ASYMMETRIC LEFT LOWER THAN RIGHT

PALPATION:

SPREAD RUGAE BETWEEN FINGERS

TWO FINGERS AND THUMB TO PALPATE

POSTERIOR SUPERIOR POSITION

EPIDIDYMIS HEAD BODY TAIL SOFTER THAN TESTIS AND NON TENDER SMOOTH.

SPERMATIC CORD SLIDE FINGERS AND THUMB UP FROM EPIDIDYMIS,SMOOTH NON TENDER

DOCUMENT DISCOLORATION EDEMA ABNORMALS

TORSION USS ER

EPIDIDYMITIS USS UA CBC

LATE IS EPIDIDY-ORCHITIS USS

FOURNIERS

HYDROCELE

HERNIA

HEMATOCELE- TRAUMA AND FLUID FILLED TUNICA VAGINALIS

SPERMATOCELE OR CYST

TESTICULAR CA

PERINEAL SWELLING

REDNESS

FEVER

VOMITING

LETHARGY

PAIN OUT OF PROPORTION TO EXAM

ECCHYMOSIS

NECROTIC ESCHAR

CREPITUS

EMERGENT SURGERY

BROAD SPECTRUM ABX

SINGLE DOSE CEFTRIAXONE AND DOXYCYCLINE 100 MG BID X 10 DAYS < 35

LEVAQUIN IV OR PO

OR CIPROFLOXACIN 10-14 DAYS

TYLENOL

BED REST

SCROTAL ELEVATION, WARM OR COLD COMPRESSES

TROUBLE GETTING

TROUBLE KEEPING ….ERECTION

REDUCED SEXUAL DESIRE

HYPOPITUITARISM

THYROID/CORTISOL

DM 11

VASCULAR

CAD, OR ATHEROSCLEROSIS

SMOKING

COPD /SLEEP APNEA'

SX RADICAL PROSTATECTOMY

PSYHOGENIC

DRUG RELATED

PEYRONIES EPISPADIAS

PRIAPISM

NEURO

SCI

CVA

MS

DM

PEYRONIES

HYPOPITUITARISM

ABBDOMINAL VASCULAR INJURIES

SICKLE CELL

HEMOCHROMATOSIS

DEPRESSION CIRRHOSIS

SUBJECTIVE

LIBIDO

ERECTILE FUNCTION

OBJECTIVE

FEMORAL AND PERIPHERAL PULSES

PLAQUES -PEYRONIES DX

ASSESS CREMASTERIC REFLEX

VISUAL FIELD DEFECTS

FBG

HGBA1C

CBC

CMP ( LIVER + RENAL FUNCTION)

TSH

LIPID PANEL

SERUM TOTAL TESTOSTERONE-GONADAL FUNCTION

IIEF 5 QUESTIONNAIRE IN MD CALC

IDENTIFY ETIOLOGY AND TREAT IF CAN ( HLD SMOKING OBESITY HTN

MEDS PDE5 INHIBITORS

TADALAFIL -LONGER DURATION OF ACTION (TARDY)

VARDANAFIL + AVANAFIL - MORE RAPID ONSET ( VELACITY)

SILDAFENIL + VARDAFENIL- ON EMPTY STOMACH

AVOID IN PTS TAKING DRUGS THAT PROLONG HALF LIFE BY

BLOCKING CYP3A4

NO NITRATES 24 HOURS

CAUTION IN PTS TAKING ALPHA BLOCKERS

SIDE EFFECTS OF PDE5I

FLUSHING

HEADACHE

DYSPEPSIA

NASAL CONGESTION

TESTOSTERONE IF HYPOGONADAL WITH

PDE5 I TO ENHANCE PDE5I, NOT AS MONOTHERAPY

=SERUM TESTOSTERONE < 300NG/DL

NORMAL IS 450-600 NG/DL

GELS AND PATCHES MOST COMMON FORM

VACUUM ERECTION DEVICES WITH BANDS- VENOUS OUTFLOW

ALPROSTADIL INJECTION YUK

PENILE PROSTHESIS

PSYCHOSOCIAL THERAPY

VASCULAR SX- FOR YOUNG MEN WITH PELVIC AND VASCULAR INJURIES

PEYRONIES PLAQUES PREVENT FULL DISTENSIBILITY

REFLUX OF URINE UP URETHRA

BACTERIA UP URETHRA

ECOLI

KLEBSIELLA

ENTEROBACTER

PSEUDOMONAS

C TRACHOMATIS N GONORRHEA

CHRONIC CAN HAVE OTHER CAUSES

FREQUENCY

DYSURIA

URGENCY

PELVIC PAIN <3 MONTHS PAIN SCROTUM TESTES PENIS

PAIN ON EJACULATION AND DEFECATION

ILL APPEARING

FEVER

PE

ENLARGED

BOGGY OR FIRM

TENDER,

DRE CAN CAUSE BACTEREMIA

STD

PROSTATE CA

BLADDER CA

COLON CA

ACUTE URINARY RETENTION

EPIDIDYMITIS /ORCHITIS

UTI

CHRONIC PROSTATITIS

CBC

ESR AND CRP (>)

PSA ( INFLAMMATION, INFECTION, MALIGNANCY)

CMP RENAL

CULTURE

URINALYSIS GRAM STAIN CULTURE

PROSTATIC FLUID GRAM STAIN C&S- PAINFUL

FEVER-BLOOD CULTURE

USS/CT NOT NEEDED UNLESS TO R/O ABSCESS

DRE

NSAIDS PAIN MGT

ABX

C&S FOR GUIDE

<35 COVER FOR C TRACHOMATIS AND N GONORRHEA

NO LONGER FLUOROQUINOLONESD/T > RESISTANCE

BACTRIM DS BID

LEVAQUIN

CIPROFLOXACIN

ALL PERMEATE PROSTATIC TISSUE

ED ACUTELY ILL WHO HAVE URINARY RETENTION OR CANNOT TOLERATE PO MEDS

UROLOGIST

SUSPECTED ABSCESS OR PERSISTENT INFECTIONS

F/U ONE WEEK REPEAT UA AND REPEAT URINE CULTURE AT SEVEN DAYS (UTD)

BACTERIAL REFLUX

>50

DECREASED STREAM /HESITANCY DRIBLLING

LOW GRADE FEVER

ED

PAIN SAME AS ACUTE

RECURRENT UTI

MILD TENDER, ENLARGED OR NORMAL, MAY HAVE NODES

CBC

ESR CRP

PSA

STD SCREENING

CMP RENAL

USS

TRANSURETHRAL USS REFER FOR CYSTOSCOPY ETC

ALWAY ABX EVEN WHEN BACTERIAL CAUSES NOT PRESENT

MAY NEED SUPPRESSION ABX THERAPY

BACTRIM

FLUOROQUIINOLONES

MAY TAKE SEVERAL MONTHS

STDS

HI DOSE CEFTRIAXONE N GONORRHEA

DOXYCYCLINE OR AZITHROMYCIN C TRACHOMATIS

F/U

MONTHLY UA

BLACK AND JAMAICAN MEN

COMMON >60

FAMILY HISTORY

OBESITY

BLACK

ASYMPTOMATIC

ELEVATED PSA

NOCTURIA

HEMATURIA

LUTS

UTI

ANEMIA

WT LOSS

BACK OR HIP PAIN RADIATING TO TESTICULAR AREA

LYMPHEDEMA

LYMPHADENOPATHY

EXAM _ HARD NODULAR ASYMMETRICAL PROSTATE

BPH

PROSTATITIS A OR C

PROSTATE STONES

PSA THRESHOLD IS 4NG/ML

>10 = BIOPSY

PROSTATE CA ANTIGEN

TESTOSTERONE

LFT

CT PELVIS

MRI

BONE SCAN

AAFP

RECOMMMENDS AGAINST ROUTINE PSA SCREENING

MEN 55-69 CONSIDER PERIODIC PSA TESTING RISKS AND BENEFITS

>70 NO SCREENING

TOPICAL MINOXIDIL

ORAL FINASTERIDE 1 MG DAY , LONG TERM( 5 ALPHA REDUCTASE INHIBITOR

NOW DUTASTERIDE 0.5 MG DAY

TYPE 1 AND TYPE 2 ARI-LESS EVIDENCE ONG TERM BUT SUPERIOR EFFICACY

TREATMENT TAKES SEVEREAL MONTHS, TRY FOR 6 MONTHS

FINASTERIDE S/E

ERECTILE DYSFUNCTION, REDUCED LIBIDO, EJACULATORY DYSFUNCTION, REDUCTION IN SPERM COUNT CAN OCCUR, GYNACOMASTIA