Genitourinary - Exam 1 (Proctological conditions)

Corpus spongiosum

contains urethra

expands to form glans

Prostate location + tissue type

base of bladder

fibromuscular and glandular tissue

Prostates in infants vs adolescents vs >25 yo

infants - small and inactive

adolescents - enlarges + active

>25 yo - continuing to enlarge

Prostate gland functions - Seminal fluid production

secretes prostatic fluid (30% of semen)

composition (enzymes/proteins/minerals)

purpose (enhances sperm motility and longevity)

Prostate gland functions - Protection of sperm

pH balance (neutralizes acidity of vaginal tract)

enzymes (breakdown semen clot after ejaculation)

Prostate gland functions - Support fertilization

sperm activation (prostatic fluid contains enzymes to activate sperm)

nutrients (zinc + citric acid to maintain sperm health)

Urge to defecate

rectum fills w/feces

reflective stimulation relaxes internal sphincter

Control of defecation

striated external sphincter (voluntary control)

Internal sphincter

smooth muscle under INVOLUNTARY autonomic control

External sphincter

striated muscle under VOLUNTARY control

Upper half of anal canal

automatic control

relatively insensitive

Lower half of anal canal

somatic sensory nerves

sensitive to pain

History question

Do you have any changes in urination, defecation, sexual function?

DRE should NOT be done with

anal cracks, anal fistula, spasticity of sphincter, rectal prolapse, hemorrhoids

If the urethral meatus is red, what is it an indication of

STI or UTI

If the urethral meatus is Bumpy/rough, what is it an indication of

HPV

Which testicle is typically lower due to a longer spermatic cord

left testicle

Transilluminate P-A through each testicle looking for

cherry-red glow

**dark ares = cancer

Cremasteric reflex

same testicle should rise

spinal nerves T12-L2

Pain in the perineal area could mean

prostate problem

Palpate prostate

anteriorly (downward)

PSA

protein produced by cells of prostate gland

helps liquefy semen (swim freely)

An increase of 25% PSA in 1 year means

cancer (even if # is low)

Normal levels of PSA

<50 = <2.5 ng/mL

50-59 = <3.5 ng/mL

60-69 = <4.5 ng/mL

>70 = <6.5 ng/mL

Mildly elevated PSA (4-10 ng/mL) - possible causes and action

Causes - BPH, prostatitis, recent ejaculation, minor infection

Action - require further monitoring or additional tests

Moderately elevated (10-20 ng/mL) - possible causes and action

Causes - higher likelihood of prostate cancer, significant BPH, prostatitis

Action - prompts more definitive testing (biopsy)

Highly elevated (>20 ng/mL) - possible causes and action

Cause - strong indication of prostate cancer, advanced BPH

Action - immediate further diagnostic tests (imaging and biopsy)

PSA Velocity

rate of increase in PSA levels over time

**Remember: rapid increase = more indicative of prostate cancer

Vitamin E and Selenium supplements

antioxidants help protect prostate

Omega-3 FA supplements

anti-inflammatory

Zinc supplements

essential mineral supports prostate health

Lycopene (tomatoes) supplements

lower risk of prostate cancer

Saw palmetto and Stinging nettle supplements

reduce symptoms of BPH

Males should be performing a self examination every _____ after puberty

month

Males should be getting colonoscopies every ____ starting at the age of 50

10yrs

Benign Prostatic Hyperplasia (BPH) occurs in what population

MC >50

70-90% in >70

BPH

non-cancerous enlargement of prostate

expands capsule causing pressure on urethra

In BPH, normal tissue is replaced by collagen in what zone

transition zone

BPH symptoms

frequent urination, nocturia, sudden strong urge to urinate

weak stream, incomplete emptying, straining

Acute urinary retention in BPH can cause

recurrent UTIs

Causes of BPH

aging (inc sensitivity to DHT)

elevated estrogen

family hx

Dx methods of BPH

DRE + PSA test

urinalysis + ultrasound

Dx findings of BPH

enlarged, smooth, boggy/squishy

fairly mobile, less sulcus

no pain w/palpation

Medications for BPH

Alpha blockers - reduce prostate muscle

5-alpha reductase inhibitors - reduce prostate size

Procedures for BPH

transurethral microwave thermotherapy (TUMT)

transurethral needle ablation (TUNA)

transurethral resection of prostate (TURP)

Prostate cancer (adenocarcinoma) prevalence

1 in 6

2nd leading cause of cancer death >65 yo

responsible for 60% of all skeletal metastasis

Prostate cancer (adenocarcinoma) risk factors

inc significantly >50

african american

high-fat diet

family hx

Prostate cancer (adenocarcinoma) symptoms

early asymptomatic, advanced:

frequent urination, difficulty start/stop flow, weak stream

pain in pelvic/lower back/hips

erectile dysfunction

hematuria or hematospermia (blood in urine or semen)

Dx methods of Prostate cancer (adenocarcinoma)

DRE + PSA

biopsy

MRI/CT/bone scans (mets)

Dx findings of Prostate cancer (adenocarcinoma)

enlarged, asymmetrical contour, hard nodules

immobile, obliterated sulcus

no pain w/palpation

Staging of Prostate cancer (adenocarcinoma)

1 - confined to prostate, not detectable on imaging

2 - more advanced, confined to prostate

3 - spread beyond prostate to nearby tissue (inguinal lymph nodes)

4 - spread to distant organs (bones + lymph nodes)

Prostate cancer (adenocarcinoma) survival rates

early/localized/regional = 5yr survivability is 100%

distant mets (stage 4) = 5yr survivability is 34%

Gleasons score for Prostate cancer (adenocarcinoma)

2 areas scored and combined

range from 1-5 (1 - normalish vs 5 - more severe)

Metastasis of Prostate cancer (adenocarcinoma) is typically

blastic

Prevention of recurrence of Prostate cancer (adenocarcinoma)

reduce red meat, healthy fats, antioxidant rich foods

at least 30min moderate exercise

quit smoking and moderation of alcohol

Prostatitis occurs in what population

<50

Acute bacterial prostatitis (SUDDEN)

sudden onset fever, malaise, muscle aches

frequent urgent/painful urination

lower abdomen/perineal/low back pain

Tx of acute bacterial prostatitis

antibiotics

anti-inflammatory meds

increase fluid intake

Chronic bacterial prostatitis (RECURRENT bacterial inf)

recurrent UTIs and low-grade fever

discomfort during urination

persistent pelvic pain

Tx of chronic bacterial prostatitis

antibiotics

anti-inflammatory meds

alpha blockers (ease urination, relax bladder neck muscles)

Chronic prostatitis/Chronic pelvic pain syndrome (CPPS)

persistent pelvic pain (w/o bacterial inf)

frequent + painful urination

painful ejaculation + erectile dysfunction

Tx for Chronic prostatitis/CPPS

anti-inflammatory meds

alpha blockers

pelvic floor therapy, acupuncture

stress management and dietary adjustments

Asymptomatic inflammatory prostatitis

found during tests for other conditions

Tx = monitoring

Risk factors for prostatitis

frequent UTIs

prostate surgery/biopsy or catheter use

STIs

Dx methods of prostatitis

DRE (tenderness/swelling) + PSA

urinalysis

prostatic fluid analysis (bacteria and WBCs)

ultrasound + MRI

Dx findings of prostatitis

enlarged, asymmetrical contour, indurated/hardened

warm to touch

fixed mobility, sulcus still present

pain w/palpation

Prostate Abscess

localized collection of pus usually caused by bacterial infection

Risk factors of Prostate Abscess

acute bacterial prostatitis (primary RF!!)

diabetes, immunosuppression, catheter

Prostate Abscess symptoms

fever, chills, malaise

frequent/painful/difficult urination

perineal/low back/ejaculation pain

Dx methods for Prostate Abscess

DRE + PSA

urinalysis + blood tests

transrectal ultrasound

CT + MRI

Dx findings of Prostate Abscess

palpate hole/divot

movable w/sulcus present

possible pain w/palpation

Tx of Prostate Abscess

same as prostatitis AND surgical drainage

Hard nodules should be considered cancerous until

proven otherwise

Prostatic calculi occurs in what population

older men

Risk factors of Prostatic calculi

chronic prostatitis + BPH

recurrent UTIs

reduced flow of urine (urinary stasis)

Prostatic calculi symptoms

frequent/painful/difficult urination

hematuria

recurrent UTIs

perineal/low abdomen/ejaculation pain

Dx methods for Prostatic calculi

DRE + urine culture

transrectal ultrasound

X-ray, CT, MRI

Tx of Prostatic calculi

TURP

Testicular torsion occurs in what population

babies and teens

Testicular torsion symptoms

acute pain, vomiting, nausea

Dx findings of Testicular torsion

scrotal discoloration (bruising)

lack of cremasteric reflex

Tx of Testicular torsion

surgical emergency

Epididymitis (bacterial inf - STD/UTI) occurs in what population

teens and adults

Epididymitis symptoms

gradual onset of pain

fever

Dx findings of Epididymitis

dysuria and pyuria

redness of scrotum

urethral discharge

Hydrocele (non-tender, smooth, firm mass/fluid filled scrotum) occurs in what population

newborns (congenital) or trauma

Tx of Hydrocele

resolve on own or surgery

What is the MC cancer in young men

testicular cancer

Testicular cancer occurs in what population

15-35 yo

Risk factors for testicular cancer

cryptorchidism

caucasian

family hx

Testicular cancer symptoms

painless lump/swelling

heaviness in scrotum

scrotum/low back/breast pain

gynecomastia

Dx methods for testicular cancer

physical exam

ultrasound

blood tests (tumor markers)

CT/MRI/biopsy

Prognosis of testicular cancer

detected early - 5yr survival rate >95%

Penile cancer (SCC) occurs in what population

>60 yo

<1% of cancers in US

Risk factors of penile cancer (SCC)

HPV

smoking

phimosis, balanitis

UV light treatment

Penile cancer (SCC) symptoms

lump/ulcer on glans or foreskin

redness/rash and thickening of skin

foul smelling discharge under foreskin

pain/bleeding from ulcer

swollen lymph nodes in groin area

Dx methods of penile cancer (SCC)

physical exam, biopsy

MRI, ultrasound, CT (check spread to lymph nodes)

Prognosis of penile cancer (SCC)

varies by stage and extent

early-stage has a high survival rate

Older adults

sphincter tone decreases

fecal impaction/constipation common

enlarged prostate

polyps more common (risk for carcinoma)

Children complication of bowel movement

encopresis (fecal soiling)