Mens Health Crash Course Notes

Benign Prostatic Hyperplasia (BPH)

  • Definition: A condition characterized by urinary frequency, hesitancy, and post-void dribbling in older men.
  • Prostate Feel: Enlarged, symmetrical, and rubbery upon digital rectal exam.
  • First-Line Medication: Alpha-adrenergic receptor antagonists (alpha blockers).
    • Examples: Terazosin, Doxazosin (Cardura), Tamsulosin (Flomax).
  • Medication to Shrink Prostate: Finasteride (Proscar).
  • Herbal Supplement: Saw Palmetto.

Acute Bacterial Prostatitis

  • Definition: Infection and inflammation of the prostate gland.
  • Signs and Symptoms:
    • Urinary urgency, frequency, dysuria.
    • Flu-like symptoms.
  • Prostate Feel: Warm, tender, boggy, and swollen on digital rectal exam.
  • Diagnosis: Urine Gram stain and culture.
  • Treatment: Antibiotics.
    • Examples: Ciprofloxacin (Cipro), Levofloxacin, Trimethoprim-Sulfamethoxazole (Bactrim DS).
    • For sexually active patients (>35) or those with high-risk behaviors: Antibiotics to cover Chlamydia and Gonorrhea.

Prostate Cancer

  • Characteristics: Often asymptomatic; most common after age 65.
  • Prostate Feel: Firm, fixed, and painless on digital rectal exam.
  • Screening Test: Prostate-Specific Antigen (PSA) test.
  • USPSTF Screening Recommendations:
    • Ages 55-69: Informed decision-making.
    • Ages 70 and older: Screening not recommended.
  • Management: Referral to urology.
  • Growth Rate: Usually slow-growing.

Hydrocele

  • Presentation: Fluid-filled mass in the scrotum, swelling and irritation on scrotal skin, no pain.
  • Evaluation: Transillumination (shining light through the scrotum).
    • Positive: Light passes through, producing a glowing effect.
  • Management:
    • Usually resolves on its own.
    • Referral to pediatric urologist if not resolved by age one.

Varicocele

  • Definition: Enlarged veins in the scrotum.
  • Symptoms: Usually asymptomatic; some patients report a heavy feeling.
  • Physical Exam: Palpable veins along the spermatic cord (described as a "bag of worms").
  • Diagnosis: Physical examination; ultrasound can also be used.
  • Management:
    • Conservative treatment.
    • Urology referral if necessary.
  • Complications: Decreased sperm count, fertility issues.

Epididymal Cyst/Spermatocele

  • Presentation: Painless, fluid-filled mass in the epididymis.
  • Spermatocele: Cyst > 2cm.
  • Assessment: Transillumination, ultrasound.
  • Management:
    • Typically no treatment required.
    • Referral to urology if discomfort is experienced.

Orchitis

  • Definition: Testicular inflammation due to viral or bacterial cause (e.g., mumps virus).
  • Presentation: Often unilateral, scrotal discomfort and swelling.
  • Assessment: Scrotal ultrasound.
  • Treatment: Supportive care.
  • Orchitis related to epididymitis: Treat as epididymitis.

Epididymitis

  • Definition: Inflammation of the epididymis.
  • Symptoms: Unilateral testicular pain and swelling.
  • Evaluation:
    • Prehn's sign: Relief of scrotal pain with elevation of the scrotum.
    • NAAT, urine culture, and urinalysis (assess for gonorrhea and chlamydia).
  • Treatment:
    • Low risk for STI: Trimethoprim-sulfamethoxazole (Bactrim).
    • Risk for STI: Ceftriaxone plus doxycycline (covers gonorrhea and chlamydia).

Testicular Torsion

  • Presentation: Sudden, severe testicular pain and swelling.
  • Cause: Twisting of the spermatic cord, leading to ischemic damage.
  • Evaluation:
    • History and physical exam.
    • Absent cremasteric reflex (stroke inner thigh, no rising of ipsilateral testicle).
    • Doppler ultrasound.
  • Management: Immediate referral to the emergency department.

Testicular Cancer

  • Prevalence: Most common in younger men.
  • Presentation: Firm, painless mass on the testicle.
  • Diagnosis: Physical examination and scrotal ultrasound.
  • Management: Referral to a specialist.

Balanitis

  • Definition: Inflammation and irritation of the glans penis.
  • Cause: Often linked to poor hygiene, common in uncircumcised patients.
  • Signs and Symptoms: Pain on the glans penis, white foul-smelling discharge.
  • Management:
    • Hygiene.
    • Antifungal treatment (Candidiasis is a common cause)

Peyronie's Disease

  • Presentation: Curved, painful erection.
  • Cause: Accumulation of fibrous scar tissue inside the penis.
  • Evaluation: History and physical exam.
  • Management: Referral to urology.

Ischemic Priapism

  • Presentation: Prolonged, painful erection (> 4 hours) unrelated to sexual desire.
  • Associated Condition: Sickle cell disease.
  • Evaluation: History and physical exam.
  • Management: Immediate referral to prevent permanent tissue damage.

Erectile Dysfunction (ED)

  • Definition: Difficulty initiating or sustaining an erection for sexual intercourse.
  • Etiology: Multiple factors; investigate underlying cause.
  • Management:
    • Lifestyle modifications.
    • Pharmacotherapy: Phosphodiesterase type 5 inhibitors (PDE5 inhibitors).
      • Example: Sildenafil (Viagra).