Benign Prostatic Hyperplasia (BPH)
- Sx:
- Dx: UA, PSA, PVR
- Tx: Lifestyle, meds (Alpha blocker -zosin, +/- 5a reductase -steride), TURP
Bladder Disorders
-
Incontinence
- Stress
- Urge
- Overflow
-
Overactive bladder
-
Prolapse
Congenital and Acquired Abnormalities
- Cryptorchidism
- undescended testes
- increased risk of testicular cancer, torsion, infertiilty
- Peyronie disease
- scar/fibrous plaque on shaft of penis
- contractures, erectile angulation
- Tx: oral pentoxyfylline, intralesional collagenase
- Trauma
- Penile
- Vesicoureteral reflux
- retrograde urine flow, MC in female
- recurrent UTI, pediatric febrile UTI
- Dx: renal US, definitive = voiding cystourethrogram
- Tx: mild = obs or abx ppx, surgery if severe (e.g. recurrent pyelo)
Infectious Disorders
- Cystitis
- UTI
- Sx: dysuria, suprapubic pain, AMS (older patients)
- Dx: UA (nitrite/LE, WBC), culture
- Tx: abx
- Epididymitis
- Rf: STI’s, poor hygiene,
- Sx: epididymal tednerness, +Prehn sign (relief with scrotal elevation), NORMAL cremasteric
- Tx: scrotal elevation, NSIAIDs, abx (age <35: STI treatment)
- Fournier gangrene
- necrotizing perineal SSTI
- Rf: alcohol, DM, immunodeficiency, VIDU, immunosuppression
- Sx: pain (out of proportion), septic, crepitus
- Dx: surgical
- Tx: surgery + abx + ICU
- Orchitis
- rare alone, usually follows epididimytis
- if alone: think viral (mumps, coxsackie, rubella)
- Dx: testicular pain, tenderness (unilateral)
- Tx: supportive, abx if suspected
- Prostatitis
- Age <35: STI, >35: E.coli
- Sx: perineal pain, dysuria, fever
- Dx: DRE w/ boggy, tender, enlarged prostate
- Tx: Bactrim or fluoroquinolone
- Pyelonephritis
- Dx: fever/flank pain/dysuria + UA/culture (MC: E. Coli, WBC casts)
- Tx: abx
- Urethritis
- MC: STI (G/C)
- Sx: dysuria, urethral discharge
- Dx: swab, culture
- Tx: empiric G/C coverage
Neoplasms
- Bladder
- MC GU cancer
- Rf: tobacco use, occupational exposures
- Sx: painless gross hematuria +/- irritative LUTS
- Dx: UA/culture (r/o benign pathologies), CT urogram w/ cystoscopy + cytology
- Tx: muscle invasive: radical cystectomy + chemo, non-invasive: TURBT +/- BCG (intravesicular chemo)
- Penile
- MC: SCC
- Rf: uncircumcised, HPV, age
- Dx: biopsy
- Tx: surgical
- Prostate
- Screen 55-69
- Rf: Age >40, genetics, black race, uptrend in PSA
- Sx: presents similar to BPH
- Dx: transrectal US biopsy
- Tx: active surveillance, radiation, prostatectomy
- Testicular
- MC cancer in males 15-40
- Rf: cryptorchidism
- Sx: painless, fixed, firm, non-mobile testicular mass
- Dx: scrotal US, CT CAP (look for metastases), tumor markers (AFP, bHCG)
- Tx: radical orchiectomy, chemo/radiation based on staging
Nephrolithiasis / Urolithiasis
Penile Disorders
-
Erectile dysfunction
-
Hypospadias / epispadias
- Tx: elective surgical repair 6mo-1yr
-
Paraphimosis / phimosis
- Paraphimosis: cannot return
- emergent: attempt reduction, surgical
- definitive: circumcision
- Phimosis: cannot retract
- Tx: topical steroids, gentle stretching (normal in peds)
- definitive: circumcision
- Paraphimosis: cannot return
-
Priapism
- prolonged painful erection not associated with sexual stimulation
- MC: ischemic (low-flow, venous occlusive)
- Rf: sickle cell, meds, Hx of intracavernosal injections
- Tx: <4hrs = intracavernosal phenylephrine, >4hrs = EMERGENT corporal aspiration
Testicular Disorders
- Hydrocele
- painless scrotal edema
- Dx: scrotal US
- Tx: adults (observe), peds usually self resolve
- varicocele
- Sx: usually left sides “bag of worms” dull aching pain, infertility
- Dx: physical exam
- Tx: NSAIDs, surgery IF significant pain/infertility
- Testicular torsion
- Sx: sudden pain, NO CREMASTERIC, N/V
- Dx: Hx and PE; imaging should not delay surgery
- Tx: manual detorse if surgucal delay
Urethral Disorders
- Prolapse
- MC in prepubertal / postmenopausal females
- Dx: clinical
- Tx: surgery if symptomatic
- Stricture
- narrowing of urethral lumen (congenital or acquired)
- Tx: urethral dilation, urethroplasty