Overview of Men's Health Issues

Oct 2, 2024

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Lecture Notes: Men's Health and Genitourinary Conditions

Introduction

  • Focus on men's health and genitourinary conditions.
  • Topics include STIs, erectile dysfunction, and BPH.
  • Importance of understanding presentations like scrotal swellings and hematuria.

Erectile Dysfunction (ED)

Causes of ED

  • Etiologies: Organic (more common) and psychogenic.
  • Organic Causes: Vascular (linked to cardiovascular disease), neurological (peripheral neuropathy, surgery), endocrine (hormonal imbalances).
  • Psychogenic Causes: Mental health issues affecting sexual performance.
  • Drugs that Cause ED: Antidepressants, antipsychotics, beta blockers, thiazide diuretics.

History and Examination

  • Assess frequency and duration of ED.
  • Differentiate between causes: initiation vs. maintenance issues, libido problems, premature ejaculation.
  • Examine psychological and cardiovascular risk factors.

Management and Investigations

  • Basic blood tests, cardiac screening, morning serum testosterone levels.
  • Lifestyle changes, manage cardiovascular risks, psychotherapy, pharmacological treatments.
  • Pharmacological Means: PDE5 inhibitors, intracavernosal injections, prostheses.
  • Contraindications: PDE5 inhibitors with nitrates.

Prostate Issues

Benign Prostatic Hyperplasia (BPH)

  • Common, affects 25% of men over 50.
  • Symptoms: FUNWISE mnemonic (Frequency, Urgency, Nocturia, Weak stream, Intermittency, Straining, Emptying).
  • Signs: Smooth, firm prostate on DRE.
  • Complications: Urinary retention, syncope, recurrent UTIs.
  • Management: Lifestyle changes, pharmacological treatments (Tamsulosin, Dutasteride).
  • Investigations: Urinalysis, PSA levels.

Prostate Cancer

  • Second most common cancer in men.
  • Risk Factors: Family history, including breast cancer.
  • Screening: PSA testing, not generally recommended without risk factors.
  • Signs: Hard, nodular prostate, asymmetry.
  • Management: Specialist referral, MRI, ultrasound, potential biopsy.

Urinary Tract Infections (UTIs) and Urosepsis

  • More common in females; E. coli most common cause.
  • Symptoms: Dysuria, frequency, urgency, flank pain.
  • Investigations: Urine dipstick, midstream urine, ultrasound for structural issues.
  • Management: Antibiotics, referral to ED for severe cases.

Sexually Transmitted Infections (STIs)

Testing and Management

  • Testing Guidelines: Hepatitis B, C, HIV, syphilis, chlamydia, gonorrhea.
  • Risk Groups: Men who have sex with men (MSM), pregnant individuals, sex workers.
  • Management: Contact tracing, antibiotics for specific STIs.

Specific STIs

  • Gonorrhea: Mucopurulent discharge, treated with IM ceftriaxone and oral azithromycin.
  • Chlamydia: Often asymptomatic, managed with doxycycline or azithromycin.
  • Herpes Simplex Virus (HSV): Painful vesicular lesions, managed with antivirals.
  • Syphilis: Stages include primary (painless chancre), secondary (rash), tertiary (organ damage), treated with Benzathine penicillin.

Other Conditions

  • HPV: Genital warts, management includes cryotherapy, immune modulators.
  • Molluscum Contagiosum: Skin-to-skin transmission, management includes cryotherapy.

Scrotal Swellings

  • Painless Lumps: Hydrocele, testicular cancer, epididymal cysts.
  • Painful Lumps: Testicular torsion (emergency), epididymo-orchitis, inguinal hernias.

Hematuria

  • Types: Microscopic, macroscopic.
  • Causes: Infection, malignancy, nephritic syndrome, stones.
  • Diagnosis: Urine dipstick, imaging.
  • Management: Treat underlying cause, repeat testing.

Note: These notes encapsulate the lecture's main points and are meant for review and study purposes.