Men's Health: Understanding Cryptorchidism

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Questions and Answers

What is the primary complication associated with bilateral cryptorchidism?

Testicular torsion

Malignancy

Hormonal imbalance

Infertility (correct)

At what age should surgery be performed if the testes have not descended?

At any age if non-palpable

By 3 months

Before 12 months (correct)

By 6 months (correct)

What method is recommended for a thorough examination of potentially undescended testes?

CT scan for imaging

Ultrasound immediately after birth

Palpation during initial examination (correct)

Serum hormone testing

Which statement is true regarding the prevalence of cryptorchidism in infants?

There is a 30% risk in premature infants. Signup and view all the answers

When should an ultrasound be obtained for undescended testes?

At birth if neither testis is palpable Signup and view all the answers

What is the primary characteristic of Peyronie disease?

Buildup of hardened fibrous tissue in the corpus cavernosum Signup and view all the answers

Which of the following can cause Peyronie disease?

Repeated penile injury during sex or activity Signup and view all the answers

What symptom is NOT typically associated with Peyronie disease?

Prolonged erection Signup and view all the answers

What recommendation does the American Urologic Association make for adolescent patients regarding testicular health?

Monthly testicular self-examinations Signup and view all the answers

Why might a curved erection not be concerning?

Variation in shape and size of penises is normal Signup and view all the answers

What is the most appropriate initial treatment for Peyronie's disease within three months of onset?

Oral pentoxifylline Signup and view all the answers

When is surgical management indicated for Peyronie's disease?

For patients whose condition has lasted more than 12 months and is refractory to medical treatment Signup and view all the answers

What imaging modality is NOT commonly used to diagnose Peyronie's disease?

Electrocardiogram (ECG) Signup and view all the answers

Which statement about Peyronie's disease curvature is correct?

Stable and mild curvature (≤30 degrees) may not require immediate intervention. Signup and view all the answers

Which of the following conditions can occur alongside Peyronie's disease?

Pain and interference with sexual function Signup and view all the answers

What is typically revealed in the urinalysis of a patient with acute prostatitis?

Increased WBC and hematuria Signup and view all the answers

In treating prostatitis in men younger than 35, which antibiotics are typically administered?

Ceftriaxone and doxycycline Signup and view all the answers

What is the primary pathogen in epididymitis for men over 35 years old?

Escherichia coli Signup and view all the answers

Which sign is associated with a positive Prehn's sign in epididymitis?

Relief with elevation Signup and view all the answers

When treating chronic prostatitis, how long should fluoroquinolones or Bactrim be administered?

6-12 weeks Signup and view all the answers

What distinguishes the symptoms of acute epididymitis from testicular torsion?

Gradual onset and posterior tenderness in epididymitis Signup and view all the answers

For hospitalized patients with severe sepsis indicating prostatitis, which intravenous antibiotic combination may be administered?

Levofloxacin and aminoglycoside Signup and view all the answers

What finding on a scrotal ultrasound may suggest testicular torsion?

Decreased blood flow Signup and view all the answers

What is the primary purpose of urinalysis in patients suspected of having prostate issues?

To rule out other conditions Signup and view all the answers

What is considered a normal PSA level?

Less than 4 Signup and view all the answers

Which medication is considered the most uroselective alpha-blocker for BPH treatment?

Tamsulosin (Flomax) Signup and view all the answers

What potential side effect is associated with alpha-blockers used in BPH treatment?

Dizziness and orthostatic hypotension Signup and view all the answers

What is the mechanism by which 5-alpha reductase inhibitors help treat BPH?

Inhibit the conversion of testosterone to dihydrotestosterone Signup and view all the answers

Combination therapy with PDE5 inhibitors and alpha-1 adrenergic blockers is noted for what benefit?

Additive beneficial effects on symptoms Signup and view all the answers

In which situation is surgery indicated for BPH patients?

When drug therapy is ineffective or complications arise Signup and view all the answers

What surgical procedure is commonly performed to relieve obstruction caused by BPH?

TURP (Transurethral Resection of the Prostate) Signup and view all the answers

What is the immediate treatment for a patient with suspected epididymitis under 35 years of age with a potential STD etiology?

Ceftriaxone and Doxycycline Signup and view all the answers

Which of the following tests would help differentiate epididymitis from testicular torsion?

Ultrasound with Doppler studies Signup and view all the answers

What complication can occur if paraphimosis is not addressed promptly?

Vascular compromise and necrosis of the glans penis Signup and view all the answers

For patients who practice insertive anal intercourse, what is the appropriate antibiotic regimen for suspected epididymitis?

Ceftriaxone and a fluoroquinolone Signup and view all the answers

What condition describes the inability to retract the foreskin in adults, often due to scarring or infection?

Phimosis Signup and view all the answers

What should be done if the foreskin is found retracted after urethral catheterization?

Reduce the foreskin immediately Signup and view all the answers

What might urinalysis and culture reveal in a case of epididymitis?

Pyuria and bacteriuria Signup and view all the answers

What is the first medical action to take in a case of paraphimosis?

Firmly compress the glans Signup and view all the answers

What is a primary characteristic of Peyronie disease?

Buildup of hardened fibrous tissue Signup and view all the answers

What commonly contributes to the development of Peyronie disease?

Genetic susceptibility Signup and view all the answers

Which of the following symptoms is NOT typically associated with Peyronie disease?

Increased libido Signup and view all the answers

When should adolescents perform testicular self-examinations according to the guidelines?

Monthly Signup and view all the answers

Why might a curved erection not be a cause for concern?

Penises can vary in shape Signup and view all the answers

What percentage of male children with bilateral cryptorchidism may experience infertility?

75% Signup and view all the answers

When should a child with non-palpable testes be referred to urology or surgery for evaluation?

At the 4-6 month well-child exam Signup and view all the answers

What is the most common site for cryptorchidism in males?

Right testicle Signup and view all the answers

What complication can arise from undescended testes aside from infertility?

Testicular torsion Signup and view all the answers

What action should be taken if neither of the testes are palpable at birth?

Obtain an ultrasound promptly Signup and view all the answers

What is an acceptable management option for men with stable, mild curvature of Peyronie's disease who maintain satisfactory erectile function?

Observation Signup and view all the answers

Which treatment is recommended within three months of the onset of Peyronie's disease?

Oral pentoxifylline Signup and view all the answers

Under what condition is surgical management indicated for Peyronie's disease?

When Peyronie's disease persists for more than 12 months and causes significant penile deformity Signup and view all the answers

What is a common symptom that may occur alongside Peyronie's disease?

Pain during sexual intercourse Signup and view all the answers

Which imaging modality is typically used for diagnosing Peyronie's disease?

Ultrasound Signup and view all the answers

What is the primary characteristic of a varicocele as observed in physical examination?

Chronic, non-tender mass with no transillumination Signup and view all the answers

Which of the following symptoms is NOT typically associated with benign prostatic hyperplasia (BPH)?

Severe abdominal pain Signup and view all the answers

What examination finding is indicative of BPH during a digital rectal exam?

A uniformly enlarged, firm, and rubbery prostate Signup and view all the answers

In the management of varicocele, when is surgical intervention likely warranted?

If it appears to cause infertility or is painful Signup and view all the answers

Which factor is least likely to trigger acute urinary retention in men with BPH?

Walking for exercise Signup and view all the answers

What is the primary action of phosphodiesterase inhibitors like sildenafil citrate?

Increases cGMP levels Signup and view all the answers

What is the recommended time to take sildenafil before sexual intercourse?

30 to 60 minutes Signup and view all the answers

What is the risk associated with using phosphodiesterase inhibitors and nitrates together?

Profound hypotension Signup and view all the answers

In which age group is acute bacterial prostatitis most commonly observed?

Younger individuals under 35 Signup and view all the answers

What is one of the most common causes of chronic prostatitis in men over 35?

E. coli infection Signup and view all the answers

Which symptom is commonly associated with acute bacterial prostatitis?

Perineal pain Signup and view all the answers

What should NOT be done if acute prostatitis is suspected during a physical examination?

Massage the prostate Signup and view all the answers

What is a common urinary symptom associated with chronic prostatitis?

Frequency Signup and view all the answers

What is the most common age range for testicular torsion to occur?

10-20 years old Signup and view all the answers

What is the initial diagnostic test for suspected testicular torsion?

Testicular Doppler ultrasound Signup and view all the answers

Which of the following signs is NOT associated with testicular torsion?

Positive cremasteric reflex Signup and view all the answers

What is the recommended treatment for testicular torsion once diagnosed?

Orchiopexy Signup and view all the answers

What is the typical resolution timeframe for phimosis in children?

By age 5 Signup and view all the answers

Which condition necessitates treatment for phimosis?

Balanitis Signup and view all the answers

In the case of testicular torsion, which timing of surgical intervention is critical for the best outcomes?

Within 6 hours Signup and view all the answers

Which of the following complications does not typically require treatment for phimosis?

No complications present Signup and view all the answers

Study Notes

Men's Health

Presented by C. Hammond, DNP,MSN, FNP-BC, PMHNP-BC

Cryptorchidism

Cryptorchidism is the failure of testes to descend (one or both)
Higher risk in premature infants (30%) compared to full-term infants (5%)
Most commonly affects the right testicle
Surgery (orchiopexy) is recommended if not descended by 6 months of age and before 12 months
Complications of untreated cryptorchidism include testicular cancer (in both descended and undescended testes) and infertility (75% in bilateral cases, 50% in unilateral cases).
Thorough genital exam, including an attempt to "milk" inguinally located testes into the scrotum
If testes are palpable, re-examine during the next well-child visit
If not palpable at birth, obtain an ultrasound immediately.
Undescended testes can be monitored for spontaneous descent in the first 4-6 months of life
If still non-palpable at 4-6 months, refer to urology/surgery for evaluation and possible orchiopexy
Specialists should be consulted for absent testes
Complications include malignancy, subfertility, and testicular torsion.
Patients should perform monthly testicular self-exams during adolescence.

Peyronie Disease

Peyronie disease (PD) is a disorder characterized by a buildup of hardened fibrous tissue in the corpus cavernosum.
Causes pain and curvature of the penis, especially during erection
Caused by repeated penile injury (sex, physical activity) and genetic susceptibility
Symptoms include pain, induration, curvature, shortening, and/or sexual dysfunction.
Diagnosis is typically apparent from patient history and penile examination.
Various imaging modalities used for diagnosis including ultrasound, plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI).
Oral pentoxifylline (vasodilator and anti-inflammatory) is the initial recommended treatment within three months of onset
Surgical management is indicated for patients with more than 3-month duration, refractory to medical treatment, and with deformity impacting sexual function
Observation is an appropriate option for men with mild curvature (≤30 degrees) and satisfactory erectile function

Erectile Dysfunction

Recurring inability to achieve and maintain an erection sufficient for satisfactory sexual performance
Affects up to half of men in the US between the ages of 40 and 70
Risk factors include atherosclerosis (e.g., hypertension, smoking, hyperlipidemia, diabetes), medications (that may lower intracavernosal pressure), sickle cell disease, pelvic surgery, perineal trauma, alcohol abuse, and conditions causing hypogonadism/low testosterone (e.g., hypothyroidism).
Various imaging modalities for diagnosis including a digital rectal examination, CBC, chemistry panel, fasting glucose, lipid profile, serum testosterone, prolactin levels, and thyroid profile
Nocturnal penile tumescence evaluations helps determine organic vs. psychogenic causes.
First-line treatment is with phosphodiesterase inhibitors (sildenafil citrate (Viagra), tadalafil (Cialis), vardenafil (Levitra)).
Treat underlying cause and address atherosclerotic risk factors

Prostatitis

Inflammation of the prostate gland
Classified into acute, chronic, asymptomatic inflammatory, and chronic pelvic pain syndrome.
Causes include ascending urinary tract infections, spread from the rectum, hematogenous spread (rare). May follow catheterization, cystoscopy, or other procedures,
Acute bacterial prostatitis usually occurs in younger individuals and is a more serious condition
Symptoms include fever, chills, malaise, frequency, urgency, dysuria, and perineal/low back pain
Chronic prostatitis commonly occurs in individuals aged 40-70 years
Diagnosis includes digital rectal examination, urinalysis, urine cultures, prostatic fluid/secretions analysis, ultrasound/CT scan/cystoscopy, blood tests (CBC, blood cultures if needed), and blood urea nitrogen/creatinine levels. Serum prostate-specific antigen (PSA) may be elevated.
Avoid prostate massage in suspected acute cases due to potential sepsis risk
Treatment involves (4-6 weeks) fluoroquinolones or Bactrim, or intravenous antibiotics in severe sepsis/bacteremia cases.

Epididymitis

Inflammation of the epididymis, characterized by dysuria, unilateral scrotal pain, and swelling
Pathogens are dependent on patient's age. Men < 35: Chlamydia and Gonorrhea; Men > 35: E. Coli
Testicular torsion should be ruled out in all cases of new-onset testicular pain
Associated symptoms include pain that is gradual in onset with tenderness posterior to the testis, high riding testicle, absence of cremasteric reflex, and absence of leukocytes on urine analysis.
Diagnosis involves urinalysis, urine cultures, studies for GC and Chlamydia; ultrasound with Doppler if torsion is suspected
Treatment depends on age and suspected etiology.

Phimosis

Foreskin cannot be retracted over the glans penis.
In adults, phimosis can result from scarring, trauma, infection, or prolonged irritation
Paraphimosis is the entrapment of the foreskin behind the glans, a medical emergency
In children, phimosis typically resolves by age 5.
Treatment for phimosis involves: firm circumferential compression of the glans to restore the foreskin to its normal position. Dorsal slit (local anesthetic) if compression is ineffective. Circumcision may be performed if edema or pain continues.

Testicular Torsion

Twisting of the spermatic cord resulting in decreased blood flow and ischemia
Often after vigorous activity or minor trauma
Primarily affects 10-20-year-old boys
Symptoms are usually sudden/rapid onset.
Significant findings include asymmetric high riding testicle ("bell clapper deformity"), negative Prehn's sign (lifting the testicle does not relieve the pain), loss of cremasteric reflex, and potential blue dot sign.
Diagnosis requires testicular Doppler ultrasound
Treatment involves emergent surgical repair within 6 hours for optimal outcomes.

Varicocele

Dilated veins in the spermatic cord, described as "bag of worms"
Worsens when upright or with Valsalva maneuver.
Improves/decreases in size with elevation or supine position
Negative transillumination
Diagnosis involves scrotal ultrasound.
Treatment may include surgery if painful or causing infertility.

BPH (Benign Prostatic Hyperplasia)

Part of normal aging process, affecting >90% of men by age 85
Symptoms include decreased force of urinary stream, hesitancy/straining/starting and stopping, postvoid dribbling, incomplete emptying, frequency, nocturia, urgency, and recurrent UTIs
Avoid anticholinergics, sympathomimetics and opioids in patients with BPH
Diagnosis involves: digital rectal exam (uniformly enlarged, firm, and rubbery prostate). Elevated PSA is a correlate for risk of progression (normal PSA < 4)
Urinalysis to rule out secondary conditions
Treatment involves observation for mild symptoms, alpha-blockers (rapid relief, rapid symptom relief, and smooth muscle relaxation). 5-alpha reductase inhibitors (reduce size of prostate) and Phosphodiesterase type 5 inhibitors (PDE5 inhibitor - tadalafil) can be used with or without alpha-1 adrenergic blockers.
Surgery is indicated if symptoms/complications don't respond to medication, or if complications such as recurrent UTIs, urinary calculi, severe bladder dysfunction, or upper tract dilation arise. Surgical options include TURP (transurethral resection of the prostate) and TUIP (transurethral incision of the prostate).

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Description

This quiz covers essential information about cryptorchidism, focusing on its definition, risk factors, and clinical management. Learn about the importance of timely intervention and the recommended surgical procedures for undescended testes. Ideal for those in the field of men's health or pediatrics.