Questions and Answers
What is the main difference between phimosis and paraphimosis?
Phimosis involves inability to retract the foreskin, while paraphimosis is when the foreskin is left retracted behind the glans.
What is a common risk factor for both phimosis and paraphimosis?
Infection
How can paraphimosis be effectively reduced in most cases?
With compression of the glands for several minutes
Why is paraphimosis considered a urological emergency?
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At what age do fewer than 10% of foreskins remain nonretractile?
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What should be done if a patient with phimosis presents with pain or fever?
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What is the curative management for phimosis?
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Why does phimosis naturally occur in uncircumcised newborns?
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What has been shown as an effective nonsurgical management option for phimosis?
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What is a common risk factor for Peyronies disease?
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Which of the following diseases is NOT linked to Peyronies disease?
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What is the typical presentation of Peyronies disease?
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Why is ultrasound often needed in diagnosing Peyronies disease?
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What is the recommended referral for patients with Peyronies disease?
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What is the most common causative agent for Prostatitis?
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Which of the following is NOT a risk factor for Prostatitis?
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Which symptom is commonly complained about by patients with Prostatitis?
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What is the initial treatment recommended for infectious prostatitis?
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What is contraindicated in the case of acute bacterial prostatitis?
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A patient with ________ will most likely complain of irritative or obstructive symptoms such as low back pain, perineal, suprapubic, or genital discomfort. These patients might have lower UTI symptoms, fevers or chills
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Presence of __________ in expressed prostatic secretions but with a negative culture is indicated of non-infectious prostatitis
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Prostatitis is most common in younger or middle-aged men
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Benign prostatic hyperplasia is a common condition that only affects young men.
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Blood work to check PSA levels should be drawn after examination of the prostate.
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What presenting symptoms are commonly associated with Benign Prostatic Hypertrophy (BPH)?
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Which tool is important in evaluating patients with Benign Prostatic Hypertrophy?
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What diagnostic finding is essential for confirming a diagnosis of BPH?
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Which factor is NOT a known risk factor for Benign Prostatic Hypertrophy?
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Why is a urinalysis important in the diagnosis of Benign Prostatic Hypertrophy?
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What is the most common site of metastases in prostate cancer?
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According to the USPSTF, which age group should have an individual conversation with their providers regarding periodic PSA screening (grade C)?
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What determines the grading of prostate cancer?
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What is a risk factor for prostate cancer?
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What is the standard method for detecting prostate cancer?
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The USPSTF recommends against PSA screening in men 70 years and older
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Androgen is commonly used in prostate cancer, but this can cause “feminization” and loss of sex drive
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A high PSA threshold excludes the diagnosis of prostate cancer
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Prostate cancer is the most common non-cutaneous cancer and the second leading cause of cancer-related death in American men
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What is the most common type of penile cancer?
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What is a major risk factor for penile cancer?
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What is the recommended approach for males with a suspicious penile lesion?
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What is the single most important prognostic factor for survival in penile cancer patients?
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Which treatment approach may be considered for men with a small distal, noninvasive primary tumor?
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In the context of penile cancer, what is the recommended approach for patients with high risk of recurrence and extensive primary tumor involvement?
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Study Notes
Phimosis
- Phimosis is the inability to retract the foreskin proximally and posterior to the glans penis.
- All patients with foreskin have a potential for phimosis.
- Risk factors for phimosis include infection, poor hygiene, and previous preputial injuries with scarring.
- Phimosis is diagnosed clinically, and treatment options include circumcision and betamethasone topical for 1-2 months.
Paraphimosis
- Paraphimosis occurs when the foreskin is left retracted behind the glans, resulting in painful engorgement and edema of the glans.
- Risk factors for paraphimosis include having a foreskin.
- Paraphimosis is a true urological emergency and can be reduced by compression of the glands for several minutes.
Peyronie's Disease
- Peyronie's disease is more common in men in their 50s and 60s.
- Risk factors for Peyronie's disease include heredity, connective tissue disorders, and family history.
- Peyronie's disease presents as curvature of the erect penis, which may or may not be painful.
- Diagnosis is clinical, and management requires outpatient urological referral.
Prostatitis
- Prostatitis is most common in younger or middle-aged men.
- Risk factors for prostatitis include anatomic or neurophysiological lower urinary tract obstruction, acute epididymitis, urethritis, and anal receptive intercourse.
- Prostatitis presents with irritative or obstructive symptoms, such as low back pain, perineal, suprapubic, or genital discomfort.
- Diagnosis includes perineal tenderness, rectal sphincter spasm, and prostatic tenderness or bogginess.
- Initial treatment for infectious prostatitis is fluoroquinolone antimicrobial therapy for 2 weeks.
Benign Prostatic Hyperplasia (BPH)
- BPH is a common condition as men get older.
- Risk factors for BPH include aging, family history of BPH, diabetes, heart disease, and obesity.
- BPH presents with obstructive symptoms, such as hesitancy, decreased force and caliber of the stream, and sensation of incomplete bladder emptying.
- Diagnosis includes clinical finding of obstructive or irritative voiding symptoms and enlarged prostate size on rectal exam.
Prostate Cancer
- Prostate cancer is the most common non-cutaneous cancer and the second leading cause of cancer-related death in American men.
- Risk factors for prostate cancer include black race, family history of prostatic cancer, and history of high dietary fat intake.
- Most prostate cancers are asymptomatic and are diagnosed because of elevations in serum PSA.
- Transrectal ultrasound-guided biopsy is the standard method for detection of prostate cancer.
- Gleason Score determines the grading of prostate cancer.
Penile Cancer
- Carcinoma of the penis typically presents as a painless lump or ulcer on the penis.
- Most cases of penile cancer are epithelial squamous cell carcinoma (SCC).
- Risk factors for penile cancer include smoking and human papillomavirus (HPV) DNA.
- Penile cancer is diagnosed with biopsy, and treatment depends on the extent of nodal metastases.
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