Physical Exam
Scrotum:
- Edema
- Nodules
- Lesions
- Transillumination- swollen testicle
- Tenderness
- Masses
The left testicle is lower than the right testicle
Hair distribution Penis
- Lesions
- Discharge
- Atrophy
- Inflammation
- Meatus
- Are they circumcised?
Diagnostic tests
- Prostate specific antigen (PSA)
- Measures amount of a protein produced by the prostate gland in the blood
- Normal PSA value is < 2.5 ng/mL but increases with age
- Older? We don’t be concerned if slightly elevated
- Greater than 4 requires follow up
- Check before rectal evaluation to avoid false positive
- Blood work 1st, then digital rectum exam
- More concerned about this more
- Early prostate cancer antigen (EPCA-2)
- Measures the amount of a protein only produced by abnormal prostate cells
- Greater than 30 ng/dL is suggestive of prostate cancer
- Digital Rectal Exam (DRE)
- Yearly screening for men over the age of 50-70 y/o
- The patient leans over the table or lays on one side in a lithotomy position
- The provider palpates the posterior portion of the prostate gland through the rectal wall
using a lubricated gloved finger (should be walnut shaped and no bigger)
- If DRE is abnormal, then pt will be referred for a transrectal ultrasound then possibly a
biopsy
, Benign Prostatic Hyperplasia (BPH)
- Enlarged prostate glad! NON-CANCEROUS
Risk factors:
- Increased age
- Smoking or chronic alcohol use
- Sedentary lifestyle or obesity
- Western diet (high fat, protein, and carbs and low fiber)
- Heart disease
Epidemiology:
- 50% of men ages 51-60
- 90% in men over age 80
Pathophysiology:
- Enlargement of the prostate gland
Clinical Manifestations- Lower Urinary Tract Symptoms:
- Effects urination overall
- Difficulty starting flow of urine
- Weak urine stream
- Multiple interruptions during urination
- Dribbling once urination is complete
- Urgency, frequency
- Nocturia
- May lead to Bladder Outlet Obstruction (BOO)
- Urinary retention (cant pee at all)
- The International Prostate Symptom Score (I-PSS) is used to evaluate the severity of
symptoms
- Scale is not really needed to be known
- Rates the urinary tract manifestations from 0-5
- Rates the quality of life affected by urinary symptoms
Medical Management- Diagnosis:
- Digital rectal examination
- Urinalysis due to urine sitting there not being able to exit, then becomes stale & infection
- r/o UTI
- Prostate-specific antigen
- r/o prostate cancer
Medical management- treatment depends on s/s:
- Watchful waiting/active surveillance
- If the pt has minimal s/s we can try medications to see if that helps
- Avoid tranquilizers and OTC decongestants
- Will increase obstructive s/s of drying you up!!!!
- Avoid excessive fluids in the evening so you don’t have to pee at night!
- Decrease nocturia
Medical management- Medications:
- 5-alpha reductase inhibitors: inhibit alpha inhibitors
Scrotum:
- Edema
- Nodules
- Lesions
- Transillumination- swollen testicle
- Tenderness
- Masses
The left testicle is lower than the right testicle
Hair distribution Penis
- Lesions
- Discharge
- Atrophy
- Inflammation
- Meatus
- Are they circumcised?
Diagnostic tests
- Prostate specific antigen (PSA)
- Measures amount of a protein produced by the prostate gland in the blood
- Normal PSA value is < 2.5 ng/mL but increases with age
- Older? We don’t be concerned if slightly elevated
- Greater than 4 requires follow up
- Check before rectal evaluation to avoid false positive
- Blood work 1st, then digital rectum exam
- More concerned about this more
- Early prostate cancer antigen (EPCA-2)
- Measures the amount of a protein only produced by abnormal prostate cells
- Greater than 30 ng/dL is suggestive of prostate cancer
- Digital Rectal Exam (DRE)
- Yearly screening for men over the age of 50-70 y/o
- The patient leans over the table or lays on one side in a lithotomy position
- The provider palpates the posterior portion of the prostate gland through the rectal wall
using a lubricated gloved finger (should be walnut shaped and no bigger)
- If DRE is abnormal, then pt will be referred for a transrectal ultrasound then possibly a
biopsy
, Benign Prostatic Hyperplasia (BPH)
- Enlarged prostate glad! NON-CANCEROUS
Risk factors:
- Increased age
- Smoking or chronic alcohol use
- Sedentary lifestyle or obesity
- Western diet (high fat, protein, and carbs and low fiber)
- Heart disease
Epidemiology:
- 50% of men ages 51-60
- 90% in men over age 80
Pathophysiology:
- Enlargement of the prostate gland
Clinical Manifestations- Lower Urinary Tract Symptoms:
- Effects urination overall
- Difficulty starting flow of urine
- Weak urine stream
- Multiple interruptions during urination
- Dribbling once urination is complete
- Urgency, frequency
- Nocturia
- May lead to Bladder Outlet Obstruction (BOO)
- Urinary retention (cant pee at all)
- The International Prostate Symptom Score (I-PSS) is used to evaluate the severity of
symptoms
- Scale is not really needed to be known
- Rates the urinary tract manifestations from 0-5
- Rates the quality of life affected by urinary symptoms
Medical Management- Diagnosis:
- Digital rectal examination
- Urinalysis due to urine sitting there not being able to exit, then becomes stale & infection
- r/o UTI
- Prostate-specific antigen
- r/o prostate cancer
Medical management- treatment depends on s/s:
- Watchful waiting/active surveillance
- If the pt has minimal s/s we can try medications to see if that helps
- Avoid tranquilizers and OTC decongestants
- Will increase obstructive s/s of drying you up!!!!
- Avoid excessive fluids in the evening so you don’t have to pee at night!
- Decrease nocturia
Medical management- Medications:
- 5-alpha reductase inhibitors: inhibit alpha inhibitors
