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Devashree Joshi (12) Hiren Jani (46) Bhagyashree Raut (47) Hitesh Chaudhari (49) Manoj Udmale (50) Pankaj chandak Master subtitle style Click to edit (57) Hemant More (58)
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Flow of presentation
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Erectile dysfunction Cryptorchidism Male infertility Inguinal hernia Gynacomastia Priapism Precocious puberty Delayed puberty Herpes simplex virus Premature ejaculation Orchitis AIDS Cancer
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Erectile Dysfunction
The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, The penis erects freely while its master is asleep. The penis mustClick to edit Master subtitle style be said to have its own mind, by any stretch of the imagination
Erectile Dysfunction
WHO Definition : It is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.
Prevalence : 20-30 million American men suffer ED It is Age dependent 2% men age <40 years 25% men age 65 75% men >75 years
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Causes
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Frequent episodes or prolonged problems lasting more than a couple of weeks requires evaluation by a physician
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Diagnosis
Duplex Ultrasound Penile nerves function Nocturnal penile tumescence (NPT) Penile biothesiometry Dynamic infusion cavernosometry (DICC) Magnetic resonance angiography (MRA)
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Treatment
Pharmacological treatments Oral medication Urethral suppositories (MUSE) Injection therapy Surgery
Non pharmacological
Vacuum constriction device Life style changes Counseling and/or Sex Therapy
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Non-pharmacological Treatment
Pharmacological Treatment
Oral Medication : Phosphodiesterase 5 inhibitors :Sildenafil, vardenafil, tadalafil Injection Therapy of vasoactive agents: Papavarine, Phentolamine, Alprostadil . Urethral suppositories : Alprostadil (MUSE)
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surgery
prosthetic implants which involves the insertion of artificial rods into the penis.
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Cryptorchidism
Derived from greek word : crypto (meaning hidden) and orchid (meaning testicle) WHO Definition : Cryptorchidism is the absence of one or both testes from the scrotum
Prevalance : - 3% of full-term, sometime descend after 9 months. - 30% of premature infant boys are born with at least one undescended testes. - 80% of cryptorchid testes descend by the first year of life (the majority within three months) 5/2/12 -Overall incidence of 1%
Causes
Cremaster muscle reflex malfunction Severely premature birth Low birthweight due to either prematurity or intrauterine growth retardation Use of mild painkillers (aspirin, ibuprofen, paracetamol) during the second trimester Exposure to regular alcohol consumption during pregnancy, exposure to pesticides, gestational diabetes, and being born to pregnant women who drink caffeine Androgen deficiency Familial (4% of fathers and 610% of brothers)
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Diagnosis
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Treatment
testes have not descended after 46 months Hormone Therapy with human chorionic (when they are in inguinal
gonadotropin canal)
or buserelin
MALE INFERTILITY
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DEFINITION
Male infertility refers to the inability of male to achieve a pregnancy in a fertile female.
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CAUSES
1.Pre-testicular causes
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2.Testicular causes
Age Genetic effect on Y chromosome Abnormal sets of chromosomes Malaria Neoplasm Testicular cancer
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3.Post-testicular causes
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1.Partner does not conceive after a year of attempting to conceive. 2.Erectile dysfunction
SYMPTOMS
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DIAGNOSIS
1.Medical history
Duration of infertility
4.Semen analysis
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1.Gonadotropins: eg.repronex,menogon 2.Antiestrogen agents: eg.tamoxifen,clomiphene 3.Bromocriptine: eg.parlodel 4.Synthetic testosterone: eg. halotestin, testred.
TREATMENT
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INGUINAL HERNIA
An inguinal hernia is a condition in which intraabdominal fat or part of the small intestine,bulges through a weak area in the lower abdominal muscles.
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CAUSES
One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia: sudden twists, pulls, or muscle strains lifting heavy objects straining on the toilet 5/2/12 because of constipation
SYMPTOMS
Symptoms of inguinal hernia include 1. a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum 2. discomfort or sharp painespecially when straining, lifting, or exercisingthat improves when resting 3. a feeling of weakness or pressure in the groin 4. a burning, gurgling, or aching feeling at the bulge
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1. 2.
TREATMENT
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Gynecomastia
A benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast
True Gynecomastia: presence of a rubbery or firm mass extending concentrically and symmetrically from the nipple. Usually bilateral but can be unilateral.
Pseudogynecomastia: fat deposition without glandular proliferation, on exam fingers will not meet any resistance until they reach the nipple
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Gynecomastia
3- mammographic patterns -representing various degrees and stages of ductal and stromal proliferation
Nodular
Dendritic
Diffuse glandular
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Gynecomastia
Associated with increased levels of estradiol and decreased levels of testosterone Physiologic changes at puberty senescence
Causes
Physiologic
Neoplasm
Hormonal
Adrenal carcinoma Pituitary adenoma Hepatocellular carcinoma Cimetidine Marijuana Thiaside diuretics Omeprazole Tricyclic antidepresasants Spironolactone Diazepam 5/2/12 Anabolic steroids Exogenouis estrogen
Systemic disease
Drug use
Idiopathic
Symptoms
Pain Nipple discharge Enlargement of the underarm lymph nodes Tenderness and sensitivity
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Treatments
Watchful waiting
In healthy adolescent with normal PE and genital exam, reevaluate in 6 months Gynecomastia attributed to a medication should be stopped and patient reassessed after stopping medication Regression will occur in 85% of patients with gynecomastia due to various causes
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Treatments
Medications May be indicated in patients with persistent gynecomastia, eg. Later puberty with severe pain, tenderness, psychosocial issues of embarrasment. Consider that current medications have only been studied in small sizes that have been unblinded and uncontrolled. Three types of medical therapy
Androgens, antiestrogens and aromatase inhibitors None are FDA approved for gynecomastia
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Diagnosis
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Surgery
Should be considered in patients who do not respond to medical therapy or who have long standing gynecomastia. Options Include Liposuction Direct surgical excision, or both Complications Permanent numbness, compromise of blood supply, irregular contour, hematoma, seroma, wound infection.
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Drugs
Company
Zydus Cadila Sanofi TLC Toronto
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Drugs
Brand Name
Tagamet Prilosec Aldactone Valium
Cimetidine
Priapism
Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is 5/2/12 not treated immediately, it can
Symptoms
Painful sensation at the base of the shaft in the perineum area Erotic Excitement Doesnt relieve the erection causes more pain Persistent erection with sexual stimulation Painful erection with sexual stimulation
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Causes
causes of priapism include: Trauma to the spinal cord or to the genital area Black widow spider bites Carbon monoxide poisoning Illicit drug use, such as marijuana and cocaine Most common IDIOPATHIC
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Other causes include leukemia multiple myeloma recent Mycoplasma infection amyloidosis black widow spider bites carbon monoxide poisoning recent heparin use oral and intra-cavernosal drugs... sickle cell disease tumor infiltration thalassemia spinal cord injury
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Treatment of priapism
Ice packs: Ice applied to the penis and perineum may reduce swelling. Surgical ligation: Used in some cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow. Intracavernous injection: Used for low-flow priapism. During this treatment, drugs known as alpha-agonists are injected into the penis that cause the veins to narrow, reducing blood flow to the penis and causing the swelling to subside. Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal. Aspiration: After numbing the penis, doctors will insert 5/2/12 a needle and drain blood from the penis to reduce pressure and swelling.
Diagnosis of pripism
Emergency medical help Routine external check-up performed by a sexologist,urologist and andrologist
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Complication of priapism
Complications after treatment Complications may occur during and after the treatment. Some types of complications are: priapism reoccurring bleeding from the holes placed in the penis as a part of the shunting procedure infections infection of the skin around the penis damage to the urethra and the urine tube
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Drugs
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What is puberty?
Biological changes and sexual maturation that occur during the transition from childhood to adulthood Average age of onset:
10 (range 8-13) years in Girls Click to edit Master subtitle style 12 (range 10-15) years in Boys
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PRECOCIOUS PUBERTY
Precocious onset of puberty is defined as occurring younger than before the average age Girls <8 years old : Develops breast & pubic hair before 8 years old Boys <9 years old : Has an increase in testicle size & penis length before 9 years of age
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enlarging penis and testicles pubic underarm and hair facial hair spontaneous erections production of sperm development of acne deepening of the voice Both boy and girls can experience the following during puberty: moodiness because of hormonal changes increased aggression
In Boy s:
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puberty
Early puberty may be caused by tumor or growths of the ovaries, adrenal glands, pituitary gland or brain. In many cases, no cause can be found for the disorder. Two types of early puberty include the following: Gonadotropin-dependent Precocious Puberty Also known as central precocious puberty. The puberty is triggered by the early release of hormones from the brain that are responsible for puberty. These hormones are called gonadotropins. Gonadotropin-independent Precocious Puberty
5/2/12 This is a form of precocious puberty that is triggered by the early release of hormones from the ovaries or testicles that
X-ray - test which uses a machine to take a special picture of tissues, bones and organs. A bone X-ray may be performed to determine bone age. Blood draw to measure the puberty hormones (LH, FSH, estradiol, testosterone) and thyroid hormones Ultrasound (sonography) of the adrenal glands and ovaries and testicles -- a test which uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Gonadotropin releasing hormone (GnRH) stimulation test a special blood draw that looks at the puberty hormone to determine the form of precocious puberty (gonadotropin-dependent or gonadotropinindependent)
5/2/12 Magnetic Resonance Imaging (MRI) -- a test that uses a combination of large magnets, radiofrequencies, and a computer to
child's age, overall health, and medical history extent of the condition child's tolerance for specific medicines, procedures, or therapies The goal of treatment for precocious puberty is to stop puberty from progressing. Treatment will also depend on the type of precocious puberty and the underlying cause, if known. The medicine used to stop puberty is called Lupron. It is usually given by a shot once a month.
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Delayed puberty
Delayed onset of puberty is defined as occurring older than 2 SD after the average age
Underweight
Chronic illness
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Physical Examination
n
Height( The height velocity should be documented over a period of at least 6 months, preferably 12 months) The signs of puberty are noted, and the stage of secondary sexual development(Marshall and Tanner stage) The length and width of the testes are measured or the volume is assessed using an orchidometer. The length and diameter of the stretched penis are determined in boys.
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Constitutional delay
n
A decrease in growth velocity occurs in some normal children just before the appearance of secondary sexual characteristic. In these individuals the onset at puberty correlates better with bone age than with chronologic age. The history and growth chart reveal a history of short stature but consistent growth rate for skeletal age No signs or symptoms of hypothalamic lesions The family history includes parents or siblings with delayed puberty Physical examination are normal
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Depends on the diagnosis and the nature of the disorder. Patients with constitutional delay in growth and adolescence ultimately have spontaneous onset and progression through puberty. However, the stigma of appearing less mature than ones peers can cause psychological stress.
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Testosterone Cypionate: Generic name: testosterone Class: androgen and anabolic steroids Android Generic name: methyltestosterone class: androgens and anabolic steroids
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Herpesviridae
Alphaherpesvirinae
Simplexvirus
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The structure of herpes viruses consists of a relatively large double-stranded, linear DNA genome encased within an icosahedral protein cage called the capsid, which is wrapped in a lipid bilayer called the envelope
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Transmission
Herpes simplex virus -1 and -2 are transmitted from contact with an infectious area of the skin during reactivations of the virus. Reactivation : virus causes atypical, subtle or hard to notice symptoms that are not identified as an active herpes infection Spread when an infected person is producing and shedding the virus
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Symptoms
Infection include watery blisters in the skin or mucous membranes of the mouth, lips or genitals Lesions heal with a scab characteristic of herpetic disease However, as neurotropic and neuroinvasive viruses, HSV1 and -2 persist in the body by becoming latent and hiding from the immune system After the initial or primary infection, where virus replication and shedding occur and cause new sores 5/2/12
Treatment
Antiviral drugs that interfere with viral replication, reducing the physical severity of disease Antivirals such as acyclovir and valacyclovir can
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Premature ejaculation (PE) is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, orearly ejaculation.
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Mechanism of Ejaculation
The emission phase is the first phase involves deposition of seminal fluid the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra The second phase is the expulsion phase
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Treatment
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Orchitis
Types :
Acute orchitis: Chronic orchitis:
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Causes:
Caused by an infection from many different types of viruses. Most common virus that causes orchitis is Mumps. It most often occurs in boys after puberty. Usually develops 4 - 6 days after the mumps begins. May also occur along with infections of the prostate or epididymis. sexually transmitted diseases (STD), such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis 5/2/12 is higher in men ages
v
v v
Risk factors :
Personal history of gonorrhea or another STD Multiple sexual partners Being older than age 45 Long-term use of a Foley catheter Not being vaccinated against the mumps Problems of the urinary tract that occurred at birth Regular urinary tract infections Surgery of the urinary tract (genitourinary surgery)
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Symptoms :
Blood in the semen Discharge from penis Fever Groin pain Pain with intercourse or ejaculation Pain with urination (dysuria) Scrotal swelling Tender, swollen groin area on affected side Tender, swollen, heavy feeling in the testicle
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A Physical Examination shows: q Enlarged or tender prostate gland q Tender and enlarged lymph nodes in groin area on the affected side q Tender and enlarged testicle on the affected side Test includes : Complete blood count (CBC) Testicular ultrasound Urinalysis
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Treatment :
Antibiotics: ceftriaxone (Rocephin-Roche) Azithromycin (Zithromax- Pfizer) Trimethoprim + Sulfamethoxazole (Bactrim- Roche) (Septra- GSK) NSAIDs : Ibuprofen (Advil- Pfizer) Bed rest, scrotal elevation and Ice packs
v v
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Definition:- Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV) How HIV virus affect immunity? HIV is a retrovirus that primarily infects CD4+ T cells (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. Once the number of CD4+ T cells per microliter (L) of blood drops below 200, cellular immunity is lost
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Transcription:RNA
Reverse transcription:DNA
DNA
RNA
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Causes of AIDS
Blood transfusion and blood product of infected person Sharing and reusing syringes contaminated with HIV-infected Perinatal transfusion Saliva, tear and urine of infected person
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Diagnosis of AIDS
ELISA Test
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Use contraceptives Avoid sexual contact with AIDS petient Avoid reused of syringes Check blood before transfusion Increase awareness Education
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Anti-Retrovirus Drugs
1. Nucleoside reverse transcriptase Inhibitors( NRTIs) eg. Zidovudine Lamivudine(LAMOSTAD) - ALKEM Zidovudine + lamivudine (DUOVIR)-CIPLA (COMBIVR)-GSK (LAMDA-Z)-CADILLA 2. Nonnucleoside reverse transcriptase Inhibitors eg. Nevirapine (VIRAMUNE-R)-GSK Efavirenz (SUSTVA) (ATRIPLA) 3. Protease Inhibitors eg. Ritonavir(NORVIR)-ABBOTT Indinavir
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Tumors
Benign Tumors (noncancerous) Enclosed in a fibrous shell or capsule. Take up space Concerned if they interfere with surrounding tissues or vessels or impede the function of the body.
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Not usually contained metastasis Invade and emit clawlike protrusions that disrupt the RNA and DNA of normal cells (these cancerous cells act like a virus).
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The prostate gland is a gland the size of two walnuts that seat on either side of the neck of the urinary bladder. Function: To secrete a milky slightly acidic fluid.
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Benign enlargement of prostate gland Creates pressure on upper part of urethra or neck of the bladder, causing obstruction to flow of urine
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Benign Prostatic Hypertrophy Pathophysiology Common in older men; varies from mild to
Nodules form around urethra Result of imbalance between estrogen and testosterone
Rectal exams reveals enlarged gland. Incomplete emptying of bladder leads to infections. Continued obstruction leads to distended bladder, dilated ureters, renal damage.
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n n n n
Exposure to Cancer-causing agents Cellular Mutations (Environment & Lifestyle agents) Genetics & Hormone exposure (i.e. breast cancer) Occupation and Environment Factors Social and Psychological Factors Chemicals in Food Viral (i.e. herpes, HPV, mononucleosis) create an opportunistic environment 5/2/12 Medical Factors
Weak urinary stream Prolonged emptying of the bladder Abdominal straining Hesitancy Irregular need to urinate Incomplete bladder emptying Post-urination dribble Irritation during urination Frequent urination Nocturia (need to urinate during the night) Urgency Incontinence (involuntary leakage of urine) Bladder pain Dysuria (painful urination) Problems in ejaculation 5/2/12
BPHTreatment
1-adrenergic receptor antagonists- doxazosin, terazosin 5-reductase inhibitors finasteride and dutasteride.
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Defined as
Malignant growth within prostate gland Creates pressure on upper part of urethra Common in men older than 50 Risk of impotence or incontinence
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BPH arises from center of gland Many are androgen dependent The more undifferentiated, the more aggressive and the faster they grow and spread Spine, pelvis, ribs, femur
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Prostate CancerEtiology
Incidence higher in black population than white Testosterone receptors found on cancer cells
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Blood in the urine. Burning in urination. Urinary frequency. Hesitancy in urination. Poor urinary stream. Nocturnal getting up too many times at night to urinate. Urinary retention. Weakness. Bone pain. Constipation. Paralysis from the waist down, due to spinal cord compression by the prostate cancer. 5/2/12
Useful screening tool for early detection elevated when metastatic cancer present
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Prostate CancerTreatment
Surgery radiation Prostate Brachytherapy Hormonal Therapy LH-RH agonist-leuprolide, goserelin, nafarelin, triptorelin androgen-blocking drugs When tumor androgen sensitive
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Defined
Malignant tumor of testicle that appears as a painless lump Also called testicular cancer
Testicular Cancer
Ages 17-34 at greatest risk Cause is unknown Undescended testicles present a great risk
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CLINICAL FEATURES
Painless Swelling of One Gonad Dull Ache or Heaviness in Lower Abdomen 10% - Acute Scrotal Pain 10% - Present with Metatstasis
- Neck Mass / Cough / Anorexia / Vomiting / Back Ache/ Lower limb 5/2/12 swelling
Testicular Cancer
Most common cancer in the men 20-35 years of age Annual incidence: 4 per 100,000 Accounts for 1-2% of all neoplasms in men
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Risk Factors
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Diagnosis
1. 2. 3.
Chest X-Ray - PA and lateral views CT Scan Tumour Markers - AFP - HCG - LDH
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TREATMENT
Treatment should be aimed at one stage above the clinical stage Seminomas - Radio-Sensitive. Treat with Radiotherapy. Non-Seminomas are Radio-Resistant and best treated by Surgery Chemotherapy
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Diagnose Evaluate Recurrence Future complications Infertility issues: Encouraging the patient to bank sperms
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