Urology
Goals and Objectives
Resources
Prostate Cancer Screening and Shared Decision Making Tools
Urology Modules from Best CME
The residency program has purchased access to a series of Urology modules. Residents received an email from Best CME asking you to complete your profile to access the modules. The email from Best CME is NOT spam. Please complete your profile to access the modules.
You can work on the urology modules during outpatient weeks, and we encourage you to use these modules when you see patients with urology concerns.
Men's Health Clustered Didactics
Slides - Part 1 Cases - Part 1
Slides - Part 2 Cases - Part 2
Board Review Questions
A 34-year-old male began a sexual relationship with a woman 3 months ago and the relationship ended on friendly terms last week. He received a call yesterday from the woman, who said she had developed a rash that resulted in a diagnosis of syphilis and that he should be evaluated and treated if appropriate. He has no symptoms and a serologic test for syphilis is negative. He has no known drug allergies.
Which one of the following would be most appropriate at this time?
A) Daily self-inspection of the penis to identify a chancre
B) Observation with a repeat serologic test for syphilis in 6 weeks
C) Azithromycin (Zithromax), 2 g orally as a single dose
D) Penicillin G benzathine (Bicillin L-A), 2.4 million units intramuscularly as a single dose
E) Penicillin G benzathine, 2.4 million units intramuscularly once weekly for 3 weeks
ANSWER: D
The evidence suggests that this patient did not have syphilis prior to this lone contact and a diagnosis of
syphilis cannot be confirmed by examination or testing at this point. He should be treated presumptively
for early syphilis, even though the serologic test result is negative, because he had sexual contact within
the past 90 days with a person who was diagnosed with secondary syphilis. The same is true for individuals exposed to sex partners diagnosed with primary or early latent syphilis during the same time period. When the contact occurred more than 90 days before confirmation of a negative serologic test result, no treatment is necessary.
The recommended treatment for individuals such as this patient and for those with primary or secondary syphilis is a single dose of penicillin G benzathine, 2.4 million units. For patients with a penicillin allergy, oral treatment with doxycycline, 100 mg twice daily; tetracycline, 500 mg four times daily; or azithromycin, 2 g as a single dose, has been effective as an alternate treatment option but should only be used when penicillin is contraindicated and should be followed by close monitoring of serologic tests.
Ref: Workowski KA, Bachmann LH, Chan PA, et al: Sexually transmitted infections treatment guidelines, 2021. MMWR
Recomm Rep 2021;70(4):39-42.
Which one of the following antihypertensive medications is LEAST likely to exacerbate erectile dysfunction?
A) Clonidine (Catapres)
B) Doxazosin (Cardura)
C) Hydrochlorothiazide
D) Losartan (Cozaar)
E) Metoprolol
ANSWER: D
Angiotensin receptor blockers (ARBs) such as losartan are least likely to cause or exacerbate erectile dysfunction. ARBs may have a favorable effect on erectile dysfunction by inhibiting vasoconstriction activity of angiotensin. Clonidine, -blockers, hydrochlorothiazide, and -blockers are more likely to negatively affect erectile function.
Ref: Viigimaa M, Vlachopoulos C, Lazaridis A, Doumas M: Management of erectile dysfunction in hypertension: Tips and
tricks. World J Cardiol 2014;6(9):908-915. 2) Rew KT, Heidelbaugh JJ: Erectile dysfunction. Am Fam Physician
2016;94(10):820-827.
A 27-year-old male has noticed some small bumps around the tip of his penis and is concerned that he might have a sexually transmitted infection. An examination reveals a row of approximately 2-mm, dome-shaped, skin-colored papules in a ring-like distribution around the corona of the glans penis.
Which one of the following is the most likely diagnosis?
A) Angiokeratomas
B) Genital warts
C) Lichen nitidus
D) Pearly papules
E) Squamous cell carcinoma
ANSWER: D
Pearly papules are a benign, normal anatomic variant and are not sexually transmitted. They are
dome-shaped, skin-colored papules 1–4 mm in size with a ring-like distribution around the corona of the
glans penis. Angiokeratomas are red or blue papules that are well circumscribed and 1–6 mm in size.
Genital warts are soft, raised masses that can be pearly and smooth or have a rough, cauliflower-like
appearance, and are not confined to the penile corona. Lichen nitidus consists of discrete, hypopigmented, 1-mm papules that are not confined to the corona and can also occur on the upper extremities and abdomen. Squamous cell carcinoma may be endophytic (ulcerated) or exophytic (thickened skin or wart-like growths that can progress to a large, irregularly shaped, fungating mass).
Ref: Teichman JMH, Mannas M, Elston DM: Noninfectious penile lesions. Am Fam Physician 2018;97(2):102-110.
A 24-year-old male presents with swelling of the right testicle. The pain started yesterday and has persistently worsened. A physical examination reveals swelling on the right side of his scrotum. His entire testicle is painful, and elevation of the scrotum improves his pain. Ultrasonography reveals hyperemia, swelling, and increased blood flow to the testis and
epididymis.
Which one of the following would be the most appropriate management?
A) Doxycycline
B) Levofloxacin (Levaquin)
C) Trimethoprim/sulfamethoxazole (Bactrim)
D) Doxycycline plus ceftriaxone
E) Urgent surgical evaluation
ANSWER: D
This patient presents with acute epididymitis. Typical symptoms develop gradually over 1–2 days with
posterior scrotal pain and swelling. Additional symptoms may include fever, hematuria, dysuria, and
urinary frequency. The pain may radiate to the lower abdomen. Physical examination findings may include tenderness of the epididymis and testis along with swelling of the scrotum. Elevation of the scrotum may decrease the pain (Prehn sign). Typical ultrasound findings include hyperemia, swelling, and increased blood flow to the epididymis.
With testicular torsion the pain is often sudden in onset and severe, with associated nausea and vomiting and no other urologic symptoms. A physical examination often demonstrates a high-riding testis that may lie transversely in the scrotum. The cremasteric reflex may be absent. Ultrasound findings would demonstrate decreased or absent blood flow with testicular torsion.
In sexually active adults <35 years of age, gonorrhea and Chlamydia are the most common causative
organisms of acute epididymitis. Ceftriaxone, 250 mg intramuscularly or intravenously once, with oral
doxycycline, 100 mg twice daily for 10 days, would be the appropriate treatment for acute epididymitis
(SOR C). In men over the age of 35 or those with a history of recent urinary tract surgery or
instrumentation, enteric organisms are the most likely cause and monotherapy with oral levofloxacin or
ofloxacin for 10 days would be the recommended treatment.
Ref: McConaghy JR, Panchal B: Epididymitis: An overview. Am Fam Physician 2016;94(9):723-726.