Tiêu đề SCA- Men Health - Dr A. Ibrahim 2024.pdf ✅

Dr Amr Ibrahim MB ChB, MD, Alexandria University, Egypt MSc, University of Tsukuba, Japan
1. 25 years old male with ED. 2. 57 years old male with ED. 3. 60 years old male requesting PSA. 4. 60 years old male with high PSA / suspected prostate ca 5. young male with UTI symptoms. 6. 30 0r 60 years old man with LUTS. 7. 45 years old male with hematospermia. 8. 28 years old male with premature ejaculation. 9. 41 years old male wants vasectomy. 10. Middle aged male with infertility / subfertility.
Erectile Dysfunction Qs to ask ▪ Pt embarrassed => Show empathy and support. ▪ For how long? Did you have good erection before? ▪ Is the problem to maintain erection or to start the erection? ▪ Do you still have morning erection? ▪ Did you try anything for it before? ▪ UTI / STI / LUTs symptoms ▪ Ask about DM , chest pain, leg pain. ▪ Ask about Pit, thyroid (↑ or ↓) ▪ Ask about cyclising (?How many hours) ▪ Ask about abnormal neurology (central or periph). ▪ Ask about gynaecomastia, mass in the testicles ▪ Ask about trauma to perineal, pelvic surgeries ▪ Ask about Mood , Relationship stress ▪ Detailed sexual hx (Homo or hetero, how many partners now and before, any hx of STI. ▪ Social Hx (don’t forget about recreational drugs, Gym drugs, alcohol and smoking, hobbies). ▪ ICE (when to ask ICE) ▪ IMPACT Drugs causing ED ▪ HTN: BB, verapamil, methyldopa, and clonidine. ▪ Diuretics — spironolactone and thiazides. ▪ Mood: SSRI, Tricyclic, lithium, venlafaxine, antipsychotics. ▪ Antiepileptics: Carba, topiramate, gabapen, and pregabalin. ▪ H2 -antagonists: cimetidine and ranitidine ▪ Cytotoxic drugs :cyclophosphamide and MTX. ▪ Hormonal Rx or hormonal excess: steroids, anti-androgens,GRHA,etc. Men with erectile dysfunction can be stratified into low-, intermediate-, or high-risk cardiovascular categories, depending on cardiovascular risk factors and co-morbidities High risk => Refer to cardio, advice to stop sex until r/v Unstable or refractory angina. Recent MI (within the last 2 weeks). HFrEF(NYHA class IV). Uncontrolled HTN. High-risk arrhythmia (exercise-induced ventricular tachycardia, implanted internal cardioverter defibrillator with frequent shocks, and poorly controlled atrial fibrillation). Hypertrophic obstructive or other cardiomyopathy. Moderate-to-severe VHD.
Mx Examination Invx: ▪ CVS examination with BP. ▪ Genital examination. ▪ Abd and pelvic examination. ▪ When to do DRE ? (in 4 cases) ▪ HBA1c, lipids and Q-risk. ▪ Fasting testosterone level , if low or borderline => What to do? ▪ Other invx acc to suspected cause. Mx Things he can do Things we can do (referral , meds, advice) Alcohol, smoking, recreation drugs, wt loss, cycling, relaxation techniques if stress. Sign post to BAUS website. ▪ Rx the underlying cause , stop the causative drug if ED started after initiating the drug. ▪ Do not recommend the use of unlicensed herbal preparations or complementary medicines. ▪ If not at high cardiac risk => PDE-5 inhibitor. (Sildenafil OTC). ▪ Refer to cardio, endo, urology acc to cause. ▪ Refer to relationship counselling, CBT ▪ If you give PDE-5 inhibitors => safety net and when to go to the hospital as emergency. What are the SEs ? ▪ FU 6–8 weeks after starting Rx.