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Men’s Health Topic Index — every topic, tiered: Core (daily) · Important (common) · Rare (recognise)
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Prostate

Benign prostatic hyperplasiaCoretap to open ▾
First-line drug = alpha-blocker (tamsulosin/doxazosin) for rapid relief; 5-alpha-reductase inhibitor (finasteride) shrinks the prostate over 6–12 months. Avoid decongestants, antihistamines, anticholinergics, TCAs, CCBs (worsen LUTS).
Assess: LUTS: voiding (hesitancy, weak stream, dribbling) vs storage (frequency, urgency, nocturia). Do IPSS, urinalysis, PSA (after counselling).
Alpha-blocker: Tamsulosin/doxazosin — fast symptom relief; side effect postural hypotension.
5-ARI: Finasteride/dutasteride — shrink prostate over 6–12 months (best if large gland); cause ↓libido, ED, ejaculatory problems, gynaecomastia; lower PSA ~50%.
Worsen BPH: Decongestants (pseudoephedrine), antihistamines, anticholinergics, TCAs, calcium-channel blockers.
A 68-year-old man has bothersome voiding LUTS and a moderately enlarged prostate. He wants the fastest symptom relief. Which drug is first-line?
  • AFinasteride
  • BTamsulosin
  • COxybutynin
  • DDesmopressin
  • EFurosemide
Correct: B — Tamsulosin
Why: An alpha-blocker (tamsulosin) gives rapid symptomatic relief in BPH; a 5-alpha-reductase inhibitor works over months and is best for larger glands.
Options:
  • Takes 6–12 months.
  • (correct)
  • Anticholinergic worsens voiding.
  • For nocturia only.
  • Not for BPH.
Prostate cancer: referral & investigationCoretap to open ▾
Malignant-feeling prostate on DRE → 2-week-wait regardless of PSA. Otherwise use age-specific PSA thresholds (roughly 3/4/5 ng/mL at 50/60/70). First-line investigation now mpMRI before biopsy. Back pain may be the first sign of metastasis.
Referral: DRE feels malignant → urgent 2-week-wait whatever the PSA. Raised age-specific PSA with symptoms → 2-week-wait.
PSA thresholds: Age-specific for symptomatic men (~3 at 50–59, 4 at 60–69, 5 at ≥70). The asymptomatic PCRMP programme now uses a single ≥3 ng/mL. No age range over 80.
Investigation: Multiparametric MRI FIRST (can spare a third of men a biopsy); then LATP/transperineal biopsy. Gleason score grades prognosis.
Metastasis: Back pain (bony mets) may be the presenting feature; check for cord compression.
A 70-year-old man has lower urinary tract symptoms and a hard, irregular prostate on rectal examination. His PSA is normal. What is the most appropriate action?
  • AReassure — normal PSA
  • BUrgent 2-week-wait referral for suspected prostate cancer
  • CRepeat PSA in a year
  • DStart tamsulosin and review
  • EAntibiotics
Correct: B — Urgent 2-week-wait referral for suspected prostate cancer
Why: A prostate that feels malignant on DRE warrants an urgent suspected-cancer referral regardless of the PSA level.
Options:
  • A normal PSA doesn’t exclude cancer.
  • (correct)
  • Delays diagnosis.
  • Doesn’t address the abnormal DRE.
  • Not indicated.
Acute & chronic prostatitisCoretap to open ▾
Acute: pain (perineum/rectum/back) ± fever ± tender boggy prostate. First-line a quinolone (ciprofloxacin/ofloxacin) 14 days; trimethoprim second-line. Chronic: same drugs for 28 days; add tamsulosin if persistent.
Acute: Ofloxacin 200 mg BD or ciprofloxacin 500 mg BD for 14 days; trimethoprim 200 mg BD 2nd line; reassess at 48 h and 2 weeks.
Chronic: Same antibiotics for 28 days; 4th-line tamsulosin.
Non-infectious (chronic pelvic pain): Negative MSU → tamsulosin.
A 40-year-old man has perineal pain, fever and a tender boggy prostate. Urine dip suggests infection. First-line antibiotic?
  • AAmoxicillin
  • BA quinolone (e.g. ciprofloxacin)
  • CNitrofurantoin
  • DDoxycycline
  • ECeftriaxone
Correct: B — A quinolone (e.g. ciprofloxacin)
Why: Acute prostatitis is treated first-line with a quinolone (ciprofloxacin/ofloxacin) for 14 days; trimethoprim is second-line.
Options:
  • Poor prostate penetration.
  • (correct)
  • Doesn’t penetrate prostate well.
  • Not first-line.
  • Not first-line here.
Prostate cancer: hormonal treatment complicationsImportanttap to open ▾
Androgen deprivation causes: tumour flare (cover with cyproterone/medroxyprogesterone), gynaecomastia (radiotherapy 1st, tamoxifen 2nd), osteoporosis (FRAX; alendronic acid, denosumab 2nd), fatigue (supervised aerobic exercise).
Tumour flare: Initial LHRH-agonist surge — cover with cyproterone or medroxyprogesterone acetate.
Gynaecomastia: Prophylactic radiotherapy first-line; tamoxifen second.
Bone: FRAX; if osteoporotic start alendronic acid (denosumab 2nd/if bisphosphonate contraindicated).
Fatigue: Supervised aerobic exercise ≥ twice weekly for 12 weeks.
A man starting an LHRH agonist for prostate cancer is at risk of a symptom flare. What is used to prevent tumour flare?
  • ATamoxifen
  • BCyproterone acetate
  • CAlendronic acid
  • DDenosumab
  • ERadiotherapy
Correct: B — Cyproterone acetate
Why: An anti-androgen such as cyproterone (or medroxyprogesterone) covers the initial testosterone surge (tumour flare) when starting an LHRH agonist.
Options:
  • Treats gynaecomastia.
  • (correct)
  • For bone protection.
  • For bone protection.
  • Treats gynaecomastia.
PSA testing: when to delayImportanttap to open ▾
Delay PSA after: DRE 1 week; ejaculation/vigorous exercise 48 hours; active UTI or prostatitis 4 weeks; prostate biopsy 6 months.
Delays: DRE 1 week · ejaculation/exercise 48 h · UTI/prostatitis 4 weeks · biopsy 6 months.
Counsel first: Explain false positives/negatives and the biopsy pathway before testing.
A man requests a PSA test but had a urinary tract infection treated 1 week ago. What should you advise?
  • ATest now
  • BDelay the PSA for about 4 weeks after the UTI
  • CNever test
  • DDelay 48 hours
  • EDelay 6 months
Correct: B — Delay the PSA for about 4 weeks after the UTI
Why: An active or recent UTI raises PSA; delay testing for about 4 weeks after treatment.
Options:
  • May be falsely raised.
  • (correct)
  • Testing still appropriate later.
  • Too short.
  • That’s post-biopsy.

Erectile Dysfunction & Penis

Erectile dysfunctionCoretap to open ▾
Absent early-morning erections + normal libido → organic cause. First-line investigations: lipids/QRISK, HbA1c/fasting glucose, morning free testosterone. First-line treatment: PDE-5 inhibitor (sildenafil/tadalafil); if contraindicated → vacuum device, then alprostadil, then prosthesis.
Organic vs psychogenic: Organic: older, gradual, no morning erections, normal libido, has medical cause. Psychogenic: younger, sudden, morning erections present, stressors, ↓libido.
Investigations: Lipids/QRISK, HbA1c or fasting glucose, morning free testosterone. If testosterone low → LH/FSH, prolactin, repeat testosterone.
Lifestyle: Weight loss, stop smoking, reduce alcohol, cycling <3 h/week, exercise.
Treatment: PDE-5 inhibitor first-line (avoid with nitrates). If contraindicated: vacuum device → alprostadil → penile prosthesis.
A 55-year-old with gradual erectile dysfunction, no morning erections and normal libido has no contraindications. What is first-line treatment?
  • AVacuum erection device
  • BA PDE-5 inhibitor (e.g. sildenafil)
  • CIntracavernosal alprostadil
  • DPenile prosthesis
  • ETestosterone
Correct: B — A PDE-5 inhibitor (e.g. sildenafil)
Why: A PDE-5 inhibitor is first-line for ED without contraindications; absent morning erections with normal libido point to an organic cause (screen cardiovascular/diabetes).
Options:
  • Second-line if PDE-5 contraindicated.
  • (correct)
  • Later-line.
  • Last-line.
  • Only if hypogonadal.
BalanitisImportanttap to open ▾
Identify the cause: candida (itchy/red after intercourse → clotrimazole); anaerobic (smelly → saline then topical metronidazole); aerobic Staph (flucloxacillin/clarithromycin); dermatitis/circinate (mild steroid); lichen sclerosus/Zoon's (high-potency steroid).
Clues: Candida: itchy, red, post-intercourse. Lichen planus: Wickham’s striae, violaceous papules. Lichen sclerosus: tight band/phimosis. Circinate: Reiter’s. Zoon’s: well-circumscribed, non-itchy.
Treat: Saline first-line + swab only if infection suspected. Candida → clotrimazole; anaerobic → metronidazole; aerobic → flucloxacillin; dermatitis/circinate → mild steroid; lichen sclerosus/Zoon’s → high-potency steroid.
A man has an itchy, red glans that flares after intercourse; his partner has vaginal thrush. First-line treatment?
  • AFlucloxacillin
  • BTopical clotrimazole
  • CTopical metronidazole
  • DHigh-potency steroid
  • EAciclovir
Correct: B — Topical clotrimazole
Why: Candidal balanitis (itchy, red, post-intercourse) is treated with topical clotrimazole.
Options:
  • For aerobic bacterial.
  • (correct)
  • For anaerobic.
  • For lichen sclerosus/Zoon’s.
  • For herpes.
PriapismImportanttap to open ▾
Persistent erection. First blood test FBC (find cause, e.g. sickle cell). Cavernosal blood gas differentiates ischaemic (low-flow, painful — emergency) from non-ischaemic. Causes: sickle cell/thalassaemia, drugs (PDE-5, alprostadil, recreational, antipsychotics), trauma.
Investigate: FBC (cause, e.g. sickle cell); cavernosal blood gas distinguishes ischaemic vs non-ischaemic.
Ischaemic: Low-flow, painful — a urological emergency (aspiration/phenylephrine).
Causes: Sickle cell/thalassaemia, ED drugs, recreational drugs, some antihypertensives/antidepressants/antipsychotics, trauma.
A young man with sickle cell disease has a painful erection lasting 5 hours. Which investigation best distinguishes the type of priapism?
  • AFull blood count
  • BCavernosal blood gas analysis
  • CToxicology screen
  • DDoppler ultrasound
  • ETestosterone
Correct: B — Cavernosal blood gas analysis
Why: Cavernosal blood gas distinguishes ischaemic (low-flow, hypoxic, acidotic — emergency) from non-ischaemic priapism.
Options:
  • Finds the cause, not the type.
  • (correct)
  • May find drugs, not the type.
  • Adjunct.
  • Irrelevant acutely.
Penile cancerRare · recognise
Rare; SCC of glans/foreskin. Risk: HPV (commonest), phimosis, smoking, HIV, PUVA, uncircumcised. Erythroplasia of Queyrat = carcinoma in situ (velvety red glans plaque). Early: creams/laser; late: surgery.
Peyronie's diseaseRare · recognise
Fibrous plaque causing penile curvature and painful erections; associated with Dupuytren’s. Observation early; surgery for stable, disabling deformity.
HypospadiasRare · recognise
Urethral opening on the ventral/underside. Surgical correction; do NOT circumcise (foreskin needed for repair).
EpispadiasRare · recognise
Urethral opening on the dorsal/upper surface; associated with bladder exstrophy and incontinence. Surgical correction required.
Balanitis xerotica obliterans (lichen sclerosus)Rare · recognise
Progressive scarring → phimosis/urethral stenosis; SCC risk. Dermovate (clobetasol) first-line; circumcision often needed. An indication for circumcision.
Pearly penile papulesRare · recognise
Benign dome papules in a row around the corona; appear at puberty, remain for life. Reassure — no treatment.
Fordyce spotsRare · recognise
Ectopic sebaceous glands on lips/genitals; benign, no treatment needed.
SmegmaRare · recognise
Shed epithelial cells + sebum under the foreskin; normal, hygiene advice; commoner if uncircumcised.

Scrotum & Testicles

Testicular torsionCoretap to open ▾
Sudden severe testicular pain ± vomiting; high-riding testis with transverse lie, ABSENT cremasteric reflex, negative Prehn’s sign. Surgical emergency — irreversible damage after ~6–12 hours. Do NOT delay for imaging; explore.
Signs: Acute severe pain, nausea/vomiting; high-riding transverse testis; absent cremasteric reflex; Prehn’s negative (pain not relieved by elevation).
Time-critical: Irreversible ischaemic damage after ~6–12 hours — immediate surgical exploration (bilateral fixation).
Vs epididymo-orchitis: Epididymo-orchitis: gradual, Prehn’s positive, cremasteric reflex present.
A 15-year-old has sudden severe left testicular pain and vomiting; the testis is high and tender with an absent cremasteric reflex. Best action?
  • AUltrasound then decide
  • BImmediate surgical exploration
  • CAntibiotics
  • DAnalgesia and review in 24 h
  • EElevate and reassure
Correct: B — Immediate surgical exploration
Why: Testicular torsion is a surgical emergency; explore immediately rather than delaying for imaging, as the testis is lost after ~6–12 hours of ischaemia.
Options:
  • Imaging delays salvage.
  • (correct)
  • That’s for epididymo-orchitis.
  • Dangerous delay.
  • Inadequate.
Epididymo-orchitisCoretap to open ▾
Gradual pain/swelling; Prehn’s positive, cremasteric reflex present. <35y (usually STI): ceftriaxone IM + doxycycline (refer to GUM). >35y (usually coliform/E. coli): ofloxacin 200 mg BD 14 days.
Signs: Gradual onset; positive Prehn’s (elevation eases pain); cremasteric reflex present.
<35 years: Likely STI (chlamydia/gonorrhoea) → ceftriaxone IM + doxycycline; refer to sexual health.
>35 years: Likely enteric (E. coli) → ofloxacin 200 mg BD 14 days.
Always: Exclude torsion first if any doubt.
A 25-year-old has gradual testicular pain and swelling, positive Prehn’s sign and an intact cremasteric reflex. What is the most appropriate management?
  • AImmediate surgery
  • BCeftriaxone IM + doxycycline and refer to sexual health
  • COfloxacin only
  • DReassure
  • EUltrasound only
Correct: B — Ceftriaxone IM + doxycycline and refer to sexual health
Why: In under-35s epididymo-orchitis is usually an STI; treat with ceftriaxone plus doxycycline and refer to GUM. Positive Prehn’s and present cremasteric reflex argue against torsion.
Options:
  • No torsion features.
  • (correct)
  • Ofloxacin is for the over-35 enteric picture.
  • Needs treatment.
  • Insufficient.
Testicular cancerCoretap to open ▾
Painless solid testicular lump in a young man (20–40). Diagnose with ultrasound. Markers: AFP & β-hCG (non-seminoma), LDH; AFP NOT raised in pure seminoma. Risk: cryptorchidism, infertility, family history, Klinefelter's, mumps orchitis.
Presentation: Painless firm lump arising from the body of the testis; ultrasound is diagnostic.
Types: Germ cell (seminoma vs non-seminoma) and non-germ cell (Leydig, sarcoma).
Markers: AFP + β-hCG + LDH; AFP raised in non-seminoma (yolk sac), not pure seminoma.
Risk factors: Undescended testis, infertility, family history, Klinefelter’s, mumps orchitis.
A 28-year-old has a painless firm lump within the body of the testis. What is the most appropriate first investigation?
  • ACT abdomen
  • BTesticular ultrasound
  • CTumour markers alone
  • DBiopsy of the testis
  • EReassure
Correct: B — Testicular ultrasound
Why: A painless intratesticular mass is investigated first with ultrasound; tumour markers (AFP, β-hCG, LDH) support staging. Trans-scrotal biopsy is avoided (seeding).
Options:
  • Staging comes later.
  • (correct)
  • Adjunct, not first.
  • Biopsy risks seeding.
  • Needs investigation.
Scrotal swellings: differentiatingImportanttap to open ▾
Testicular cancer: solid, from body of testis. Epididymal cyst: separate, cystic, transilluminates. Hydrocele: transilluminates, testis impalpable. Varicocele: 'bag of worms', usually left. Hernia: reducible, can’t get above it.
Transilluminates: Hydrocele, epididymal cyst.
Solid: Testicular tumour (from body of testis) → ultrasound.
Bag of worms: Varicocele — usually left; right-sided needs urgent referral (retroperitoneal mass).
Can’t get above it: Inguinoscrotal hernia (reducible on lying down).
A young man has a left scrotal 'bag of worms' that disappears on lying down. A NEW right-sided version of the same finding should prompt what?
  • AReassurance
  • BUrgent referral to exclude a retroperitoneal mass
  • CAntibiotics
  • DUltrasound in a year
  • ESurgery only if painful
Correct: B — Urgent referral to exclude a retroperitoneal mass
Why: Varicoceles are usually left-sided; a new right-sided varicocele can indicate a retroperitoneal mass obstructing venous drainage and warrants urgent referral (renal USS).
Options:
  • Right-sided is a red flag.
  • (correct)
  • Not infective.
  • Too slow.
  • Misses the red flag.
VaricoceleImportanttap to open ▾
'Bag of worms', usually LEFT, disappears lying down. Can impair spermatogenesis (raised FSH, subfertility). Right-sided or non-reducing → urgent referral / renal USS to exclude a mass.
Features: Dilated pampiniform plexus; usually left; may cause subfertility.
Red flags: Right-sided, sudden onset, or doesn’t empty on lying → image for renal/retroperitoneal mass.
Manage: Reassure most; refer for repair if pain or subfertility.
A subfertile man has a left varicocele and a raised FSH. What does the raised FSH suggest?
  • ANormal finding
  • BImpaired spermatogenesis
  • CTesticular cancer
  • DHypogonadism from the pituitary
  • ENothing relevant
Correct: B — Impaired spermatogenesis
Why: A raised FSH with a varicocele indicates impaired spermatogenesis, a recognised cause of subfertility.
Options:
  • Not normal here.
  • (correct)
  • Different presentation.
  • FSH is raised, not low.
  • It is relevant.
Cryptorchidism (undescended testis)Importanttap to open ▾
Orchidopexy for a unilateral undescended testis, ideally before age 1 (definitely by 2). Bilateral impalpable at birth → urgent paediatric/endocrine review (DSD). Malignancy risk remains raised despite surgery.
Refer: Not descended by 3 months → refer to be seen by ~6 months; orchidopexy before age 1 (by 2 at latest).
Bilateral impalpable: Urgent review for disorder of sex development / endocrine cause.
Risk: Increased testicular cancer risk persists even after orchidopexy; teach self-examination.
A 6-month-old boy has a unilateral undescended testis still not palpable in the scrotum. What is the appropriate management?
  • AReassure — will descend
  • BRefer for orchidopexy (ideally before age 1)
  • CWait until age 5
  • DHormone therapy only
  • EImmediate orchidectomy
Correct: B — Refer for orchidopexy (ideally before age 1)
Why: Orchidopexy is recommended for a persistently undescended testis, ideally before the first birthday (and by 2 years), to preserve fertility and aid cancer surveillance.
Options:
  • Unlikely after 3–6 months.
  • (correct)
  • Too late.
  • Not first-line.
  • Not indicated.
Fournier's gangreneImportanttap to open ▾
Necrotising fasciitis of the perineum/scrotum: pain, swelling, redness, crepitus, systemic sepsis. A surgical emergency — resuscitate and refer to urology via A&E for urgent debridement + broad-spectrum antibiotics.
Features: Rapidly spreading perineal/scrotal pain, redness, crepitus, sloughing; septic (fever, tachycardia).
Organisms: Polymicrobial — E. coli, Group A strep, Clostridium perfringens.
Action: 999/A&E to urology; IV broad-spectrum antibiotics + urgent surgical debridement.
A diabetic man has rapidly spreading perineal pain, redness and crepitus with fever and tachycardia. Most appropriate action?
  • AOral antibiotics and review
  • BEmergency referral to urology via A&E for debridement
  • CTopical antibiotics
  • DReassure
  • EUltrasound then decide
Correct: B — Emergency referral to urology via A&E for debridement
Why: Fournier’s gangrene is a necrotising fasciitis and surgical emergency — resuscitate and get the patient to urology urgently for debridement and IV antibiotics.
Options:
  • Far too slow.
  • (correct)
  • Inadequate.
  • Dangerous.
  • Delays life-saving surgery.
HydroceleRare · recognise
Painless scrotal swelling that transilluminates; testis impalpable within it. Idiopathic (older) or secondary (tumour/infection — image if in doubt). Reassure/surgery if large.
Epididymal cystRare · recognise
Smooth, separate, cystic swelling above/behind the testis; transilluminates. Benign; reassure or excise if symptomatic.
VasectomyRare · recognise
Failure ~1 in 2000. Two clear semen analyses (≈12 and 16 weeks) before stopping other contraception. Complications: bruising, haematoma, infection, chronic testicular pain (5–30%), sperm granuloma.

Renal, Bladder & Urinary

Haematuria: referral rulesCoretap to open ▾
Visible haematuria ≥45 → 2-week-wait (bladder/renal cancer). Non-visible haematuria ≥60 with dysuria or raised WCC → 2-week-wait. Recurrent UTI ≥60 without those → non-urgent referral.
Visible haematuria: Aged ≥45 (unexplained, or persisting after UTI treatment) → urgent 2-week-wait.
Non-visible haematuria: Aged ≥60 with dysuria OR raised white cells → 2-week-wait.
Confirm: Dipstick; exclude transient causes (menstruation, exercise, sex, beetroot, rifampicin). Persistent = ≥2 of 3 samples positive.
Work-up: U&E, ACR; refer per rules.
A 50-year-old man reports painless visible haematuria with no infection. What is the appropriate referral?
  • ARoutine urology referral
  • BUrgent 2-week-wait referral for suspected bladder/renal cancer
  • CReassure
  • DRepeat dip in 6 months
  • EAntibiotics
Correct: B — Urgent 2-week-wait referral for suspected bladder/renal cancer
Why: Unexplained visible haematuria at 45 or over triggers an urgent suspected-cancer (2-week-wait) referral.
Options:
  • Too slow.
  • (correct)
  • Needs investigation.
  • Delays diagnosis.
  • No infection present.
Male urinary incontinenceImportanttap to open ▾
Urge incontinence (may be BPH-related): lifestyle/bladder training first, then anticholinergic (oxybutynin) or mirabegron in older men; if BPH-related and unresponsive → tamsulosin. Stress: lifestyle/pelvic floor; then duloxetine. Oxybutynin worsens voiding LUTS.
Urge: Bladder training first; then oxybutynin (or mirabegron in older/frail); tamsulosin if BPH-related and unresponsive.
Stress: Weight loss, pelvic-floor exercises first; duloxetine if unresponsive.
Caution: Oxybutynin worsens voiding symptoms in BPH.
An older man with BPH has urge incontinence. Lifestyle and bladder training have failed. Which drug carries a risk of worsening his voiding symptoms?
  • AMirabegron
  • BOxybutynin (anticholinergic)
  • CTamsulosin
  • DDuloxetine
  • EFinasteride
Correct: B — Oxybutynin (anticholinergic)
Why: Anticholinergics such as oxybutynin can worsen voiding LUTS and precipitate retention in BPH; mirabegron is often preferred in older men.
Options:
  • Beta-3 agonist, safer here.
  • (correct)
  • Improves voiding.
  • For stress incontinence.
  • Shrinks prostate.
HaemospermiaImportanttap to open ▾
Blood in semen. Under 40 and single episode with no red flags → usually benign; do urinalysis. Over 40 or persistent → DRE + PSA (and refer). Consider TB (seminal microscopy) and STI.
Young, single episode: Often benign (infection/inflammation); urinalysis, reassure.
Older/persistent: DRE + PSA; refer to exclude prostate pathology.
Consider: STI screen; TB if risk factors (seminal MC&S).
A 55-year-old man reports recurrent blood in his semen. Besides urinalysis, what should you do?
  • AReassure only
  • BPerform a DRE and PSA and refer
  • CAntibiotics only
  • DUltrasound scrotum only
  • ENothing
Correct: B — Perform a DRE and PSA and refer
Why: Haemospermia in an older or persistent case warrants DRE and PSA with referral to exclude prostate and other pathology.
Options:
  • Not adequate at this age.
  • (correct)
  • Doesn’t assess cause.
  • Wrong target.
  • Under-investigates.
Renal cancerRare · recognise
Triad: loin pain, haematuria, abdominal mass. Paraneoplastic: polycythaemia (EPO), hypercalcaemia (PTHrP), Cushing’s (ACTH), Stauffer’s syndrome (deranged LFTs). Associations: VHL, tuberous sclerosis, ADPKD.
Bladder cancerRare · recognise
Painless visible haematuria is the classic presentation; risk factors smoking and aromatic amines. Refer per haematuria rules; cystoscopy is diagnostic.
Male UTIRare · recognise
Treat for 7 days (upper tract/complicated longer). Investigate underlying cause (obstruction/BPH); recurrent UTI in older men → consider referral.

Other Men's Health

Genital ulcers: differentiatingImportanttap to open ▾
Painful: herpes (multiple, HSV-2, systemic — aciclovir) and chancroid (ragged undermined border, tender inguinal nodes, Haemophilus ducreyi — azithromycin). Painless: syphilis (single clean chancre) and LGV.
Painful: Herpes (multiple vesicles/ulcers, fever) → aciclovir; chancroid (sharply-defined ragged border, painful nodes) → azithromycin.
Painless: Syphilis (single indurated painless chancre) → benzathine penicillin; lymphogranuloma venereum.
Herpes first episode: Treat clinically; saline bathing, analgesia, topical lidocaine, aciclovir 400 mg TDS 5 days.
A man has multiple painful genital ulcers with fever. What is the most likely cause and treatment?
  • ASyphilis — penicillin
  • BGenital herpes (HSV) — aciclovir
  • CChancroid — azithromycin
  • DLGV — doxycycline
  • EBehçet’s — steroids
Correct: B — Genital herpes (HSV) — aciclovir
Why: Multiple painful ulcers with systemic symptoms are typically genital herpes (HSV-2); treat with aciclovir and supportive measures.
Options:
  • Syphilis is painless.
  • (correct)
  • Chancroid ulcers are usually single/few with ragged edges.
  • LGV is painless.
  • Not the usual picture.
Genital wartsImportanttap to open ▾
Anogenital warts (HPV 6/11). Multiple/soft → topical treatment (podophyllotoxin or imiquimod); solitary/keratinised → cryotherapy. Screen for other STIs.
Multiple: Topical podophyllotoxin or imiquimod.
Solitary/keratinised: Cryotherapy.
Advise: HPV vaccination context; screen for coexisting STIs.
A young man has several soft anogenital warts. What is the most appropriate first-line treatment?
  • ACryotherapy
  • BTopical podophyllotoxin or imiquimod
  • CSurgical excision
  • DOral aciclovir
  • EReassure, no treatment
Correct: B — Topical podophyllotoxin or imiquimod
Why: Multiple soft warts are treated first-line with a topical agent (podophyllotoxin or imiquimod); cryotherapy suits solitary/keratinised lesions.
Options:
  • Better for solitary lesions.
  • (correct)
  • Not first-line.
  • Warts are not herpes.
  • Treatment is offered.
Abdominal aortic aneurysm screeningImportanttap to open ▾
One-off abdominal ultrasound for men at 65. 3–4.4 cm yearly; 4.5–5.4 cm 3-monthly; ≥5.5 cm (or symptomatic/growing) → refer for repair. DVLA: Group 1 bar ≥6.5 cm; Group 2 bar ≥5.5 cm.
Screen: Men at 65 — single abdominal ultrasound.
Surveillance: 3–4.4 cm yearly; 4.5–5.4 cm 3-monthly; ≥5.5 cm refer.
Risk factors: Smoking, hypertension, Marfan/Ehlers-Danlos, family history.
DVLA: Group 1 must not drive if ≥6.5 cm; Group 2 barred at ≥5.5 cm.
At screening, a 65-year-old man has a 5.6 cm abdominal aortic aneurysm. Management?
  • AYearly ultrasound
  • BRefer to vascular surgery for repair
  • C3-monthly ultrasound
  • DDischarge
  • EStart a statin only
Correct: B — Refer to vascular surgery for repair
Why: An AAA of 5.5 cm or more (or symptomatic/rapidly growing) is referred for repair; smaller ones are kept under surveillance.
Options:
  • Too large for yearly.
  • (correct)
  • That’s for 4.5–5.4 cm.
  • Needs repair pathway.
  • Repair is the priority.
Chordee & other congenital penile anomaliesRare · recognise
Ventral curvature often with hypospadias; surgical correction; avoid circumcision if repair planned.