Given the breadth of this request (40 diseases, both sexes, full clinical detail across treatment, investigations, findings, DDx, contraindications, ICU management, OPD prescriptions), I will now compile a comprehensive, evidence-based reference from authoritative textbooks (Campbell-Walsh Urology, Berek & Novak's Gynecology, Smith & Tanagho's General Urology, Goldman-Cecil Medicine, Sabiston Surgery, and others in the library).
GENITAL SYSTEM DISEASES — COMPREHENSIVE CLINICAL REFERENCE
40 Most Important Diseases: Male & Female
PART A — MALE GENITAL SYSTEM DISEASES (20 Conditions)
1. BENIGN PROSTATIC HYPERPLASIA (BPH)
| Feature | Details |
|---|
| Definition | Non-malignant enlargement of the transition zone of the prostate causing bladder outlet obstruction |
| Etiology | Age-related androgen/estrogen imbalance; DHT-mediated stromal-epithelial proliferation |
| Key Findings | LUTS (frequency, urgency, nocturia, weak stream, hesitancy, incomplete emptying); enlarged, smooth, firm prostate on DRE |
| Investigations | PSA, urinalysis, serum creatinine, post-void residual (PVR) ultrasound, uroflowmetry (Qmax <10 mL/s severe), IPSS score, cystoscopy if needed |
| Differential Diagnosis | Prostate cancer, urethral stricture, bladder neck obstruction, neurogenic bladder, prostatitis, UTI |
| Treatment (OPD) | Alpha-blockers: Tamsulosin 0.4 mg OD (first-line); 5-alpha reductase inhibitors: Finasteride 5 mg OD (prostate >30 g); Combination therapy for large prostates; Anticholinergics for OAB component |
| OPD Prescription | Tab Tamsulosin 0.4 mg – 1 tab at bedtime × 3 months; Tab Finasteride 5 mg – 1 tab OD × 6–12 months; avoid cold decongestants (α-agonists) |
| Contraindications | Alpha-blockers: orthostatic hypotension, concurrent PDE-5 inhibitors; Finasteride: women of childbearing age (teratogenic) |
| Surgical Indications | Refractory urinary retention, recurrent UTI, bladder stones, hydronephrosis, renal impairment |
| Surgery | TURP (gold standard); HoLEP; open prostatectomy for >80–100 g |
| ICU Management | Post-TURP syndrome (dilutional hyponatremia): restrict fluids, isotonic/hypertonic saline, loop diuretics; monitor electrolytes; manage coagulopathy |
2. PROSTATE CANCER
| Feature | Details |
|---|
| Definition | Adenocarcinoma arising from peripheral zone; most common male malignancy |
| Risk Factors | Age >50, African-American, family history, BRCA2 mutation |
| Findings | Often asymptomatic; hard, irregular, nodular prostate on DRE; elevated PSA; metastatic: bone pain, pathological fractures |
| Investigations | PSA (>4 ng/mL suspicious; >10 ng/mL highly suspicious), free:total PSA ratio, TRUS-guided prostate biopsy (12 cores), MRI prostate (PI-RADS), bone scan, CT abdomen/pelvis for staging |
| Grading | Gleason score → Grade Groups 1–5 |
| Staging | TNM; D'Amico risk (low/intermediate/high) |
| Differential Diagnosis | BPH, prostatitis, prostate abscess, bladder cancer |
| Treatment | Low-risk: active surveillance; Intermediate/high: radical prostatectomy (RARP) or external beam radiotherapy (EBRT) + brachytherapy; Metastatic: ADT (LHRH agonist — Leuprolide/Goserelin + anti-androgen — Bicalutamide); Castration-resistant: Enzalutamide, Abiraterone, Docetaxel |
| OPD Prescription | Tab Bicalutamide 50 mg OD (flare protection); Inj Goserelin 10.8 mg SC every 3 months; Tab Enzalutamide 160 mg OD (CRPC); Zoledronic acid 4 mg IV (bone mets) |
| Contraindications | ADT contraindicated in untreated severe osteoporosis without bone protection; Enzalutamide: seizure disorder (relative) |
| ICU Management | Spinal cord compression (metastatic): high-dose dexamethasone (10 mg IV bolus then 4 mg q6h), emergency MRI, neurosurgical decompression or EBRT; hypercalcemia of malignancy: IV fluids + bisphosphonates |
3. PROSTATITIS SYNDROMES
| Feature | Details |
|---|
| Classification | NIH Category I: Acute bacterial; II: Chronic bacterial; III: CPPS (IIIa inflammatory / IIIb non-inflammatory); IV: Asymptomatic |
| Organisms | E. coli (most common), Klebsiella, Enterococcus, Pseudomonas |
| Findings | Perineal/pelvic pain, dysuria, fever (acute); tender, boggy prostate on DRE (AVOID vigorous massage in acute); elevated PSA |
| Investigations | Urine C&S, Meares-Stamey 4-glass test, expressed prostatic secretions (EPS), STI screen, PSA, TRUS if abscess suspected |
| Treatment (Acute Bacterial) | Ciprofloxacin 500 mg BD × 4–6 weeks OR Trimethoprim-sulfamethoxazole DS BD × 4–6 weeks; IV: Ampicillin + Gentamicin if septic |
| OPD Prescription (Chronic) | Tab Ciprofloxacin 500 mg BD × 6 weeks; Tab Tamsulosin 0.4 mg nocte; Tab Ibuprofen 400 mg TDS (pain); pelvic floor PT |
| Contraindications | DRE massage contraindicated in acute prostatitis (bacteremia risk); fluoroquinolones caution in tendinopathy |
| ICU Management | Septic prostatitis/abscess: IV Piperacillin-Tazobactam 4.5 g q8h + CT/TRUS-guided drainage if abscess |
| Differential Diagnosis | BPH, prostate cancer, UTI, epididymo-orchitis, pelvic floor dysfunction |
4. EPIDIDYMO-ORCHITIS
| Feature | Details |
|---|
| Etiology | <35 years: STI (Chlamydia trachomatis, N. gonorrhoeae); >35 years: enteric gram-negatives (E. coli); Mumps orchitis (viral) |
| Findings | Unilateral scrotal pain/swelling/erythema; Prehn sign positive (pain relief on elevation — distinguishes from torsion); fever; urethral discharge |
| Investigations | Urine C&S, urethral swab (NAAT for Chlamydia/GC), scrotal ultrasound Doppler (increased flow — differentiates from torsion), FBC, CRP |
| Differential Diagnosis | Testicular torsion (surgical emergency — absent Doppler flow), testicular tumor, hydrocele, inguinal hernia |
| Treatment | STI-related: Ceftriaxone 500 mg IM stat + Doxycycline 100 mg BD × 10–14 days; Enteric: Ciprofloxacin 500 mg BD × 10–14 days; Scrotal elevation, NSAIDs |
| OPD Prescription | Inj Ceftriaxone 500 mg IM stat; Tab Doxycycline 100 mg BD × 14 days; Tab Ibuprofen 400 mg TDS; Scrotal support; treat partner |
| Contraindications | Doxycycline contraindicated in pregnancy/children <8 yrs; Fluoroquinolones: resistance areas |
| ICU Management | Septic orchitis: IV antibiotics, monitoring; surgical drainage/orchidectomy if abscess/necrosis |
5. TESTICULAR TORSION
| Feature | Details |
|---|
| Definition | Rotation of testis on spermatic cord → venous obstruction → ischemia → infarction |
| Peak Age | Neonates and puberty (12–18 years); "bell-clapper deformity" |
| Findings | Sudden severe scrotal pain, nausea/vomiting, high-riding transverse testis, absent cremasteric reflex, Prehn sign negative |
| Investigations | CLINICAL DIAGNOSIS — do not delay surgery for imaging; Color Doppler US if diagnosis uncertain (absent/reduced flow) |
| Differential Diagnosis | Epididymo-orchitis, torsion of appendix testis, incarcerated hernia, trauma |
| Treatment | Surgical emergency: manual detorsion (temporary) → bilateral orchidopexy within 6 hours (salvage rate >90%); orchidectomy if non-viable |
| Time to Surgery | <6 hrs: ~100% salvage; 6–12 hrs: ~50%; >24 hrs: <10% |
| ICU Management | Post-op monitoring; analgesics; antibiotics if secondary infection |
| Contraindications | Delaying surgery for imaging when torsion is clinically obvious |
6. TESTICULAR CANCER
| Feature | Details |
|---|
| Classification | Germ cell tumors (95%): Seminoma (40%) and Non-seminoma (NSGCT: embryonal, choriocarcinoma, yolk sac, teratoma); Non-GCT: Leydig cell, Sertoli cell |
| Peak Age | 15–35 years; most common solid malignancy in young men |
| Findings | Painless unilateral testicular mass, heaviness; gynecomastia (HCG-secreting); systemic symptoms if metastatic |
| Tumor Markers | AFP (yolk sac/NSGCT), β-HCG (choriocarcinoma/seminoma), LDH (bulk) |
| Investigations | Scrotal ultrasound, AFP, β-HCG, LDH, CT chest/abdomen/pelvis (staging), CXR |
| Staging | TNM + IGCCCG risk (good/intermediate/poor) |
| Treatment | Radical inguinal orchidectomy (NOT transscrotal); Seminoma: surveillance (stage I), RPLND or BEP chemo (advanced); NSGCT: BEP chemotherapy (Bleomycin + Etoposide + Cisplatin) |
| OPD Prescription | Tumor marker surveillance every 3 months; BEP × 3–4 cycles; consider sperm banking before chemo |
| Contraindications | Transscrotal biopsy (disrupts lymphatic drainage, upstages disease); Bleomycin in poor pulmonary reserve |
| ICU Management | Tumor lysis syndrome (high-bulk disease on chemo): IV hydration, allopurinol/rasburicase, electrolyte correction |
7. ERECTILE DYSFUNCTION (ED)
| Feature | Details |
|---|
| Definition | Inability to achieve/maintain erection sufficient for satisfactory sexual activity |
| Causes | Vascular (most common), neurogenic, hormonal (hypogonadism), psychogenic, drug-induced |
| Investigations | Fasting glucose, lipid profile, testosterone, prolactin, LH/FSH, TFT, nocturnal penile tumescence (NPT), penile Doppler USS |
| Differential Diagnosis | Hypogonadism, Peyronie's disease, psychological ED, medication-induced (antihypertensives, SSRIs, finasteride) |
| Treatment | PDE-5 inhibitors: Sildenafil 50 mg (1 hour before) or Tadalafil 5 mg OD (daily); Testosterone replacement (if hypogonadal); Vacuum erection device; intracavernosal alprostadil; penile implant |
| OPD Prescription | Tab Sildenafil 50 mg PRN (1 hr before intercourse); OR Tab Tadalafil 5 mg OD; lifestyle modification (weight loss, exercise, stop smoking) |
| Contraindications | PDE-5 inhibitors: concurrent nitrates (severe hypotension), recent MI/stroke, severe cardiac disease, hypotension |
| ICU Management | Priapism (prolonged erection >4 hours): aspiration of corpus cavernosum, intracavernosal phenylephrine; surgical shunt if refractory |
8. PHIMOSIS & PARAPHIMOSIS
| Feature | Details |
|---|
| Phimosis | Inability to retract prepuce; physiological (<3 yrs) vs pathological (BXO/lichen sclerosus) |
| Paraphimosis | Retracted foreskin cannot be reduced — penile/glans ischemia emergency |
| Findings | Tight foreskin; in paraphimosis: swollen glans, constricting ring |
| Investigations | Clinical diagnosis; biopsy if BXO suspected |
| Treatment (Phimosis) | Topical betamethasone 0.05% cream BD × 4–8 weeks; preputioplasty or circumcision |
| Treatment (Paraphimosis) | Manual reduction (compress glans, push glans through foreskin); if failed: dorsal slit → elective circumcision later |
| ICU Management | Necrotizing fasciitis of genitalia (Fournier's gangrene): IV broad-spectrum antibiotics + emergency surgical debridement |
9. PENILE CANCER
| Feature | Details |
|---|
| Risk Factors | HPV (types 16,18), phimosis, poor hygiene, smoking, lichen sclerosus |
| Findings | Ulcerating/exophytic lesion on glans/prepuce, inguinal lymphadenopathy |
| Investigations | Biopsy (SCC), MRI penis, PET-CT/CT for staging, sentinel node biopsy |
| Treatment | Organ-sparing (laser, Mohs, glansectomy) for stage I/II; partial/total penectomy for advanced; inguinal lymph node dissection; chemoradiation |
| OPD Prescription | Antifungal if candidal superinfection; wound care; onward referral |
| Contraindications | Wide excision margins required; avoid delay in inguinal node management |
10. URETHRAL STRICTURE (MALE)
| Feature | Details |
|---|
| Causes | Trauma (pelvic fracture, straddle injury), infection (gonorrhea, lichen sclerosus), iatrogenic (catheterization/TURP) |
| Findings | Weak/split urinary stream, incomplete emptying, recurrent UTI, AUR |
| Investigations | Uroflowmetry, retrograde urethrogram (RUG), ascending urethrogram, cystoscopy |
| Treatment | Urethral dilation; optical internal urethrotomy (OIU); urethroplasty (anastomotic or substitution) — gold standard for recurrent strictures |
| OPD Prescription | Clean intermittent self-catheterization (CISC) post-urethrotomy; antibiotics prophylaxis |
| Contraindications | Repeated dilation without definitive repair leads to worsening fibrosis |
| ICU Management | AUR: suprapubic catheter; sepsis management if complicated UTI |
11. VARICOCELE
| Feature | Details |
|---|
| Definition | Abnormal dilation of pampiniform plexus; left >> right (due to angle of left renal vein drainage) |
| Findings | "Bag of worms" on palpation; dull ache; male infertility (oligo/asthenospermia) |
| Investigations | Scrotal Doppler USS (reflux with Valsalva), semen analysis |
| Treatment | Surgical ligation (open/laparoscopic/microsurgical) or percutaneous embolization; indicated for pain or infertility |
| OPD Prescription | Scrotal support; analgesics; referral for surgery if fertility concern |
| Differential Diagnosis | Hydrocele, epididymal cyst, secondary varicocele (right-sided → renal tumor) |
12. HYDROCELE
| Feature | Details |
|---|
| Definition | Collection of fluid in tunica vaginalis |
| Causes | Congenital (patent processus vaginalis), secondary (infection, trauma, tumor) |
| Findings | Soft, transilluminable scrotal swelling; testis palpated separately |
| Investigations | Scrotal USS (exclude underlying tumor), transillumination test |
| Treatment | Jaboulay procedure (eversion), Lord's procedure, aspiration (high recurrence); congenital: herniotomy |
| OPD Prescription | Reassurance if asymptomatic; aspiration for elderly/poor surgical risk |
13. UNDESCENDED TESTIS (CRYPTORCHIDISM)
| Feature | Details |
|---|
| Findings | Absent testis in scrotum; may be palpable in inguinal canal |
| Investigations | USS inguinal canal; MRI/laparoscopy if non-palpable |
| Treatment | Orchidopexy by 6–12 months of age (improves fertility, reduces but does not eliminate cancer risk); orchidectomy if post-pubertal |
| Complications | Infertility, testicular torsion, malignant transformation (10× risk) |
14. SCROTAL ABSCESS / FOURNIER'S GANGRENE
| Feature | Details |
|---|
| Fournier's | Polymicrobial necrotizing fasciitis of perineum/genitalia; risk: DM, immunosuppression, obesity |
| Organisms | E. coli, Bacteroides, Streptococcus, Clostridium (synergistic) |
| Findings | Severe pain, swelling, crepitus, dusky skin, systemic sepsis; rapidly progressive |
| Investigations | CT perineum (gas tracking), FBC, CRP, blood cultures, wound cultures |
| ICU Management | Aggressive IV fluids; Broad-spectrum antibiotics: Piperacillin-Tazobactam + Metronidazole + Vancomycin; Emergency surgical debridement (repeat daily); HBO therapy adjunct; VAC wound dressing; vasopressors if septic shock |
| Contraindications | Delayed surgery is fatal; do NOT wait for imaging if clinical diagnosis is certain |
15. MALE INFERTILITY
| Feature | Details |
|---|
| Causes | Pre-testicular (hypogonadism, hyperprolactinemia), testicular (Klinefelter's, cryptorchidism, orchitis), post-testicular (obstruction, retrograde ejaculation) |
| Investigations | Semen analysis ×2 (WHO 2021 criteria: count >16 M/mL, motility >42%, morphology >4% normal); FSH, LH, testosterone, prolactin; karyotype; TRUS; testicular biopsy |
| Treatment | Varicocelectomy; gonadotropins (hypogonadotropic hypogonadism); sperm retrieval + ICSI; donor insemination |
| OPD Prescription | Clomiphene citrate 25–50 mg OD; lifestyle modification; antioxidants (Vitamin E, CoQ10); Inj FSH + LH if hypogonadotropic |
| Contraindications | Exogenous testosterone suppresses spermatogenesis (use Clomiphene or gonadotropins instead) |
PART B — FEMALE GENITAL SYSTEM DISEASES (20 Conditions)
16. POLYCYSTIC OVARIAN SYNDROME (PCOS)
| Feature | Details |
|---|
| Diagnosis | Rotterdam criteria (2 of 3): oligo/anovulation, hyperandrogenism (clinical/biochemical), polycystic ovaries on USS |
| Findings | Irregular cycles, hirsutism, acne, obesity, acanthosis nigricans, infertility |
| Investigations | LH:FSH ratio (>2:1), free testosterone, SHBG, DHEAS, fasting glucose, HbA1c, lipid profile, pelvic USS (≥12 follicles 2–9 mm OR ovarian volume >10 mL) |
| Differential Diagnosis | Hypothyroidism, CAH (21-hydroxylase deficiency), hyperprolactinemia, Cushing syndrome, androgen-secreting tumors |
| Treatment | Lifestyle modification (weight loss); COCP for cycle regulation/hyperandrogenism; Metformin 500–1500 mg/day (insulin resistance); Clomiphene/letrozole (infertility); laparoscopic ovarian drilling |
| OPD Prescription | Tab COCP (e.g., Diane-35 or Yasmin) OD × 21 days; Tab Metformin 500 mg TDS with meals; Spironolactone 50–100 mg OD (hirsutism); folic acid 5 mg if planning pregnancy |
| Contraindications | COCP: thrombophilia, migraine with aura, smoker >35 yrs, hepatic disease; Metformin: eGFR <30 |
| ICU Management | OHSS (ovarian hyperstimulation syndrome): fluid resuscitation, thromboprophylaxis, albumin infusion, dopamine agonist (cabergoline), paracentesis for tense ascites |
17. ENDOMETRIOSIS
| Feature | Details |
|---|
| Definition | Ectopic endometrial glands and stroma outside uterus (ovaries, peritoneum, rectovaginal septum, fallopian tubes) |
| Findings | Dysmenorrhea, dyspareunia, dyschezia, infertility, chronic pelvic pain; retroverted fixed uterus; chocolate cysts (endometriomas) |
| Investigations | CA-125 (elevated but not specific), pelvic USS (endometrioma: "ground glass" cyst), MRI, definitive: laparoscopy with biopsy |
| Staging | rASRM I–IV (minimal to severe) |
| Differential Diagnosis | Adenomyosis, PID, IBS, ovarian cyst, ectopic pregnancy |
| Treatment | NSAIDs + COCP (first-line); Progestins (Medroxyprogesterone, Dienogest); GnRH agonists (Leuprolide 3.75 mg IM monthly) + add-back therapy; surgical: laparoscopic excision/ablation; definitive: hysterectomy + BSO |
| OPD Prescription | Tab Dienogest 2 mg OD continuous; OR GnRH agonist + norethisterone add-back; NSAIDs for pain |
| Contraindications | GnRH agonists >6 months without add-back: osteoporosis risk |
| ICU Management | Ruptured endometrioma: emergency laparoscopy; sepsis management |
18. UTERINE FIBROIDS (LEIOMYOMA)
| Feature | Details |
|---|
| Definition | Benign smooth muscle tumors; most common uterine tumor |
| Types | Intramural, submucosal (most symptomatic), subserosal, pedunculated |
| Findings | Heavy menstrual bleeding (HMB), dysmenorrhea, bulk symptoms (pressure, urinary frequency, constipation), enlarged irregular non-tender uterus, infertility |
| Investigations | Pelvic USS (hypoechoic masses), MRI (best for surgical planning), FBC (iron deficiency anemia), SIS (saline infusion sonography), hysteroscopy |
| Differential Diagnosis | Adenomyosis, ovarian cyst, endometrial polyp, uterine sarcoma, pregnancy |
| Treatment | Medical: Tranexamic acid, NSAIDs, COCP, LNG-IUS (Mirena), GnRH agonists (preoperative shrinkage); Surgical: hysteroscopic myomectomy (submucosal), laparoscopic/open myomectomy, hysterectomy (definitive); UAE (uterine artery embolization) |
| OPD Prescription | Tranexamic acid 1 g TDS during menses; Tab Mefenamic acid 500 mg TDS; Iron supplementation; GnRH agonist × 3–6 months pre-surgery |
| Contraindications | GnRH agonists: not for long-term use alone (rebound growth); UAE: desire future fertility (relative) |
| ICU Management | Degenerated/torted fibroid: analgesia, hydration; emergency hysterectomy if septic fibroid; post-partum hemorrhage from fibroid: uterotonic agents, B-Lynch suture, hysterectomy |
19. OVARIAN CYSTS & OVARIAN CANCER
| Feature | Details |
|---|
| Benign Cysts | Follicular, corpus luteum, dermoid (teratoma), endometrioma, serous/mucinous cystadenoma |
| Malignant | Epithelial (70%: serous, mucinous, endometrioid, clear cell), GCT (granulosa cell), sex cord-stromal |
| Findings | Pelvic pain, bloating, urinary urgency, ascites, weight loss; pelvic mass; irregular, fixed, solid mass = malignancy |
| Investigations | Pelvic USS, CA-125, HE4, ROMA score, CT CAP (staging), AFP/βHCG/LDH (GCT), CA19-9/CEA (mucinous) |
| RMI (Risk of Malignancy Index) | USS score × menopausal status × CA-125 |
| Differential Diagnosis | Ectopic pregnancy, appendiceal abscess, tubo-ovarian abscess, fibroid, bladder mass |
| Treatment (Benign) | Watchful waiting (<5 cm, simple, premenopausal); OCP (suppress); laparoscopic cystectomy |
| Treatment (Malignant) | Staging laparotomy + debulking (cytoreductive surgery) + platinum-based chemotherapy (Carboplatin + Paclitaxel × 6 cycles); BRCA testing → PARP inhibitors (Olaparib) for maintenance |
| OPD Prescription | COCP for functional cysts; Olaparib 300 mg BD (BRCA+ maintenance); Antiemetics; G-CSF support |
| Contraindications | Rupture of dermoid → chemical peritonitis; PARP inhibitors: myelosuppression monitoring |
| ICU Management | Ovarian torsion: emergency laparoscopy (detorsion within 4–6 hours); ruptured malignant cyst: resuscitation + emergency surgery; chemotherapy toxicity: hydration, electrolytes, antiemetics |
20. CERVICAL CANCER
| Feature | Details |
|---|
| Etiology | HPV (types 16, 18) → 99% of cases; cofactors: smoking, immunosuppression, COCP, early coitarche |
| Histology | Squamous cell carcinoma (70%), adenocarcinoma (25%) |
| Findings | Often asymptomatic early; post-coital bleeding, intermenstrual bleeding, offensive discharge; advanced: pelvic pain, hydronephrosis, fistulae |
| Investigations | Pap smear (CIN: I/II/III), colposcopy + biopsy, MRI pelvis (staging), CT CAP, cystoscopy/sigmoidoscopy (FIGO); HPV DNA test |
| Staging | FIGO 2018: I–IVB |
| Differential Diagnosis | Cervical ectropion, cervicitis, cervical polyp, vaginal cancer, endometrial cancer |
| Treatment | CIN2/3: LLETZ/cone biopsy; Stage IA1: simple hysterectomy; IA2–IB1: radical hysterectomy + PLND; IB2–IVA: concurrent chemoradiation (Cisplatin 40 mg/m² weekly + EBRT + brachytherapy); IVB: palliative chemo (Bevacizumab + Paclitaxel + Carboplatin) |
| OPD Prescription | HPV vaccine (Gardasil-9: 3 doses at 0, 2, 6 months); Pap smear 3-yearly (25–64 yrs); Folic acid; antiemetics during chemo |
| Contraindications | Pregnancy: LLETZ only after delivery if possible; Bevacizumab: fistula history |
| ICU Management | Massive vaginal hemorrhage: packing, UAE, embolization; ureteric obstruction: nephrostomy; rectovaginal/vesicovaginal fistula: surgical repair |
21. ENDOMETRIAL CANCER
| Feature | Details |
|---|
| Risk Factors | Unopposed estrogen, obesity, DM, PCOS, nulliparity, Lynch syndrome, tamoxifen use |
| Type I | Endometrioid, estrogen-dependent, better prognosis |
| Type II | Serous, clear cell, estrogen-independent, worse prognosis |
| Findings | Postmenopausal bleeding (PMB) — cancer until proven otherwise; premenopausal: irregular HMB |
| Investigations | Transvaginal USS (endometrial thickness >4 mm postmenopausal → biopsy), outpatient endometrial biopsy (Pipelle), hysteroscopy + D&C, MRI pelvis, CT CAP |
| Differential Diagnosis | Endometrial polyp, atrophic endometritis, submucosal fibroid, cervical cancer, ovarian cancer |
| Treatment | Stage I/II: total hysterectomy + BSO + PLND ± adjuvant radiotherapy; Stage III/IV: surgery + chemo (Carboplatin/Paclitaxel) + EBRT; Recurrent: hormonal (progestins, Medroxyprogesterone 200 mg OD) if hormone receptor-positive; Pembrolizumab (MSI-high) |
| OPD Prescription | Tab Medroxyprogesterone acetate 200 mg OD (hormone-sensitive); refer for staging surgery |
| Contraindications | Estrogen replacement alone (without progestin) in intact uterus; delay in investigating PMB |
| ICU Management | Post-op complications: DVT prophylaxis (LMWH), wound dehiscence, ileus management |
22. VULVAL CANCER
| Feature | Details |
|---|
| Histology | SCC (90%), melanoma, Bartholin gland carcinoma |
| Risk Factors | HPV, lichen sclerosus, VIN, immunosuppression, smoking, age |
| Findings | Pruritus (most common), ulcer/mass on vulva, inguinal lymphadenopathy, bleeding |
| Investigations | Punch biopsy (diagnostic), MRI, CT CAP, PET-CT |
| Treatment | VIN: laser/LLETZ/imiquimod; Invasive: wide local excision (>1 cm margins) + ipsilateral ISND (inguinoscrotal node dissection) or sentinel node biopsy; bilateral ILND if bilateral; chemoradiation for advanced |
| OPD Prescription | Imiquimod 5% cream × 16 weeks (VIN); Clobetasol 0.05% (lichen sclerosus) |
| Contraindications | Radical vulvectomy: high morbidity, prefer individualized surgery |
23. VAGINAL CANCER
| Feature | Details |
|---|
| Most Common | Squamous cell carcinoma; also clear cell adenocarcinoma (DES exposure) |
| Findings | Vaginal bleeding, discharge, dyspareunia, mass on anterior wall |
| Treatment | Radiotherapy (primary); surgery for small upper vaginal tumors; chemo for advanced |
24. PELVIC INFLAMMATORY DISEASE (PID)
| Feature | Details |
|---|
| Organisms | N. gonorrhoeae, C. trachomatis, anaerobes, Mycoplasma genitalium |
| Findings | Lower abdominal pain, cervical motion tenderness (Chandelier sign), adnexal tenderness, fever, vaginal discharge; Fitz-Hugh-Curtis syndrome (perihepatitis) |
| Investigations | Pelvic USS (TOA), endocervical swab (NAAT), FBC, CRP, ESR, laparoscopy (gold standard) |
| Differential Diagnosis | Ectopic pregnancy, appendicitis, ovarian torsion, UTI, endometriosis |
| Treatment (Outpatient) | Ceftriaxone 500 mg IM stat + Doxycycline 100 mg BD + Metronidazole 400 mg BD × 14 days |
| Treatment (Inpatient) | IV Cefoxitin 2 g q6h + Doxycycline 100 mg BD → oral step-down; or IV Clindamycin + Gentamicin |
| OPD Prescription | Ceftriaxone 500 mg IM stat; Tab Doxycycline 100 mg BD × 14 days; Tab Metronidazole 400 mg BD × 14 days; treat partner; counsel re: STI |
| Contraindications | IUD retention debated; remove if severe PID + no improvement in 72 hrs |
| ICU Management | TOA rupture → septic shock: broad-spectrum IV antibiotics + emergency laparotomy/CT-guided drainage; vasopressors if needed |
25. TUBO-OVARIAN ABSCESS (TOA)
| Feature | Details |
|---|
| Findings | As PID + palpable adnexal mass, high fever, peritonism |
| Investigations | Pelvic USS/CT (complex adnexal mass), FBC (leukocytosis), blood cultures |
| Treatment | IV antibiotics × 24–48 hrs; if no response: CT-guided drainage or laparoscopic drainage; if ruptured: laparotomy |
| ICU Management | Septic shock protocol: resuscitation, vasopressors, source control |
26. ECTOPIC PREGNANCY
| Feature | Details |
|---|
| Sites | Fallopian tube (95%+), ovarian, cervical, abdominal |
| Risk Factors | PID, previous ectopic, IVF, tubal surgery, IUD, smoking |
| Findings | Amenorrhea + unilateral lower abdominal pain + vaginal bleeding (classic triad); signs of shock if ruptured (peritonism, shoulder tip pain, tachycardia, hypotension) |
| Investigations | β-HCG (rising), TVUSS (empty uterus + adnexal mass), FBC, group & cross-match, progesterone |
| Discriminatory zone | β-HCG >1500–2000 mIU/mL + no IUP on TVUSS = ectopic until proven otherwise |
| Differential Diagnosis | Threatened miscarriage, appendicitis, ovarian torsion, TOA, corpus luteum cyst |
| Treatment | Ruptured: emergency laparoscopic salpingectomy + resuscitation; Unruptured/stable: methotrexate 50 mg/m² IM (if criteria met); expectant management (selected cases) |
| OPD Prescription | Methotrexate IM (if criteria: β-HCG <5000, no fetal cardiac activity, mass <3.5 cm, compliant patient); Folic acid contraindicated with MTX; rhogam if Rh negative |
| Contraindications | Methotrexate: renal/hepatic impairment, immunodeficiency, active pulmonary disease, breastfeeding, β-HCG >5000 |
| ICU Management | Ruptured ectopic (hemoperitoneum): massive transfusion protocol, O-negative blood, emergency laparoscopy/laparotomy; cell salvage |
27. GESTATIONAL TROPHOBLASTIC DISEASE (GTD)
| Feature | Details |
|---|
| Spectrum | Complete/partial hydatidiform mole → invasive mole → choriocarcinoma → PSTT |
| Findings | Hyperemesis, uterus large for dates, absent fetal heart sounds, "snowstorm" USS, very high β-HCG, theca-lutein cysts, early pre-eclampsia |
| Investigations | β-HCG (dramatically elevated), USS, CXR/CT (metastasis), LFT, RFT |
| Treatment | Suction curettage + serial β-HCG monitoring; chemotherapy if persistent GTD/choriocarcinoma: Methotrexate (low-risk) or EMA-CO regimen (high-risk) |
| OPD Prescription | Contraception × 12–18 months post-treatment; serial β-HCG monitoring; avoid pregnancy until β-HCG negative |
| ICU Management | Acute respiratory failure (pulmonary trophoblast embolism): supportive ventilation; massive hemorrhage: transfusion + suction curettage |
28. STRESS URINARY INCONTINENCE (SUI) — FEMALE
| Feature | Details |
|---|
| Mechanism | Urethral hypermobility or intrinsic sphincter deficiency |
| Findings | Urine leak with coughing, sneezing, exertion; positive cough stress test |
| Investigations | Urinalysis, bladder diary, urodynamics (UDS), TVUSS, post-void residual |
| Differential Diagnosis | Urge incontinence (OAB), overflow incontinence, fistula |
| Treatment | Pelvic floor exercises (Kegel); Duloxetine 40 mg BD (moderate); midurethral sling (TVT/TOT — surgical gold standard) |
| OPD Prescription | Pelvic floor physiotherapy; Duloxetine 20 mg BD titrated to 40 mg BD; weight loss; topical vaginal estrogen (postmenopausal) |
| Contraindications | Duloxetine: MAOIs, uncontrolled narrow-angle glaucoma; mesh sling: history of mesh complications |
29. PELVIC ORGAN PROLAPSE (POP)
| Feature | Details |
|---|
| Types | Cystocele, rectocele, uterine prolapse, vaginal vault prolapse, enterocele |
| Risk Factors | Multiparity, vaginal delivery, menopause (hypoestrogenism), obesity, chronic cough |
| Findings | Feeling of "something coming down," pelvic heaviness, urinary/bowel symptoms; POP-Q staging I–IV |
| Treatment | Pelvic floor exercises; pessary (ring/Gellhorn); surgical: anterior/posterior repair, sacrocolpopexy, Manchester repair, hysterectomy + vault suspension |
| OPD Prescription | Topical vaginal estrogen (Estriol cream nightly × 2 weeks, then twice weekly); pessary fitting; physiotherapy referral |
| Contraindications | Mesh sacrocolpopexy: avoided in fertile women; estrogen: hormone-sensitive malignancy |
30. BARTHOLIN CYST & ABSCESS
| Feature | Details |
|---|
| Findings | Unilateral, tense, painful labial swelling (abscess) or non-tender fluctuant cyst |
| Treatment | Cyst: Word catheter or marsupialization; Abscess: I&D + Word catheter 4–6 weeks; Bartholin gland excision (recurrent/postmenopausal — exclude cancer) |
| OPD Prescription | Sitz baths; antibiotics if cellulitis (Co-amoxiclav 625 mg TDS × 5 days); Word catheter insertion |
| Investigations | Swab for C&S (STI screen); biopsy if >40 years (exclude Bartholin carcinoma) |
31. VULVODYNIA / VESTIBULODYNIA
| Feature | Details |
|---|
| Findings | Chronic vulvar pain/burning without identifiable cause; dyspareunia, allodynia |
| Treatment | Amitriptyline 10–75 mg nocte; Gabapentin; topical lidocaine; pelvic floor PT; psychosexual counseling; vestibulectomy (localized provoked vulvodynia) |
| OPD Prescription | Tab Amitriptyline 10 mg nocte, titrate up; topical 5% lidocaine ointment PRN; refer to vulval clinic |
| Contraindications | Exclude contact dermatitis, lichen sclerosus, infection before diagnosis |
32. SEXUALLY TRANSMITTED INFECTIONS (STIs)
| Disease | Organism | Key Features | Treatment |
|---|
| Gonorrhea | N. gonorrhoeae | Urethral/vaginal discharge, dysuria, PID, septic arthritis | Ceftriaxone 500 mg IM stat + Azithromycin 1 g oral |
| Chlamydia | C. trachomatis | Often asymptomatic; urethritis, cervicitis, PID, reactive arthritis, LGV | Doxycycline 100 mg BD × 7 days OR Azithromycin 1 g stat |
| Syphilis | T. pallidum | Primary: painless ulcer (chancre); Secondary: rash, condylomata lata; Tertiary: gumma, CVS, neurosyphilis | Benzathine Penicillin G 2.4 MU IM stat (primary/secondary); × 3 weeks (tertiary) |
| Herpes (HSV-2) | HSV-2 | Painful genital ulcers, inguinal LAP, dysuria | Acyclovir 400 mg TDS × 7–10 days (primary); 400 mg BD (suppression) |
| Trichomonas | T. vaginalis | Frothy yellow-green discharge, strawberry cervix, pH >4.5, wet mount shows motile trichomonads | Metronidazole 2 g oral stat (both partners) |
| Candidiasis | C. albicans | Thick white "cottage cheese" discharge, pruritus, satellite lesions, pH <4.5 | Clotrimazole 500 mg pessary stat OR Fluconazole 150 mg oral stat |
| BV | Gardnerella/anaerobes | Thin grey offensive discharge, Clue cells, Whiff test +ve, pH >4.5, Amsel criteria | Metronidazole 400 mg BD × 7 days OR 2 g stat |
| HPV | HPV 6, 11 | Condylomata acuminata (genital warts) | Podophyllotoxin 0.5% BD × 3 days/week; imiquimod 5%; cryotherapy |
| LGV | C. trachomatis L1–L3 | Painless genital ulcer → inguinal bubo ("groove sign") → rectal syndrome | Doxycycline 100 mg BD × 21 days |
| Chancroid | H. ducreyi | Painful soft ulcer + painful inguinal LAP (bubo) | Azithromycin 1 g stat OR Ceftriaxone 250 mg IM |
33. URINARY TRACT INFECTIONS — MALE & FEMALE
| Feature | Details |
|---|
| Classification | Uncomplicated (young women, lower UTI); Complicated (men, pregnancy, structural/functional abnormality, catheter-associated) |
| Organisms | E. coli (80%), Klebsiella, Proteus, Staphylococcus saprophyticus (young women), Enterococcus |
| Findings | Dysuria, frequency, urgency, suprapubic pain; pyelonephritis: flank pain, fever, rigors, CVA tenderness |
| Investigations | MSU C&S, urine dipstick (nitrites + leukocytes), FBC, CRP (if systemic); USS if complicated; DMSA scan (scarring); MCUG (reflux in children) |
| Treatment | Uncomplicated: Nitrofurantoin 100 mg MR BD × 5 days OR Trimethoprim 200 mg BD × 7 days; Pyelonephritis: Ciprofloxacin 500 mg BD × 7–14 days; Severe/Septic: IV Ceftriaxone or Piperacillin-Tazobactam |
| OPD Prescription | Tab Nitrofurantoin 100 mg BD × 5 days (female uncomplicated); Tab Ciprofloxacin 500 mg BD × 7 days (male/pyelonephritis); increase fluid intake; cranberry (adjunct) |
| Contraindications | Nitrofurantoin: eGFR <30, pregnancy near term; Trimethoprim: pregnancy (folate antagonist) |
| ICU Management | Urosepsis/septic shock: SEPSIS-3 bundle — IV fluids (30 mL/kg), blood cultures before antibiotics, IV Piperacillin-Tazobactam or Meropenem (if resistant), vasopressors (noradrenaline), source control (urological drainage) |
34. INTERSTITIAL CYSTITIS / BLADDER PAIN SYNDROME
| Feature | Details |
|---|
| Findings | Chronic pelvic/bladder pain, urinary urgency/frequency, nocturia, no infection; Hunner ulcers on cystoscopy |
| Investigations | Urine C&S (negative), cystoscopy + hydrodistension + biopsy, urodynamics |
| Treatment | Pentosan polysulfate 100 mg TDS; amitriptyline; intravesical DMSO/heparin; cystoscopic Hunner ulcer fulguration; neuromodulation; cystectomy (last resort) |
| OPD Prescription | Tab Pentosan polysulfate 100 mg TDS; Tab Amitriptyline 25 mg nocte; dietary modification (avoid caffeine, citrus, spicy foods) |
35. URETHRAL CARUNCLE (FEMALE)
| Feature | Details |
|---|
| Findings | Painful red tender mass at urethral meatus; postmenopausal women; may mimic cancer |
| Treatment | Topical estrogen cream; if persistent: surgical excision + histology (exclude malignancy) |
| OPD Prescription | Estriol cream applied topically to meatus BD × 4 weeks |
36. HYDATIDIFORM MOLE (see GTD, #27)
37. FEMALE GENITAL MUTILATION (FGM) COMPLICATIONS
| Feature | Details |
|---|
| Complications | Chronic pain, dyspareunia, obstructed labor, recurrent UTI, keloid, obstetric complications |
| Management | Deinfibulation; obstetric planning; safeguarding; psychological support; contraception counseling |
38. UTERINE/FALLOPIAN TUBE ANOMALIES
| Feature | Details |
|---|
| Types | Unicornuate, bicornuate, septate (most common), didelphys, arcuate uterus; Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome |
| Findings | Recurrent miscarriage, preterm labor, abnormal menses, amenorrhea (MRKH); USS/MRI |
| Treatment | Hysteroscopic metroplasty (septate uterus); progressive vaginal dilation (MRKH); IVF/surrogacy |
39. ADENOMYOSIS
| Feature | Details |
|---|
| Definition | Endometrial glands/stroma within myometrium |
| Findings | Dysmenorrhea, HMB, globally enlarged "boggy" uterus, tender on palpation; thickened junctional zone on MRI (>12 mm) |
| Investigations | Pelvic USS (heterogeneous myometrium, myometrial cysts), MRI (gold standard), CA-125 mildly elevated |
| Differential Diagnosis | Fibroids (more focal), endometriosis, endometrial cancer |
| Treatment | LNG-IUS (Mirena — first-line); GnRH agonists; Dienogest 2 mg OD; hysterectomy (definitive) |
| OPD Prescription | LNG-IUS insertion; Tab Dienogest 2 mg OD; tranexamic acid; NSAIDs |
| Contraindications | Conservative management may not control symptoms in severe cases; exclude malignancy in postmenopausal |
40. GENITAL TRACT FISTULAE (VESICOVAGINAL, RECTOVAGINAL)
| Feature | Details |
|---|
| Causes | Obstetric (prolonged obstructed labor — most common worldwide), post-surgical (hysterectomy), radiation, malignancy |
| Findings | Continuous urine or stool leakage through vagina; VVF: continuous wet, always damp; RVF: flatus/stool per vaginum |
| Investigations | Dye test (methylene blue intravesically for VVF), cystoscopy, MRI, fistulogram |
| Treatment | Small/early: catheter drainage × 4–6 weeks may allow spontaneous closure; Surgical: VVF repair (Latzko/transvaginal or abdominal); RVF: endorectal advancement flap or colostomy + delayed repair; 3-month wait post-radiation |
| OPD Prescription | Catheter drainage; topical estrogen; refer to specialist fistula center |
| ICU Management | Urosepsis complicating fistula: antibiotics, nephrostomy if obstructed; post-radiation fistula: HBO therapy adjunct |
KEY DRUG CONTRAINDICATIONS SUMMARY TABLE
| Drug/Class | Key Contraindications |
|---|
| PDE-5 inhibitors (Sildenafil, Tadalafil) | Nitrates (ABSOLUTE), recent MI/stroke, severe hypotension, uncontrolled BP |
| GnRH agonists (Leuprolide, Goserelin) | Not sole long-term treatment (bone loss); pregnancy |
| Methotrexate | Renal/hepatic impairment, active infection, pregnancy, breastfeeding, immunodeficiency |
| COCP | Thrombophilia, migraine with aura, smoker >35, hepatic disease, undiagnosed vaginal bleeding |
| Doxycycline | Pregnancy, breastfeeding, children <8 years |
| Nitrofurantoin | eGFR <30, term pregnancy, G6PD deficiency |
| Metformin | eGFR <30, IV contrast (hold 48 hrs), hepatic failure |
| Bleomycin | Poor pulmonary reserve (pulmonary fibrosis risk) |
| Cisplatin | Severe renal impairment, pre-existing neuropathy, poor hearing |
| Bevacizumab (anti-VEGF) | Fistula history, active bleeding, recent surgery, hypertension (uncontrolled) |
| Testosterone replacement | Prostate cancer, polycythemia, severe BPH with obstruction |
| Transscrotal testicular biopsy | Testicular cancer (disrupts lymphatic drainage) |
ICU MANAGEMENT QUICK REFERENCE
| Condition | ICU Priority |
|---|
| Fournier's Gangrene | Immediate surgical debridement + Pip-Tazo + Metro + Vancomycin; daily wound reviews; consider HBO |
| Ruptured Ectopic | Massive transfusion, emergency laparoscopy, cell salvage |
| Septic Shock (PID/Urosepsis) | SEPSIS-3 bundle: cultures → antibiotics → 30 mL/kg IV fluid → noradrenaline if refractory; source control |
| OHSS (severe) | Thromboprophylaxis, albumin infusion, dopamine agonist, paracentesis, monitor renal function |
| Post-TURP Syndrome | Dilutional hyponatremia → hypertonic saline (3% NaCl, correct Na+ at ≤8–10 mEq/L/day) |
| Testicular Torsion | Operating room within 1 hour of presentation |
| Ovarian Torsion | Emergency laparoscopy within 6 hours |
| GTD Respiratory Failure | Ventilatory support; avoid aggressive diuresis; early chemo |
| Spinal Cord Compression (Prostate Ca mets) | Dexamethasone 10 mg IV bolus → 4 mg q6h + emergency MRI + EBRT or decompression |
| Tumor Lysis Syndrome (Testicular Ca) | IV hydration, rasburicase/allopurinol, monitor K+, PO₄, uric acid, creatinine |
OPD PRESCRIPTION TEMPLATES (Key Conditions)
BPH:
Rx: Tab Tamsulosin 0.4 mg — 1 tab at bedtime
Tab Finasteride 5 mg — 1 tab OD (if prostate >30g)
Duration: 6–12 months; review PSA at 6 months
PID:
Rx: Inj Ceftriaxone 500 mg IM — stat dose
Tab Doxycycline 100 mg — 1 tab BD × 14 days
Tab Metronidazole 400 mg — 1 tab BD × 14 days
Advise: treat partner; abstain during treatment; STI screen
PCOS (menstrual regulation + hyperandrogenism):
Rx: Tab Co-cyprindiol (Diane-35) — 1 tab OD D1–21, then 7-day break
Tab Metformin 500 mg — 1 tab TDS with meals (titrate)
Tab Folic acid 5 mg OD (if planning pregnancy)
Endometriosis:
Rx: Tab Dienogest 2 mg — 1 tab OD continuously
Tab Mefenamic acid 500 mg — TDS during pain episodes
OR: GnRH agonist + add-back if severe
Uncomplicated female UTI:
Rx: Tab Nitrofurantoin 100 mg MR — 1 tab BD × 5 days (with food)
Increase fluid intake to 2–3 L/day
Urine C&S if recurrent (>2 episodes/year)
Genital Herpes (Primary):
Rx: Tab Acyclovir 400 mg — 1 tab TDS × 7–10 days
Tab Ibuprofen 400 mg TDS PRN (pain)
Saline bathing; advise abstinence during active lesions
Syphilis (Primary/Secondary):
Rx: Inj Benzathine Penicillin G 2.4 MU IM — stat
(If penicillin allergic: Doxycycline 100 mg BD × 14 days)
Advise: partner notification; retest at 3, 6, 12 months
Sources: Campbell-Walsh Urology (9780323546423), Berek & Novak's Gynecology (9781496380357), Smith & Tanagho's General Urology (9781259834332), Goldman-Cecil Medicine (9780323930345), Sabiston Textbook of Surgery (9780443124341), Creasy & Resnik's Maternal-Fetal Medicine (9780323828499)
