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Integration for Clinical Application > 3.1.1 Men's Health Urology I > Flashcards

3.1.1 Men's Health Urology I Flashcards

1
Q

What is phimosis?

A

Prepuce (foreskin) cannot be fully retracted

1% of adult non-circumcised population

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2
Q

What is physiological phimosis?

A

Normal non-retractability up to adolescence

50% at 1 year
10% at 3 years
1% at 17 years

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3
Q

What causes phimosis?

A

Poor hygiene leading to increased STD risk causing an accumulation of smegma

No images to save your eyes from burning

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4
Q

What can happen in phimosis if left untreated?

A
  • Increased STD risk
  • Pain on intercourse, splitting/bleeding
  • Balanitis (inflamed glans)
  • Posthitis (inflamed foreksin)
  • Balanitis Xerotica Obliterans (BXO)
  • Paraphimosis
  • Urinary retention
  • Penile cancer
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5
Q

What is paraphimosis?

A

Painful constriction of the glans penis by the retracted prepuce proximal to the corona-

Basically foreskin gets stuck when pulled back, oedema, tight ring forms

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6
Q

What causes paraphimosis?

A

Phimosis
Catheterisation (esp. elderly ensure its pulled back after in elderly)
Penile cancer

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7
Q

How is phimosis managed?

A

May be associated with other pathologies, so may have to deal with that

Circumcision is the best treatment

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8
Q

How is paraphimosis treated?

A

Needs reduction, usually achieved manually

May need dorsal slit

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9
Q

What type of cancer is penile cancer?

A

Squamous cell carcinoma

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10
Q

What are the risk factors for developing penile cancer?

A

Phimosis, hygiene problem- smegma

HPV 16 and 18

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11
Q

Who is affected by penile cancer?

A

20% < 50 years old

If left untreated most die within 2 years, almost all within 5 years

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12
Q

What are the key indications for paediatric and adult circumcisions?

A

Paediatric
-Religious
-Recurrent balanitis/UTIs

Adult
-Recurrent balanitis
-Phimosis
-Recurrent paraphimosis
-Balanitis xerotica obliterans
-Penile cancer

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13
Q

What are some causes of acute scrotal pain?

A
  • Testicular torsion
  • Epididymitis / Orchitis / Epididymo-orchitis
  • Torsion of hydatid of Morgagni
  • Trauma
  • Ureteric calculi (rarely)
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14
Q

What causes epididymitis?

A

– Urinary tract infection (UTI)
– Sexually transmitted infection (STI)
– Mumps

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15
Q

What is the typical presenting history of testicular torsion?

A
  • Usually younger patient ( < 30 y)
  • SUDDEN onset e.g. woke from sleep
  • Unilateral pain; may be nauseated/vomit; often no LUTS
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16
Q

What do you find on examination of testicular torsion?

A

Very tender testis
Lying high in scrotum with horizontal lie

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17
Q

How do you manage suspected testicular torsion?

A

Patient needs emergency scrotal exploration

Do not waste time with investigations

18
Q

What is the typical presenting history for epididymo-orchitis?

A
  • Age
    – 20-40/50 – STI (esp Chlamydia)
    – 40/50+ - UTI (esp. E. Coli)
  • Gradual onset
  • Usually unilateral
  • Often recent history of
    – UTI
    – Unprotected intercourse
    – Catheter/urethral instrumentation
    – Check for mumps history
19
Q

What do you find on examination of epididymo-orchitis?

A

Pyrexial, can be septic
Erythematous scrotum
Enlarged testis/epididymis, tender
Fluctuat areas may represent abscess
May have reactive hydrocoele

20
Q

What is forunier’s gangrene?

A

Rare complication of epididymo-orchitis

Necrotic area of scrotal skin

High mortality ~50%

21
Q

What investigations are there for epididymo-orchitis?

A

Bloods
-FBC
-U&Es
-Cultures if septic

Urine
-MSU for MC&S

Radiology
-Scrotal USS if suspected abscess

22
Q

How do you treat epididymo-orchitis?

A

Antibiotics

Abscess-surgical drainage and antibiotics

Fournier’s gangrene- emergency debridement & abx

23
Q

What key questions should be asked about scrotal lumps?

A

Is it painful?
How quickly has it appeared?

24
Q

Features of scrotal lump examination

A

*Can I get above it?
– If not, likely to be a hernia
*Is it in the body of the testis?
– If yes, could be a testicular tumour
*Is it separate to testis?
*Does it fluctuate and transilluminate?

25
Q

What are some causes of painless scrotal lumps?

A

Testis tumour
Epididymal cyst
Hydrocele
Reducible inguino-scrotal hernia

26
Q

What causes scrotal lumps that are painless/aching at the end of day?

A

Not tender

Varicocele-bag of worms

27
Q

What causes painful-tender acute presentation with scrotal lumps?

A

Epididymitis
Epididymo-orchitis
Strangulated inguino-scrotal hernia- emergency

28
Q

What is the typical history of a testicular tumour?

A

Usually painless
Germ cell tumours (seminoma/teratoma) men < 45
Older men- may be lymphoma

29
Q

What increases the risk of testicular cancer?

A

History of undescended testis

30
Q

What is found of examination of testicular tumours?

A

-Body of testis is abnormal
-Not tender
-Can get above

31
Q

How do you manage suspected testicular tumours?

A

Refer via 2 week wait to urology

Urology will arrange USS to confirm diagnosis
Check for tumour markers aFP,hCG, LDH

32
Q

Typical history of a hydrocele

A

Slow, sudden onset
Uni/bilateral scrotal swelling

33
Q

What causes hydroceles?

A

Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis

34
Q

What is found on examination of a hydrocele?

A

Testis not palpable separately
Can usually get above
Transilluminates

35
Q

What is found on examination of an epididymal cyst?

A

Usually painless

Separate from testis
Can get above mass
Transilluminates

36
Q

What is the typical history of a varicocele?

A

Dull ache at the end of the day

More likely to affect left than right

Associated with reduced fertility, especially if bilateral

37
Q

What is present on examination of a varicocele?

A

Bag of worms above testis
NOT tender
Palpable abdominal/renal mass

38
Q

How do you treat a testicular tumour?

A

Inguinal orchidectomy

39
Q

How do you treat an epididymal cyst?

A

Reassure; excise if large

40
Q

How do you treat an adult hydrocele?

A

If normal testis on USS, reassure

Surgical removal if large/symptomatic

41
Q

How do you treat a varciocele?

A

Reassure
Radiological embolisation if symptomatic, infertility (slow motility of sperm), if present in adolescent and growth of testis affected

42
Q

How do you treat an inguinio-scrotal hernia?

A

Surgery-emergency if strangulated

Integration for Clinical Application (16 decks)

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