4 - Penis Flashcards
(98 cards)
1
Q
Penis
A
Anatomy slides 7,8
2
Q
What is balantitis and balanoposthitis?
A
Inflammation of the glans penis and/or foreskin
3
Q
Common cause of balanitis and balanopsthitis?
A
Usually candida albicans
- poor hygiene
- complication of phimosis
4
Q
What is phimosis?
A
Contracted foreskin cannot retract over glans
- can develop smegma, calculi and SCC under foreskin
5
Q
Presentation of phimosis?
A
Pain or tenderness of foreskin
Chronic “yeast infections”
6
Q
Tx for phimosis?
A
- Broad spectrum abx
- Circumcision
7
Q
What is paraphimosis?
A
Retracted foreskin is trapped behind glans penis
- tourniquet effect
- painful swelling of the glans
- necrosis
MEDICAL EMERGENCY
8
Q
Tx for paraphimosis?
A
Manual reduction (1st line)
Immediate urology referral if 1st line fails
- incision under local anesthesia
9
Q
So you did a manual reduction (never making eye contact) now what?
A
All paraphimosis pts require urological referral for circumcision to prevent further recurrence
10
Q
MC congenital malformation of the penis?
A
Abnormal location of the urethral meatus:
- Hypospadias - ventral meatus (penis, scrotum, perineum)
- epispadias - meatus opens on dorsal aspect of penis
11
Q
Hypospadiasis characteristics?
A
- More common
- associated w feminization
- excellent prognosis with repair
12
Q
Tx for hypospadias?
A
No circumcision (used as a graft)
Repair <18mo (usually 6mo)
13
Q
Epispadias characteristics
A
- Rare
- Urinary incontinence is common
- Dorsal curvature of penis is common
- Poorer prognosis
14
Q
What is chordee?
A
Abnormal congenital ventral curvature of the penis
- short urethra and or fibrous tissue around the corpus spongiosum
- commonly associated w hypospadias
15
Q
What is peyronie’s disease?
A
Fibrous d/o of tunica albuginea, curvature, deformity, pain
- acquired malformation
Middle aged men
16
Q
Causes of peyronie’s?
A
Probably minor penile trauma
- inflammation of corpora cavernosa -> d/o collagen disposition
17
Q
PE for peyronie’s disease?
A
Plaque involving the tunica albuginea that is:
- Palpable
- Dense
- Fibrous
- dorsal midline (usually)
18
Q
Peyronie’s diesase is associated with what condition?
A
Dupuytren contracture
19
Q
Tx for peyronie’s disease?
A
10% spontaneously improve
Medical therapies
- collagenase clostridial histolyticum inj
- CCB or interferon
Surgery (if compromised sexual function)
20
Q
Priapism is?
A
Erection >4hrs
- not associated w sexual arousal or desire
21
Q
Causes of priaprism?
A
Idiopathic (60%)
- leukemia
- SCD
- pelvic tumors
- penile trauma
- spinal cord trauma
- meds
22
Q
Types of priapism?
A
Non-ischemic
Ischemic
- both need urology consult
23
Q
Non-ischemic priapism?
A
- High flow priapism
- Arteriovenous shunging -> unregulated high blood flow
- perineal or spinal cord trauma
- may not require tx
- ED usually spared
24
Q
Ischemic priapism?
A
- Low flow-> venous congestion and arterial inflow cessation -> ischemic injury to corpora cavernosa
- painful erection
25
Tx for ischemic priapism?
Emergent treatment to prevent erectile function loss
- large needle blood aspiration
- adrenergic meds (phenylephrine)
26
How common is penile cancer?
Its not
| <1%
27
Risk factors for penile cancer?
```
Uncircumcised
- poor hygiene
Phimosis
- 7-10% increase
HPV infection
```
Usually seen in 6th decade
28
Types of penile cancer?
SCC - 98%
- seen on glans
```
Bowen disease (SCC in situ)
- red plaque on shaft
```
Erythroplasia of queyrat
- velvety red lesion w ulcerations on glans
- bowen disease of glans
29
Penile cancer ddx?
Biopsy - manditory to r/o
- syphilis
- chancroid
- condylomata
30
Scrotal pain, swelling and masses?
Pic on slide 36 shows the different types
31
Scrotal anatomy?
40, 41, 43
32
How is the scrotum evaluated?
Palpate testes between fingertips of both hands
Palpate for any suspicious masses
Transillumination -solid vs cystic lesion
33
MCC urology referral is for?
Mass on scrotum
They must decide if lesion is w/in testicle, related to epididymis or cord
34
Masses arising from w/in testes are?
Usually malignant
| - so there is that...
35
What testicular masses are usually benign?
Epididymis and spermatic cord are usually benign
36
Describe testicular malignancies?
Lesion that is:
- Painless
- Firm
- Solid
- W/in substance of testicle
- Does not transilluminate
37
Testicular mass “when in doubt?”
Image
- US preferred
Safe reliable method to relieve anxiety of the pt
38
List of scrotal/testicular masses
```
Hydrocele
Varicocele
Epididymal cyst
Spermatocele
Hernia
Testicular cancer
```
39
What is a hydrocele?
Collection of fluid between the 2 layers (parietal and visceral) of tunica vaginalis
40
Causes of hydrocele?
2/2
- congenital cause (patient process vaginalis)
- infection (epididymitis)
- trauma/testicular torsion
- tumors (cancer)
41
Describe hydrocele?
Young (usually 1st yr of life)
Painful (if large)
Heaviness in scrotum
Transilluminates
42
Tx for hydrocele
Watchful waiting
Surgery
- excision of hydrocele sac
43
With hydrocele?
DO NOT ASPIRATE
44
What is epididymal cyst?
Cyst occuring at the caput of the epididymus
- <2cm
- distinct from testicle
Benign
45
What is a spermatocele?
Benign cystic accumulation that arises from the head of the epididymis
>2cm
46
Symptoms of spermatocele?
Asymptomatic
- non tender on exam
If large, may feel “heavy”
47
Where do you palpate a spermatocele?
Palpable on exam
| - near upper pole of the testicle
48
Tx for spermatocele?
Watchful waiting
| Surgery (if symptomatic)
49
What is a varicocele?
Abnormal dilation of the pampiniform plexus of the spermatic veins
- bag of worms
50
Varicocele is most commonly found?
On the L
51
Varicocele presentation?
```
Dull ache
Size
- increase when upright
- decrease when supine
Pain worsens w activity
```
52
Varicocele a big deal?
May cause infertitlity
- increase scrotal temp -> germ cell apoptosis
- testicular atrophy
53
PE for varicocele?
Bag of worms
increase W valsalva
decrease when supine
Left side
+/- US (its a clinical dx)
54
Grades of varicoceles?
1: small - palp only w valsalva
2: moderate - nonvisible on inspection but palp on standing
3: large - visible on gross inspection
55
Further eval needed (varicocele)
- Unilateral right sided
- Lesion remains dilated when supine
- Occur abruptly (obstruction)
- Enlarge rapidly
56
R sided sudden varicocele may be?
Retroperitoneal malignancy
Get a CT scan
57
Tx for varicocele
Initially -> symptomatic management
- reassurance and watchful waiting
- scrotal support
- activity mod
- NSAID
W infertility/pain
Surgery
- ligation of gonadal vein via inguinal canal, laparoscopy or microsurgery
58
Types of hernias?
Indirect: congenital patient process vaginalis
Direct: arises from protrusion of abdominal viscera -> weakness of the posterior wall of inguinal canal (acquired)
Pics 67-69
59
Which type of hernia may extend into the scrotum and goes through the deep or internal inguinal ring into inguinal canal?
Indirect (congenital)
60
Diagnosis of hernia?
Palpable bulge (esp w valsalva)
US or CT
61
If there is any doubt wheteher a mass is w/in or outside testicle?
Get a scrotal US
urologic consult
It could be cancer to dont fuck around
62
MC neoplasm in men 15-35?
Testicular cancer
63
How is testicular cancer diagnosed?
Orchiectomy
| - damn, that escalated quickly
64
What type of cancer is testicular cancer?
90-95% are germ cell tumors
| - arise from spermatogenic cells w/in seminiferous tubules
65
Risk factors for testicular cancer?
- Cryptorchidism
- Testicular trauma/torsion
- Infection-related testicular atrophy
- Chemical exposure/pollutants
66
S/s of testicular cancer
- Painless enlargement of testes
- sense of heaviness
- palpable mass
- hydrocele (10%)
67
Labs for testicular cancer
Elevated
- hCG
- AFP (alpha fetoprotein)
- (LDH) lactate dehydrogenase
Advanced disease
- CBC
- LFT (liver mets)
68
Imaging for testicular cancer?
Scrotal US
| CT/PET after orchiectomy for staging
69
Treatment for testicular cancer?
Radical orchiectomy
| - further tx depending on what path says
70
Prognosis for testicular cancer?
Stage I-III : 5 yr = 95-100
Bulky retroperitoneal malignancy or advanced = 55-80%
71
Secondary testicular tumors are?
Rare
| Lymphoma (usually)
72
USPSTF says
No testicular self exam
- i say what you do in the privacy of your own home is your own business
73
Age prevalence of testicular torsion?
Neonates - MC
Post-puberty 60%
Men >21 40%
74
Presentation of testicular torsion?
Sudden onset of pain
- several hours after activity/trauma
- after cremasteric contraction during REM sleep (well damn)
Pain, N/V
75
PE for testicular torsion?
Classic sign:
- high riding testes w long axis oriented transversely
Early: profound swelling
Late: after 12hr reactive hydrocele and scrotal erythema
Exquisite tenderness
Absent cremasteric reflex
Neg phren sign
76
Testicular torsion is MC associated w?
Bell clapper deformity
77
Test of choice for testicular torsion?
Doppler US
| - if you dont have it just do the surgery
78
Tx for testicular torsion?
Surgery - life limb or eyesight
Removal or orchipexy
79
Manual detorsion?
Its a thing but should you?
Either way, its call “open book” R - counterclockwise and L - clockwise
30-70% success
80
You did the open book and it worked what now?
Still surgery
81
MCC of scrotal pain in adults
Epididymitis and epididymo-orchits
82
Epididymitis and epididymo-orchits are usually caused by?
Infection (2 types)
STI
- Men <40
- urethritis
- N gonorrea/chlamydia
Non-STI
- older men
- UTI and prostatitis
- Gram-neg rods
83
Acute presentation of Epididymitis and epididymo-orchits?
Follows physical strain (heavy lifting), trauma, or sex
Fever
Exquisite tenderness and swelling of epididymis, testicle and or scrotum
Irritative voiding symptoms
84
PE for Epididymitis and epididymo-orchits?
Induration
Swelling
TTP (exquisite)
+ phren sign
Epididymo-orchitis also have testicular swelling and pain w scrotal wall erythema and may have reactive hydrocele
85
What does phren sign differentiate?
Phren sign relieves pain w epididymitis
Does not relieve pain w testicular torsion
86
Diagnostic tests for Epididymitis and epididymo-orchits?
Diagnosed by PE
Also get:
- CBC
- UA
- Urine culture
- Gram stain of urethral discharge
- US (Equivocal exam)
87
Tx for Epididymitis and epididymo-orchits?
STI
- ceftriaxone + doxycycline
- treat the partner
Non-sexually transmitted form
- ciprofloxacin/levofloxacin
- eval urinary tract
Viral/non-infectious
- symptomatic care
Everybody:
- bed rest
- scrotal elevation
88
Direct blow or straddle type injury to the testicles can cause?
Hematocele
Rupture
Surgery referral
89
Blue dot sign?
Torsion of appendix testis
| infarction/necrosis
90
Torsion of appendix testis presentation?
Similar to testicular torsion (more gradual)
Blue dot sign
+ US
91
Tx for torsion of appendix testis?
Conservative tx
- rest
- scrotal elevation
- analgesics
92
Referred testicular pain?
```
Stones
Uti
Pyelonephritis
Low back pain
AAA
Post surgical (herniorrhaphy)
```
93
What does mumps do to the testicles?
Orchitis
| - fever, Parotitis usually precede orchitis
94
What os fournir’s gangrene?
Necrotizing fasciitis of perineum and scrotal skin
| - Diabetics
95
Fournier’s gangrene tx?
Urgent surgical debridement
96
What is PVPS?
Post-vasectomy pain syndrome
- chronic pain following vasectomy
- painful granuloma palpable at site of vas
- foreign body reaction
Blessedly uncommon
97
How is chronic orchalgia diagnosed?
Diagnosis of exclusion
98
Id like to give a big shout out to all the sidewalks
For keeping me off the streets
