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Renal / Urology > Benign / Lumps in the Groin > Flashcards

Benign / Lumps in the Groin Flashcards

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1
Q

What is testicular torsion

A

Spermatic cord which supplies blood to the testicles becomes twisted

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2
Q

How does testicular torsion present

A 
Painful scrotum - acute, usually unilateral 
Tender
Painful to walk or move
Vomitnig
Redness
Transverse lie
Not relieved by lifting 
Thick cord
Firm testis 
Retracted / elevated testis
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3
Q

What happens to cremaster reflex in torsion of testis

A

Absent on side

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4
Q

Who is at risk

A

Young men
Congenital bell clapper - allows testis to rotate within tunica as not fixed to tunica vaginalis
Cryptochordism
Exertion / minor trauma

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5
Q

How do you treat

A 
SURGICAL EMERGENCY 
Clinical Dx 
Urine dip and bloods normal 
Inform senior and prep surgery 
NBM, analgesia
Pre-op blood - FBC, U+E, G+S 
Bilateral orchidopexy - fix both testis 
If >6 hours ischaemia is often irreversible causing infertility 
Orchiectomy if dead - consent for this 
Fix both as higher risk of othe
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6
Q

What Is DDX

A

Epididymitis - pain / discharge / urine
- +ve trans sign - elevating testis removes pain
- Abnormal dip / bloods
Torsion appendix
Trauma

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7
Q

What happens if don’t remove necrotic tissue

A

Atrophy

Anti-sperm Ab attacks contralateral side

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8
Q

What causes torsion appendix testis

A

Remnant of duct

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9
Q

How does it present

A

Unilateral scrotal pain
Could be on tender
Blue dot

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10
Q

What happens to cremaster reflex

A

Preserved and marked

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11
Q

How do you treat

A

Diathermy

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12
Q

What causes prostatitis

A

E.coli
S. faecalis
Chlamydia + G
Previous TB

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13
Q

How does prostatitis present

A 
UTI
Acute retention
Pain
Haematospermia
Swollen prostate on DRE
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14
Q

How do you Dx and Rx

A

Rectal swab
Analgesia
Ax

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15
Q

What is balantits

A

Inflammation of foreskin and glands

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16
Q

What causes balantitis

A 
Strep
Staph
Candida
STI
Dermatitis - contact, eczema, psoriasis
BXO 
Zoon's
- Persistent erythematous plaque on glands of penis - orange / red 
- Causes foreskin malfunction 
- Chronic and benign 
Circante
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17
Q

When is balantitis common

A

DM
Young children with tight foreskins / phismosis
Poor hygiene
Eczema / psoriasis

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18
Q

What is phimosis

A

Foreskin occludes the meatus and cannot be retracted

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19
Q

How does phimosis present

A

Recurrent balantitis in children
Painful intercourse
Infection
Ulceration

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20
Q

What is associated with balantiis and how does it present

A

BXO (male equivalent of lichen sclerosis

  • Painful itchy white spots
  • Tight white ring
  • Dysuria
  • Reduced sensation

Complications

  • Phismosis due to scarring
  • Balantitis
  • SCC
  • Infection
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21
Q

What is paraphismosis

A

Tight foreskin is retracted and becomes irreplaceable
Prevents venous return
Oedema
Possible ischaemia

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22
Q

How do you treat paraphismosis

A 
Return foreskin after catheter
Squeeze glands
Apply glucose swab or lidocaine gel 
Aspiration
Circumcision
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23
Q

How do you Dx balantitis

A

Swab if unclear or suspect bacterial

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24
Q

How do you Rx

A

Saline bath
Rx underlyin
Topical Ax or anti-fungal
Topical hydrocortisone

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25
What do you do for recurrent balantitis / Zoons
Circumcision | Hygiene advice
26
What are reasons for circumcision
``` Religious Recurrent balantitis BXO Pharphismosis Phismosis Reduce risk of penile cancer / STI / UTI ```
27
What do you do prior to circumcision
Hydrospadia as risk of stricture
28
What suggests an organic cause of erectile dysfunction and what causes this
``` Normal libido Ability to ejaculate Vascular = most common Neurogenic Structural Hormonal ```
29
What suggests a psychogenic cause
``` Sudden onset Decreased libido Self-erection Major life event Previous psych Problems in relationship History premature ejaculation ```
30
What are the RF for erectile dysfunction
``` Age Obesity DM Dyslipidaemia Metabolic HYpertension Alcohol Drugs TURP / pelvic surgery RT Endocrine Neuro ```
31
What drugs can cause
SSRI BB 5 alpha reductase
32
How do you investigate erectile dysfunction
CVS risk / examine system Free testesterone hypogonadism + HbA1c and lipid profile FSH, LH prolactin if low Refer to endocrine if abnormal
33
How do you treat erectile dysfunction
PDE-5 inhibitor - SIldenafil (Viagra) - Cause vasodilation in blood vessel supplying corpus cavernosum Regardless of cause Vacuum erection if not appropriate
34
When is Viagra CI and what are SE
CI - Patients taking nitrates - Hypotension - Recent stroke or MI SE - Blue visual disturbance due to ischaemic neuropathy - Flushing - GI - Headache
35
What do you do if never had an erection
Refer to urology
36
What other advise
Stop cycling
37
Differential of lumps in the groin
``` Epididymal cyst Hydrocele Varicocele Haematocele Epididymo-orchitis Inquinal heria Testicular torsion Tumour ```
38
What is 1st line investigation for ANY lump in the groin
USS
39
What is it if you CAN'T get above it
Inguinal hernia | Proximal extending hydroceles
40
What is it if separate from testis and cystic
Epididymal cyst - most common cause of lump
41
What is it if separate from tests and solid
Epididymitis | Varicocele
42
What is it If inside testis and cystic
Hydrocele
43
What is it if inside testis and solid
Tumour Haemaocele Granauloma Orchitis
44
What is an epididymal cyst
Above and behind testis Separate Contains clear milky fluid
45
How do you Rx and Rx
USS | Remove if causing symptoms
46
What is a hydrocele
Accumulation of fluid in tuna vaginalis of testis caused by patenty of PPV in children or excess Anterior and below Can get above May be difficult to palpate testis if large Soft Non tender Transilluminates
47
What should you always do with hydrocele
USS to exclude tumour as can be secondary to testicular tumour
48
What else can cause hydrocele
``` Primary in young to PPV drawing fluid in = communicating Trauma Torsion Infection - epidido-orchitis Malignancy - testicular ```
49
How do you treat
Resolve spontensous Aspiration Repair in the young by age 1 or 2 as due to PPV
50
What is a varicocele
Dilated veins of pampinoform plexus
51
How does it present
Bag of worms in scortum | Dull ache
52
What is varicocele associated with and what do you do to look for this
Infertility - serum parameters | If L could be RCC so do renal USS
53
How do you Rx
Conservative if mild | Surgery if symptomatic / abnormal semen parameters as affects fertility
54
What is haematocele
Blood in tunica vaginalis following trauma
55
How do you Rx
Drainage | Excision
56
What can cause epidymo-orchitis Infection of epididymis - epididymitis Infection of testis - orchitis
``` C+G E.coli Mumps TB Usually spreads from urethra or bladder ```
57
What is non-infective cause
Amiadarone
58
How does it present
``` Sudden onset Swelling Dysuria Erythema Sweats Fever Relieved by lifting Discharge suggests C+G May have hydrocele Pain confined to epididymis where as in torsion it is the whole scrotum ```
59
How do you Dx
1st catch urine Look for discharge STI screen USS can confirm
60
How do you treat
DONT MISS TORSION Ax Drain Warn of infertility
61
What is priaprism
Persistent painful erection in absence of sexual stimulation
62
What are two types
Ischaemic | Non-ischaemia
63
What causes ischaemic
Impaired vasorelaxation Reduced vascular outflow Congestion and trapping of deoxygenated blood
64
What causes non-ishcameic
High arterial inflow e.g. due to a fistula / congenital malformation
65
What is more suggestive of non-ischaemic
Not painful Not fully rigid Hx trauma
66
What are RF
``` Erectile dysfunction meds Recreational drugs - cocaine / ectasy Prescribed drugs - anti-hypertensive / coagulant / depressant Sickle cell / haemoglobinopathy Trauma ```
67
How do you Dx / investigate for cause
``` Clinical Cavernous blood gas analysis Doppler USS FBC Tox screen ```
68
What suggest sischaemia
Low O2 | High CO2
69
How do you treat
``` Ischaemic = emergency If >4 hours = aspiration of blood + injection saline flush Inject vasoconstriction agent if fails Surgery Non-ischaemia = watch and waste ```
70
What are complications
Permanent tissue damage | Persistent erectile dysfunction
71
What does intermittent testicular torsion require
Emergency surgery
72
If can't get above what is it
Inguinal hernia
73
If can get above it what do you ask
Is it separates from testis
74
If it is NOT separate
Does it transilluinate YES = hydrocele No = tumour
75
If it IS separate
Does it feel like worms Yes = varicocele No = epidiymal cyst
76
For any L scrotal mass or any torturous vein what must you rule out
Testicular or renal malignancy
77
Hydrocele in young
Malignancy till proven otherwise
78
Red and swollen
Torsion till proven otherwise
79
What is Fournier gangrene
NF of perineum
80
What causes
E.coli Staph Anoerobe - clostridium
81
Who is it common in
Immunocompromsied Type II DM ALcohl
82
How do you Rx
``` ABCDE Sepsis 6 NBM Fluid Broad spec Ax (tax and gent) Surgical debirdmenet ```
83
Peyronies disease
Scar tissue in penis makes it bend Can be painful and lead to ED Should recover in 12 months

Renal / Urology (16 decks)

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