Diseases of Penis, Male Urethra, and Scrotal Contents Flashcards Preview

RGU 3 > Diseases of Penis, Male Urethra, and Scrotal Contents > Flashcards

Flashcards in Diseases of Penis, Male Urethra, and Scrotal Contents Deck (53)

What are the most important modalities needed to make a diagnosis of the male genitalia?

- thorough inspection of the penis, palpation, and ultrasound of the scrotal contents


What is the most common mass lesions within the scrotum?

- hydrocele


*** What is a hydrocele?

- an accumulation of fluid between the visceral and parietal layers of the tunica vaginalis that can surround the testicle, cord, or both.
- results when there is a reduction in the reabsorption of or increase in the production due to injury or infection, cancer, or we just don't know.


*** What is a congenital hydrocele?

- a persistence of peritoneal fluid within 1 or more unobliterated segments of the process vaginalis as it descends from the abdomen and through the inguinal canal.
*almost always accompanied by indirect inguinal hernia, which requires surgical repair.


What are the physical findings of a hydrocele?

- involved side larger than the other.
- involved side has sense of fluctuation and feels like a balloon filled with water.
- will usually transilluminate
- will not reduce unless it communicates.
- testicle may not be palpable.


What is the treatment for a hydrocele?

- observation (may resolve spontaneously, particularly in children).
- large or uncomfortable, then surgical resection.


What is an inguinoscrotal hernia?

- indirect hernia sac extending through the inguinal canal down into the scrotum.
- usually contains bowel but can contain omentum, bladder, etc...
- does not transilluminate well.
- testicle and epididymus usually palpable.


Is an inguinoscrotal hernia usually reducible?

- YES, but occasionally incarcerated or strangulated, which would require urgent surgery.


What is a spermatocele (epididymal cyst)?

- a benign retention cyst of the head of the epididymus or aberrant tubules of the rete teste.
- usually transilluminates.
- contain spermatozoa


What will a spermatocele (epididymal cyst) feel like on palpation?

- separate from the testicle on palpation.
- is firm to palpation, usually non-tender and about the size and shape of a marble.


How do you treat a spermatocele?

- remove surgically only if painful (rare).


*** What is the most common cause of male infertility?

- varicocele


How should you always check for a hernia?

- with the man STANDING.


*** What is a varicocele?

- a dilation of the internal and external spermatic and vasal veins within the scrotum.
- caused by incompetency or absence of valves in the internal spermatic vein allowing retrograde flow of blood.
- if acutely could be due to retroperitoneal mass.


Does varicocele happen more often on the left or right?

- left side due to anatomy of the left spermatic vein draining into the left renal artery at a 90 degree angle.


With what are varicoceles associated?

- rise in scrotal temperature leading to reduction in sperm motility and maturation and thus infertility
- palpated as "bag of worms" in the upright position. NOT palpable in supine position.


Should you treat varicoceles?

- only if discomfort or fertility is a problem.


What is a hematocele?

- blood between the parietal and visceral layers of the tunica vaginalis resulting from trauma to the testicle.
- cannot palpate testicle


With what is a hematocele usually associated?

- ecchymosis (discoloration) of the scrotum


How do we treat a hematocele?

- surgery


What must you remember about torsion of the spermatic cord?

- extreme urgency that requires prompt diagnosis and treatment.
- most occur in the 1st year of life.


What is the most common form of a spermatic cord torsion?

- intravaginal torsion occurring in boys during puberty.
- testicle and cord twist within the tunica vaginalis.


What are the clinical findings of torsion of the spermatic cord?

- sudden onset severe pain that may be referred along the cord to groin.
- exquisite tenderness to palpation
- nausea and vomiting common.
- testicle engorged and high in scrotum with thickened cord.
*pain may subside spontaneously and be recurrent.


Will you see urinary tract symptoms with torsion?



How long do you have to save a boy's testicle after a torsion?

- 5-12 hours and FIX both sides bc this is a congenital anomaly.


What should be on your DDx for torsion?

- epididymitis and epididymo orchitis.


What are the testicular appendages and can torsion occur in these?

- appendix testes and appendix epididymis, which can both succumb to torsion.


What is epididymitis, epididymo orchitis, and orchitis?

- inflammation of the epididymis followed by the testicles due to infection causing mild discomfort in lower abdomen and within scrotum progressing to severe pain, mostly in scrotrum.
- commonly associated with fever.
- pyuria (pus in the urine) is often present if bacterial.
*always rule out torsion first.


What causes orchitis often?

- secondary to systemic viral infection with MUMPS


How do we treat epididymitis/orchitis?

- ice, elevation, scrotal support, analgesics
- cord block if pain is severe
- broad spectrum antibiotics if bacterial.


Does pain or size resolve first in epididymitis/orchitis?

- pain resolves first


What is the most common cancer in men age 18-40?

- testicular cancer
*most are germ cell tumors (seminoma, embryonal, teratoma, choriocarcinoma, or yolk sac tumors).


How does testicular cancer present?

- painless swelling
- can produce hydrocele or hematocele.
- any area of the testicle that is firmer or harder than other areas must be suspicious.


How should a primary testicular tumor be removed?

- surgically through inguinal approach.


Is chemo effective in treating metastatic testicular cancer?

- YES very :)
*not chemo will not be effective on the primary tumor, so this is why it must be removed surgically.


What is the most common cause for testicular avulsion?

- trauma due motorcycle accidents or getting caught in machinery.


What is Fournier's gangrene?

- infection of the genitalia that causes severe pain in the penis and scrotum or perineum, and progresses from erythema to necrosis of tissue.


What is urinary extravasation?

- collection of urine in other cavities due to blunt or penetrating trauma to the anterior or posterior urethra.
- can be iatrogenic from catheterization.


How do you diagnose urinary extravasation?

- retrograde urethrogram


What are the common dermatoses of the inguinal area?

- tinea crurus
- eczema
- monillia
- lice (crabs)
- folliculitis
- hemangiomas


What STDs and other cutaneous disorders can occur on the penis?

- genital herpes (HSV-2)
- primary chancre (syphilis)
- kaposi's sarcoma (HIV)
- condyloma accuminatum (HPV)
- chancroid (haemophilus ducreyi)
- lymphogranuloma venereum
- granuloma inguinale


If patient is uncircumcised, what should you always do to the foreskin of the penis?

- retract the skin to inspect the glans penis.


What are almost all cancers of the penis?

- squamous cell carcinomas
*almost exclusively found in uncircumcised males.


How does penile cancer metastasize?

- through lymphatics


What is Peyronie's Disease?

- growth of fibrous plaques on the dorsal or ventral tunica albuginia causing an abnormal dorsal or ventral curve of the erect penis.
- can present with pain, difficulty with penetration or poor erection.
*requires surgery to correct.


What is priapism?

- prolonged painful erection not related to sexual stimulation.
- glans and corpora spongiosum will be soft, but corpora cavernosa will be firm.
*urologic emergency


What can cause of priapism?

- intracavernous injection of vasoactive agents for impotence
- PDE-5 inhibitors
- leukemia
- sickle cell disease
- pelvic tumors
- trauma
- prolonged stimulation


How do you reverse priapism?

- intracorporeal adrenergic injection of epinephrine
- irrigate the blood.


What is phimosis?

- a condition in which the foreskin cannot be retracted due to stenosis or underlying adhesions.


What is paraphimosis?

- the retracted foreskin cannot be reduced. Progressive swelling occurs resulting in a urologic emergency.


What has reduced the amount of urethral strictures?

- the advent of penicillin


What is fracture of the penis?

- rupture of one or more of the tunica albuginea of the penis during aggressive intercourse.
*easily treated surgically.


When are posterior urethral valves most often diagnosed?

- in utero