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?
*** 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?
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?
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
- lice (crabs)
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.
What can cause of priapism?
- intracavernous injection of vasoactive agents for impotence
- PDE-5 inhibitors
- sickle cell disease
- pelvic tumors
- 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.