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Flashcards in Genitalia Deck (23)
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1
Q

DDX for lump in scrotum

A
Testicular cancer until proven otherwise!
Hydrocoel
Epididymal cyst or spermatocele
Hernia
Varicocoel
Benign tumour - lipoma
Lymphoma 
Skin: 
- Idiopathic scrotal oedema 
- Skin cancer
- Sebaceous cyst
2
Q

Presentation of testicular cancer

What investigations?

A

Hard PAINLESS lump in scrotum, appearing over history of months (fast growing)

Young male

Past HX cryptochordism

INV:
- scrotal U/S looking for distorted architecture
- Serum tumour markers alpha fetoprotein, beta-HCG and LDH
- Abdo CT and CXR (staging - mets to lungs, and retroperitoneal lymph nodes)
+/- brain CT and bone scan (mets to brain, bone)

3
Q

Markers of testicular cancer

A

Alpha fetoprotein
BEta-HCG

LDH is non-specific tumour market

*not always elevated but performed for surveillance and progress purposes)

4
Q

Treatment of testicular cancer

A

Inguinal orchidectomy
Bleomycin, Etopicide and Plisplatin (BEP) x4 courses

+/- Retroperitoneal lymph node dissections

5
Q

DDX for acute scrotum (new onset scrotal pain +/- swelling, tenderness, erythema)

A
Testicular torsion 
Appendage torsion 
Epididymitis
Scrotal edema 
Orchitis
Hernia
Trauma
Hydrocoel 
Varicocele
6
Q

Investigations for acute scrotum?

A
Dipstick 
MSU urinalysis
Urethral swab
Testicular U/S w doppler 
Surgical exploration
7
Q

What are factors pre-disposing to testicular torsion?

A

Bell-clapper deformity (Testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels)

Cryptochordism

8
Q

Presentation of testicular torsion

A

15-20 year old males
Rapid onset unrelenting testicular pain, nausea and vomiting
Testes higher than normal, tender, firm +/- swelling
thickened spermatic cord with ABSENT cremasteric reflex

9
Q

Treatment of testicular torsion

A

○ Urological emergency - 6 hour window before irreversible ischaemia occurs.

○ Needs surgery
Fixation +/- dartos pouch -> DO BOTH SIDES WHILE YOU’RE THERE!

10
Q

Appendage torsion:
- clinical presentation

Treatment

A

8-10 year old boys
Testicular pain
Palpation reveals small firm nodule on upper portion of testes with characteristic “blue dot” sign

Active cremasteric reflex

Treatment:

  • analgesia with self-resolution within 2-3 days
  • OR surgical dissection
11
Q

Presentation of epidymitis and orchitis

A

Sudden onset scrotal pain +/- radiation along cord to flank
Scrotal erythema, tenderness +/- lump if large abscess present
FEVER
Storage or inflammatory LUTS, purulent discharge

Resembles testicular torsion!

12
Q

Causes of and investigations for epidymitis and orchitis

A

young people: N. gonorrhoea or chlamydia trachoma’s

older people: With penetrative anal intercourse: GI organisms (E Coli), or urinary tract pathogens (KEEPS)

Mumps, Tb

INV:

  • U/A for MCS
  • urethral D/C swap for gram stain and PCR
  • Doppler U/S or surgical exploration if torsion is a DDX
13
Q

Risk factors epididymitis and orchitis

A
  1. UTI
  2. Unprotected sexual intercourse
  3. Instrumentation/catheterisation
  4. Reflux
  5. Immunocompromised
14
Q

Presentation of prostatitis

A

Acute bacterial: acute onset fever, chills, malaise, rectal/lower back/perineal pain and LUTS

Chronic: Pelvic pain, ejaculatory and post-ejaculatory pain + storage LUTS. Recurrent exacerbations of acute bacterial prostatitis or recurrent UTI.

15
Q

Investigations and Treatment of prostatitis

A

Investigations: Pelvic x-ray +/- U/S, Urinalysis, blood FBE and cultures.

Supportive care
PO or IV antibiotics depending on severity
+/- catheterisation depending on level of obstruction

Consider alpha blocker with chronic prostatitis

16
Q

Treatment of epidymitis

A

Elevation
Analgesia
Empiric antibiotics for GNB and STI coverage (Trimethoprim, cephalexin or augmentin, AND cefriazone or azithromycin)

STI screen and contact tracing

17
Q

What is Fournier’s gangrene?

A

○ Necrotising fasciitis of testes and perineum

○ Life-threatening spreading cellulitis and necrosis of skin and subcut fat

○ Typically presents with “crackling” of skin on examination

○ Needs aggressive debridement with skin grafts etc

○ Often in diabetic patients

18
Q

What is a haematocoel and how can it be caused?

Investigations and treatment?

A

Caused by trauma -> bleeding into space under tunica vaginalis .

Visualise any testicular rupture with U/S -> surgical exploration and evaculation/repair or orchidectomy + empirical antibiotics to prevent secondary abscess formation

19
Q

What leads to hydrocoeal?

A

in infants - congenital Patent processus vaginalis means free fluid in abdomen can leak into the space next to the testes causing painless enlargement

In adults, can be due to infection/inflammation, or neoplasm in testes

20
Q

What causes a varicocele? How does this present?

A

Abnormal enlargement of the pampiniform venous plexus (veins or spermatic cord) in the scrotum due to defective valves.
RARELY caused by RCC leading to venous congestion.

Presents as achy scrotal pain, worse at end of day, palpable and sometimes visible tortuous vein(s) in scrotum (‘bag of worms’) - often L side of scrotum

21
Q

What are the 3 most common forms of testicular cancer?

A

Seminoma
Mixed germ cell
lymphoma

22
Q

Why are most varicocoels on the left?

A

Because the L testicular vein drains into the L renal vein at a 90 degree angle which is can be difficult (vs R testicular veins drains into the R SVC at a lesser angle)

23
Q

What is idiopathic scrotal oedema?

A

Unilateral but more often bilateral swelling, red, warmth but non-tender testes

Causes:

  • Wall thickened due to allergic response to insect bite, common in boys under 10
  • or due to CCF or nephrotic syndrome in older patients