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Genito-urinary Flashcards

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1
Q

what is an epididymal cyst

A

usually develop in adulthood and contain clear on milky (spermatocele) fluid.

lie above and behind the testis

remove if symptomatic

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2
Q

what is a hydrocele

A

fluid within the tunica vaginalis

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3
Q

what is a congenital hydrocele

A

associated with a patent processus vaginalis, which typically resolves during the 1st year of life.

communicating:

    • occurs due to the failed closure of the processus vaginalis during development.
    • usually discovered in infancy
    • reducible. increases in size with the valsalva manoeuvre.

non-communicating hydrocele

  • no connection to the peritoneal cavity present.
    • NOT reducible. doesn’t increases in size with the valsalva manoeuvre.
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4
Q

what is an acquired hydrocele

A

secondary to underlying pathology: testis tumour/ trauma/ infection/ torsion

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5
Q

clinical features of hydrocele

A

fluctuant, painless swelling of affected scrotum.

  • may be present since infancy or childhood
  • may or may not be reducible

positive transillumination

palpation above the swelling is possible - a normal spermatic cord and inguinal ring are present

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6
Q

diagnosis of hydrocele

A

clinical usually

ULTRASOUND every hydrocele to rule out malignancy - hypoechoic fluid confirms the diagnosis.

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7
Q

treatment of hydrocele

A

congenital hydrocele usually resolves spontneously within 6 months of birth.

indications for surgery

  • if spontaneous resolution doesn’t occur by 1 year of age.
  • excessive discomfort
  • underlying pathology suspected
  • testicle not palpable
  • infertility is a concern

procedures

  • surgical excision of the hydrocele sac
  • percutaneous aspiration of the hydrocele fluid
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8
Q

what is a varicocele

A

abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum due to proximal obstruction of the spermatic vein.

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9
Q

causes of primary varicoele

A

not fully understood.
left testicle most commonly affected (85%)
- longer course of the left spermatic vein and its insertion at a 90° angle into the left renal vein predisposes to slower drainage and increased hydrostatic pressure.

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10
Q

causes of a secondary varicocele

A

mass in the retroperitoneal space (Ormond disease, lymphoma, RCC) obstructing venous drainage into the IVC (right-sided varicocele) or left renal vein (left-sided varicocele)

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11
Q

clinical features of a varicocele

A

painless enlargement may be present.
dull, aching pain of the hemiscrotum
HEAVINESS OF THE AFFECTED SCROTUM.
soft bands/strands are palpable in the upper pole of the affected scrotum (‘bag of worms’)

symptoms worsen when standing or performing the valsalva maneouver.

negative transillumination

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12
Q

diagnosis of varicocele

A

BILATERAL ULTRASOUND (dilated >2mm hypoechoic pam-uniform vessels)

doppler ultrasonography

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13
Q

treatment of varicocele

A

conservative management - scrotal support.

invasive treatment

  • laparoscopic varicocelectomy - occluded by ligation.
  • percutaneous embolisation
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14
Q

complications of varicocele

A

infertility

  • sperm is produced in the testicles at 2°C below the average body temp
  • in a varicocele, blood stasis within the scrotum increases local temp, resulting in sub-optimal environment for spermatogenesis.
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15
Q

what is cryptorchidism

A

failure of one or both testicles to descend to their natural position in the scrotum

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16
Q

risk factors for cryptorchidism

A

prematurity

low birth weight

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17
Q

clinical features of cryptorchidism

A

palpable (80%) - testicle cannot be manually manipulated into the scrotum.

non-palpable - may be intra-abdominal or absent.

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18
Q

variants of cryptorchidism

A

inguinal testis - testicle is located between the external and internal inguinal ring, preventing adequate mobilisation (90%).

intra-abdominal testis - testicle is located proximal to the internal inguinal ring.

ascending testes - testicular retraction into the scrotal pouch is possible.

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19
Q

diagnosis of cryptorchidism

A

clinical diagnosis
laboratory tests
- testosterone (bilateral - low, unilateral - normal (normal Leydig cell function))

  • low inhibin B
  • high FSH, high LH
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20
Q

treatment of cryptorchidism

A

typically resolves without treatment via spontaneous descent of testicles by 6 months of age.

persistent cases (6-18 months of age)
- ORCHIDOPEXY
- Orchidectomy
(if non-viable testicular remnants or late discovery of undescended testicle (>2y).

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21
Q

complications of cryptorchidism

A

testicular cancer (germ cell tumours)

infertility - higher temp of the abdo cavity is suboptimal for spermatogenesis –> oligospermia –> infertility

testicular torsion
inguinal hernia

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22
Q

what are the different types of testicular tumour

A

Seminoma (55%) 30-65yeard olds

Non-seminomatous germ cell tumours e.g. teratoma (33%) - 20-30 year olds

mixed germ cell tumour

lymphoma

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23
Q

signs of testicular tumour

A

PAINLESS TESTIS LUMP, found after trauma/infection ± haematospermia, secondary hydrocele.

dyspnoea (lung mets)

abdominal mass (enlarged nodes) or effects of secreted hormones.

25% of seminomas and 50% of NSGCT present with metastases

gynaecomastia - if HCG high

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24
Q

risk factors for testicular cancer

A

cryptorchidism (undescended testis)

infertility

contralateral testicular cancer

family history of testicular cancer

Klinefelter syndrome; trisomy 21 (increased risk for germ cell tumours).

germ cell neoplasia in situ

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25
tumours markers used in testicular cancer
AFP | Beta-HCG
26
which tumour marker is raised in testicular choriocarcinoma (NSGCT)
beta-HCG - extremely high levels
27
which tumour marker is raised in yolk sac tumours (NSGCT)
AFP - high
28
what type of nonseminomatous GCT are there
embryonal carcinoma teratoma testicular choriocarcinoma yolk sac tumour
29
what is a teratoma in testicular cancer
commoner in children may contain elements of muscle, cartilage, bone, teeth.
30
what is the most common testicular tumour in men >60 years of age
LYMPHOMA (large b-cell lymphoma) - extra-nodal non-hodgkins lymphoma
31
how to testicular tumours metastasise
via the lymphatic system - drain to the para-aortic lymph nodes first.
32
what are the paraneoplastic features of testicular cancer
hyperthyroidism | - HCG can mimic TSH, enabling weak stimulation of the TSH receptor in tumours with HCG overproduction.
33
investigations for testicular cancer
lab tests - AFP, HCG + LDH imaging - ULTRASOUND CT TAP - for staging and checking for mets biopsy - only done following removal of testis to prevent tumour seeding.
34
treatment of testicular cancer
prior to surgery - sperm cryopreservation radical inguinal orchidectomy adjuvant chemoradiotherapy (based on histology findings and staging)
35
symptoms of torsion of testis
SUDDEN ONSET PAIN IN ONE TESTIS - making walking uncomfortable. typically swollen and tender testicle and/or lower abdo tenderness. pain in the abdomen nausea and vomiting
36
signs of torsion of testis
inflammation of one testis - tender, hot and swollen lies high and transversely ABSENT CREMASTERIC REFLEX PREHN SIGN NEGATIVE
37
what is torsion of testicular appendage (hydatid of Morgagni)
causes less pain tiny BLUE nodule may be visible under scrotum. Mx - NSAIDs or if in doubt, surgical exploration
38
ddx of testicular pain
testicular torsion epididymo-orchitis tumour trauma
39
treatment of testicular torsion
SURGERY WITHIN 6 HOURS consent for bilateral orchidopexy and possible orchidectomy. only do a doppler ultrasound if diagnosis is uncertain but DO NOT DELAY SURGERY!
40
ddx of undescended testes
cryptorchidism retractile testis - excessive cremasteric reflex. found in external inguinal ring. mx - reassure. maldescended testis - found anywhere from abdo to groin ectopic testis - common in superior inguinal pouch but could be in the abdo, perineal, penile or femoral triangle.
41
complications of maldescended and ectopic testis
infertility testicular cancer testicular trauma testicular torsion hernias (patent processus vaginalis)
42
treatment for maldescended or ectopic testis
ORCHIDOPEXY hormonal - HCG
43
what is balanitis
acute inflammation of the foreskin and glans associated with strep and staph infections MOST COMMON IN DIABETICS often seen in young children with tight foreskin
44
management of balanitis
antibiotics circumcision hygiene advice
45
causes of balanitis
poor genital hygiene contact allergies and topical irritants drug reaction bacterial infection e.g. STI (gonorrhoea) yeast infection - recent hx of ABx use trauma
46
clinical features of balanitis
pruritus, pain, and oedema of the glans penis erythema and ulcerated lesions of the glans or foreskin fever, arthralgia, malaise thick penile discharge
47
investigation for balanitis
clinical usually gram stain and culture for bacterial infection
48
treatment of balanitis
conservative - daily retraction of foreskin and bathing with warm saline solution. - avoid known irritants e.g. soap - topical anti fungal e.g. clotrimazole - Abx for bacterial infection - topical corticosteroid cream for irritant contact or drug reaction. - treat underlying chronic condition (psoriasis, reactive arthritis, diabetes) surgery - circumcision in recurrent cases
49
complications of balanitis
post inflammatory phimosis UTI recurrent UTI penile cancer
50
what is phimosis
tight foreskin that cannot be completely retracted over the glans penis
51
causes of phimosis
post-infection of balanitis congenital scarring after trauma or circumcision
52
sx of phimosis
difficulty in retracting the foreskin posteriorly painful erection and/or dyspareunia
53
treatment of phimosis
conservative - topical corticosteroid cream stretching exercises surgical - vertical incision or circumcision
54
complication of phimosis
foreskin tear - haemorrhage paraphimosis
55
what is paraphimosis
urological emergency tight foreskin is pulled back behind the head of the penis and then becomes stuck. it cannot be placed forward again to its usual position covering the tips of the penis. causing swelling, pain and loss of blood flow to the tip of the penis.
56
causes of paraphimosis
complications of phimosis iatrogenic - following bladder catheterisation trauma
57
features of paraphimosis
noticeable band of constricting tissue foreskin cannot be returned to original position. oedema and pain of the glans penis features of penile ischaemia (blue skin)
58
treatment of paraphimosis
conservative - manual reduction with adequate pain control (topical anaesthesia, local anaesthesia, regional block) surgery - dorsal slit reduction surgery - circumcision (last resort)
59
complication of paraphimosis
penile necrosis
60
what is prostatitis
inflammation of the prostate gland which may be infectious (acute and chronic bacterial prostatitis) or non-infectious (chronic pelvic pain syndrome).
61
common cause of acute bacterial prostatitis
E. COLI | gonorrhoea and chlamydia - consider in men <35y of age.
62
common cause of chronic prostatitis
bacterial - e.coli non-bacterial - immune response to a prior UTI - nerve damage in the pelvic region - chemical irritation - pelvic floor muscle dysfunction - parasitic or viral infection
63
causes of both acute and chronic bacterial prostatitis
UTI - urethritis, cystitis, epididymitis genitourinary tract interventions - catheter, prostate biopsy voiding dysfunction and bladder outlet obstruction
64
clinical features of acute bacterial prostatitis
spiking fevers, chills, malaise acute dysuria, frequency, urgency severe pain in lower back, perineal, pelvic and with defecation prostate - tender, boggy, warm and swollen
65
clinical features of chronic bacterial prostatitis
low-grade fever in some patients. dysuria, frequency, urgency, ED, bloody semen mild genitourinary pain prostate - normal, may be enlarged or tender
66
clinical features of chronic pelvic pain syndrome
possibly ED painful ejaculation bloody semen moderate, diffuse pain in the lower abdo, lower back, perineum, scrotum and penis. prostate - normal usually.
67
laboratory tests for acute bacterial prostatitis
urinalysis - MSU - high WCC urine culture - e.coli most common urine gram statin bloods - raised WCC, CRP. blood cultures - if septic
68
treatment of bacterial prostatitis
first line - Antibiotic therapy for 6 weeks (ciprofloxacin, co-trimoxazole) if acute retention and persistent fever - suprapubic catheterisation
69
treatment of chronic pelvic pain syndrome
alpha-blockers - tamsulosin 5-alpha reductase inhibitors - finasteride NSAIDs psychological support and treatment physiotherapy
70
complication of prostatitis
prostatic abscess (antibiotics + transrectal USS-guided drainage) acute urinary retention pyelonephritis and sepsis epididymitis

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