Genitourinary #3 Flashcards by Tyler Cichowski

Prostatitis is prostate gland inflammation secondary to an ascending infection. What are the MC causes if the patient is > 35 years and < 35 years old?

> 35: E. Coli
< 35: Chlamydia and Gonorrhea

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However, in children, the MCC of prostatitis is

Viral (Mumps)

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Symptoms of prostatitis

Irritative voiding: dysuria, frequency, urgency
Obstructive voiding: hesitancy, dribbling, incomplete emptying, malaise, arthralgia

Acute: fever, chills, perineal pain. Lower back pain.

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What symptoms does the patient usually have if the prostatitis is chronic in nature?

Recurrent UTIs or intermittent dysfunction
Fever NOT common in chronic

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On physical exam for prostatitis, the prostate is usually boggy. What is the difference in prostate exam if the case is acute vs chronic

Acute: VERY tender, boggy
Chronic: contender, boggy

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Explain the unique diagnostics of prostatitis

UA and urine culture: pyuria and bacteriuria in acute. Often negative in chronic so prostatic massage to increase bacterial yield. However, do NOT do massage in acute, can lead to bacteremia.

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Treatment for prostatitis if the patient is > 35 years old

Fluoroquinolones or Trimethoprim-Sulfamethoxazole x 4-6 weeks

If inpatient, IV Fluoroquinolones with Aminoglycoside

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If the patient is < 35 years old, then an STI is likely cause of prostatitis. Therefore the treatment is

Ceftriaxone + Doxycycline (or Azithromycin instead of Doxy)

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If the prostatitis is refractory to other medications, you should do

Transurethral resection of the prostate (TURP)

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MCC of epididymitis in males 14-35 years old

Chlamydia Trachomatis and Gonorrhea

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In men > 35, the MCC of epididymitis is

E. Coli

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Symptoms of epididymitis

Gradual onset of localized testicular pain and swelling (unilateral)

Groin, flank, or abdominal pain

May be associated with fever, chills, or irritative symptoms (dysuria, urgency, frequency)

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What is seen on physical exam of a patient with epididymitis?

-Scrotal swelling and tenderness
-Positive Prehn Sign (relief of pain with scrotal elevation)
-Positive cremasteric reflex: elevation of testicle after stroking inner thigh

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What is the best initial test for epididymitis and what is seen on it?

Scrotal US: enlarged epididymis and increased testicular blood flow

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However, what other test for epididymis should also be done and why?

NAAT to rule out Gonorrhea and Chlamydia

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Conservative Management of epididymitis

Scrotal elevation, NSAIDs, cool compresses

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Medical management of epididymitis

< 35 years: Doxycycline + Ceftriaxone (or Azithromycin instead of Doxycycline)

> 35 years: Fluoroquinolones (Ciprofloxacin, Ofloxacin, Levofloxacin) (Bactrim is an alternative)

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MCC of orchitis

Viral (Mumps MC, Echovirus, Rubella, Coxsackie)

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Symptoms of orchitis

-Scrotal pain, swelling, and tenderness
-Scrotal erythema and tenderness

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Treatment for orchitis

-Symptomatic management: NSAIDs, bed rest, scrotal support, and cool packs.

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Who is at highest risk for testicular torsion (2 groups)?

Males 10-20 years of age & Neonates

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Symptoms of testicular torsion

Abrupt onset of scrotal, inguinal, or lower abdominal pain (usually < 6 hours)

Nausea, vomiting

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If ____ and ___ are present, suspect torsion over epididymitis

Nausea and vomiting

Physical exam findings of a patient with testicular torsion

-Swollen, tender, high-riding testicle that may have horizontal lie
-Negative Prehn Sign: no pain relief with elevation
-Negative cremasteric reflex

Although testicular torsion is a clinical diagnosis, what study is most commonly done, but what other study gives a definitive diagnosis?

Common: testicular doppler US Definitive: Surgical exploration

Treatment for testicular torsion

Urgent detorsion and orchiopexy within 6 hours of pain onset (Irreversible damage of ischemia after 12 hours)

What is cryptorchidism?

Testicle that has not descended into the scrotum by 4 months of age

Name 3 facts about cryptorchidism

-Most resolve spontaneously -Most are right-sided -Most commonly found just outside the external ring, inguinal canal, or abdomen

Risk factors for cryptorchidism

Prematurity Low birth weight Maternal obesity Maternal Diabetes

Treatment for cryptorchidism

Orchiopexy as early as 4-6 months old, before 2 years old

What are four major complications of cryptorchidism

Increased risk of testicular cancer Decreased fertility Testicular torsion Inguinal hernia

True or False: Testicular cancer is the MC solid tumor in young men 15-35 years old

True

Most significant risk factor for testicular cancer

Cryptorchidism

Other risk factors for testicular cancer

Caucasians Klinefelter's Syndrome Hypospadias

What type of testicular cancer type is the MC?

Germinal cell tumors (Nonseminomas and Seminomas)

Nonseminomas, the MC type of testicular cancer, is associated with what 2 labs and....

-Increased serum alpha-fetoprotein and beta-HcG Resistance to radiation

What are the 4 S's of Seminomas?

-Simple (lacks tumor marker alpha-fetoprotein) -Sensitive (sensitive to radiation) -Slower growing -Stepwise spread

Symptoms of testicular cancer

-Painless testicular mass (MC) -May have dull pain or testicular fullness -Firm, hard, fixed mass that does not transilluminate

Initial test of choice for testicular cancer

Scrotal US

On scrotal US, what is seen with a nonseminoma?

Cystic, non homogenous mass

On scrotal US, what is seen with a seminoma?

Hypoechoic mass

What tumor markers are present in nonseminomas?

Increased alpha-fetoprotein and beta-hCG

For staging of testicular cancer, what diagnostic is done

CT of the abdomen, pelvis, and chest

What is the prognosis usually like with testicular cancer?

Excellent (5 year survival rate > 95%)

If the testicular cancer is low-grade seminoma vs high-grade seminoma, what's the treatment?

Low grade: radical orchiectomy. May need radiation High grade: chemotherapy followed by orchiectomy and radiation

What is a hydrocele?

Serous fluid collection within the layers of the tunica vaginalis of the scrotum

A hydrocele is the MCC of

painless scrotal swelling

MCC of a hydrocele

Idiopathic

Symptoms of a hydrocele

Painless scrotal swelling (may increase throughout the day) Dull ache or heavy sensation with increasing size

Initial test of choice for a hydrocele

Testicular US

What is unique about a hydrocele on physical exam?

It transilluminates

Treatment for a hydrocele

watchful waiting (often resolves within first 12 months of life) Surgical if persists beyond 1 year in age or communicating (link to peritoneum) to reduce risk of hernia

What is a spermatocele?

Epididymal cyst that contains sperm

Physical exam findings of a patient with a spermatocele

Round, soft mass at the head of the epididymis that is superior, posterior, and separate from the testes Freely movable and transilluminates

Even though scrotal US is done for a spermatocele, what is the treatment?

No treatment usually necessary, but surgical excision if chronic pain (rare)