GU Problems

Question 1

define hydrocele

Answer 1

an abnormal collection of fluid within the remnants of the processus vaginalis around the testes

Question 2

describe a simple hydrocele

Answer 2

accumulation of fluid within the tunica vaginalis

in neonates is simply congenital but in adults, occurs due to trauma, torsion or tumour formation

Question 3

describe a communicating hydrocele

Answer 3

persistence of the processus vaginalis to allow peritoneal fluid to communicate freely with scrotal portion of the processus

Question 4

describe a non-communicating hydrocele

Answer 4

occurs due to imbalance between secretion and reabsorption of fluid

Question 5

risk factors of hydroceles

Answer 5

younger age 
FH of hydroceles 
connective tissue disorder
low birth weight 
trauma

Question 6

clinical features of hydroceles

Answer 6

non-tender smooth enlargement of the scrotum

often transilluminates

Question 7

investigations of hydroceles

Answer 7

US of scrotum

Question 8

management of hydroceles in infants < 6mnths

Answer 8

watchful waiting as should self-resolve

Question 9

indication for surgical management of hydroceles in infants

Answer 9

unresolved >12mnths
excessive discomfort
compromised scrotal skin
suspect underlying pathology

Question 10

management of hydroceles in adolescents

Answer 10

reassurance and monitoring but if large and uncomfortable, consider surgery

Question 11

management of hydroceles in asymptomatic adults

Answer 11

observation

Question 12

management of hydroceles in symptomatic adults

Answer 12

aspiration and surgery

Question 13

define testicular torsion

Answer 13

an event in which tissues around the testicles are not sufficiently attached, causing twisting around the spermatic cord which obstructs blood flow

Question 14

describe intravaginal testicular torsion

Answer 14

torsion occurring secondary to lack of normal fixation of the posterior lateral aspect of the testes to tunica vaginalis

Question 15

describe extravaginal testicular torsion

Answer 15

torsion of both the spermatic cord and tunica vaginalis together

Question 16

clinical features of testicular torsion

Answer 16

sudden onset unilateral testicular pain causing swollen erythematous appearance
nausea and vomiting

Question 17

signs of testicular torsion

Answer 17

high rising scrotum
unilateral absence of cremaster reflex
no pain relief on testicle elevation (-ve prehn’s sign)

Question 18

management of testicular torsion

Answer 18

expedited surgical exploration and orchidoplexy

Question 19

define varicocele

Answer 19

a scrotal swelling consisting of an abnormal collection of dilated veins of the pampiniform plexus of spermatic cord

Question 20

describe subclinical and Grade I varicoceles

Answer 20

subclinical: detect only on Doppler US

Grade I: small and detected only on Valsalva manoeuvre

Question 21

describe Grade II and Grade III varicoceles

Answer 21

Grade II: moderate size and palpable without Valsalva

Grade III: large size and visible through scrotal skin

Question 22

clinical features of varicoceles

Answer 22

painless scrotal swelling
scrotum feels like “bag of worms”
feelings of scrotal heaviness

Question 23

investigations of varicoceles

Answer 23

colour Doppler studies
thermography
sperm counts

Question 24

management of subclinical or Grade I varicoceles in adolescent and adults

Answer 24

no treatment and annual examinations + sperm counts (in adults)

Question 25

management of Grade II and Grade III varicoceles in adolescent and adults

Answer 25

refer to urology

Question 26

common scrotum affected in varicocele cases

Answer 26

left

Question 27

define phimosis

Answer 27

inability of the foreskin to retract over the glans penis due to tightness of the foreskin

Question 28

clinical features of phimosis

Answer 28

``` issues retracting foreskin painful erections poor urine stream ballooning of foreskin of micturition recurrent balanitis ```

Question 29

management of phimosis in patients < 2yrs

Answer 29

reassurance advise against forceful retraction advise good hygiene

Question 30

management of phimosis in patients >2yrs

Answer 30

``` topical corticosteroid (e.g. Betamethasone) vertical incision ```

Question 31

define paraphimosis

Answer 31

an inability of retracted foreskin to return to its original anatomical location due to glans penis swelling

Question 32

clinical features of paraphimosis

Answer 32

unmoveable foreskin swelling and pain of the penis discolouration of the penis

Question 33

conservative management of paraphimosis

Answer 33

gradual manual reduction using topical or local anaesthetic

Question 34

surgical management of paraphimosis

Answer 34

dorsal slit reduction therapy

Question 35

last resort of phimosis and paraphimosis management

Answer 35

circumcision

Question 36

define cryptorchidism

Answer 36

an incomplete descent of one or both testes from the abdomen through the inguinal canal, causing absence from the scrotum

Question 37

risk factors of cryptorchidism

Answer 37

``` FH of undescended testes low birth weight preterm delivery endocrine disorder maternal smoking ```

Question 38

clinical features of cryptorchidism

Answer 38

lack of testes or a testicle within the scrotum

Question 39

investigations of cryptorchidism

Answer 39

bloods (FBC, TFTs and serum testosterone) | pelvic and abdominal US

Question 40

management of bilateral cryptorchidism

Answer 40

urgent referral to paeds for endocrine and genetic testing if still not present at 3mnths: referral for surgery by 6mnths

Question 41

management of unilateral cryptorchidism

Answer 41

review at 6-8wks if still not present: review at 3mnths if still not present: referral for surgery by 6mnths

Question 42

surgical method of choice in cases of cryptorchidism

Answer 42

orchidoplexy

Question 43

common complications of cryptorchidism

Answer 43

testicular torsion infertility testicular cancer