hydrocele/ varicocele/ torsion

Question 1

hydrocele definition

Answer 1

Liquid between the tuica albiginea and tunica vaginalis

Question 2

what is the importance of hydrocele in urology

Answer 2

it has little effect on hte testis but determining the primary cause in the main concern from the URO POV

Question 3

etiological classification of Hydrocele

Answer 3

Congential - d/2 patent processus vaginalis

Acquired

• 1ry- Idopathic d/2 imbalacation between secretion and absoprtion rates of Tunica vaginalis
• 2ndary-
  
  • Tumors,
  • FIlariasis,
  • Trauma,
  • Torsion

Question 4

cause of congenital hydrocele

Answer 4

patent processus vaginalis

Question 5

cuses of primary hydrocele

Answer 5

imalance in the secretion and reabsorption in the tunica vaginalis

Question 6

causes of secondary hydrocele

Answer 6

1. Filariasis
2. tumor
3. torsion
4. trauma

Question 7

what are the 2 classifications of hydrocele

Answer 7

communicationg and non communicating

Question 8

what is a communicating hydrocele

Answer 8

congenital type

communicates w/ abdom cavity via patent processus vaginalis

Question 9

what is non communicating hydrocele

Answer 9

1. viral infection in older children d/2 serositis
2. after filiarisis d/2 lymphatic absorption

Question 10

sx/ clinical features of hydrocele

Answer 10

soft round cystic swelling

non tender w/ dragging discomfort

Question 11

what is the method of diagnosing a hydrocele

Answer 11

Transillumination US

Question 12

Treatment of Hydrocele

what are the 3 steps

what is the borgman operation

Answer 12

1. incise scrotum
2. evacuate liquid
3. tissue around testicle to avoid winklemanns disease

borgmanns operation removal of peritesticular liquid and tissue

Question 13

what is winklemanns/ granuloma? disease

Answer 13

Cutaneous extravascular necrotizing granuloma

systemic immunoreactive or autoimmune diseases in a majority of cases. Typically, Churg Strauss granuloma presents as symmetrical papules or nodules on the extremitie???

Question 14

VARICOCELE

Answer 14

Dilation of the paminiform venous plexus and internal spermatic vein

Question 15

etiology of Varicoele

which side is it on and why

Answer 15

Usually on the LEFT side

1. Left testicular vein drains into the Left renal vein at an Acute angle
2. Lack of effective valves at the junction of the Testicular vein and renal vein
3. Increased pressure on the renal vein d/2 compression by the SMA & Aorta

Question 16

what is the venous drainage from the testicle

Answer 16

Left

Paminiform plexus -> Posterior part of Epidydimis-> Spermatic cord-> Left Testicular vein

Right

Paminiform plexus -> Left Testicular vein

Question 17

what is the functino of the pampiniform plexu s of veins

how is thi important in a varicocele

Answer 17

pampiniform plexus cools the temp around the testes

engorment and dilation of this plexus in a varicocele causes it to lose this function and may lead to infertility

Question 18

sx of varicocele

Answer 18

Scrotal heaviness

feels like a bag of worms

Question 19

clinical classification of varicocele on phys exam

Answer 19

Small - palpated w/ vasalva

Moderate- Palpation alone

Large- visible on inspection

Question 20

why are small varicoceles visible on vasalva

Answer 20

increased intra abdom pressure–> further impedes drainage-> engorment and vurther dilation

Question 21

dg of varicocle

Answer 21

Semen analysis

not visible on Transillumination

Question 22

surgical indications for varicocele

Answer 22

1. pain
2. large size
3. male infertility on semen anlysis

Question 23

how is a varicocele treated

Answer 23

Varicolectomy

1. ingional canal incision
2. ligation of testicular vein

Question 24

Testicular Torsion

Answer 24

Torsion of spermatic cord structures and subsequent loss of blood the ipsilateral testicle

Question 25

PP of Testicular Torsion

Answer 25

twisting of the testicle--\> **venous occlusion** and engorgement--\> arterial **ischemia** *(6hrs)*--\> testicular **infarctinon***(12hrs)*

Question 26

sx of Testicular Torsion

Answer 26

* _severe **unilateral** pain_ *preceeding* scrotal **swelling** * lower abdominal pain * loss of **cremasteric reflex** * associated pyrexia, **nausea**, vomitting

Question 27

diagnosis of testicular torsion

Answer 27

* pain _over 6 hours_ * swellng * _loss of cremasteric reflex_ * **_colour doppler_** for testicular blood flow

Question 28

tyopes of treatment of testicular torsion

Answer 28

_1)**Manual adjustment**_ - succesful if pain stops and confimred w/ doppler _2)**Orchipexy**_ - fix testes to scrotal wall - warm sponge to save viability _3)**Orchidectomy**_ - in case of necrosis

Question 29

how is ## Footnote Manual adjustment confimred in torsion

Answer 29

1. - succesful if pain stops 2. w/ doppler

Question 30

Orchipexy for torsion 2 procedures

Answer 30

- fix testes to scrotal wall - warm sponge to save viability

Question 31

when is Orchidectomy indicated in torsino

Answer 31

- in case of necrosis

Question 32

dx diagnosis of testicalr swelling

Answer 32

hydrocele * painless swelling w/ draging sensation * positive transillumination varicocele * bag of worms swelling * infertility/ semen analysis * negative transillumination Torsion * severe unilateral pain preceedes swelling * prehn's sign - loss of cremasteric reflex * collour doppler- reducd bf

Question 33

when does testicular ischemia occur in torsion

Answer 33

6 hrs

Question 34

when does infarction occur in torsion

Answer 34

12hrs

Question 35

what is prehns sign

Answer 35

loss of cremasteric reflex in testicular torsion d/2 ischemia