Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GU > Lecture 11: Scrotal and Penile Disorders > Flashcards

Lecture 11: Scrotal and Penile Disorders Flashcards

(90 cards)

Start Studying
1
Q

What is a hydrocele?

A

Accumulation of fluid around the testis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the MCC PAINLESS scrotal swelling in pediatrics?

A

Hydrocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 noncommunicating hydroceles?

A
  • Testicular
  • Inguinoscrotal
  • Cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What connection makes a hydrocele communicating?

A

Processus vaginalis

Usually only present in newborns.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the usual S/S of a hydrocele?

A
  • Little to no pain
  • Fluid-filled mass ANTERIOR to testis
  • +/- scrotal fullness or heaviness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does a hydrocele look like on PE?

A

Like a little lightbulb on your penis

Transilluminates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging should we order if we suspect torsion related to a hydrocele?

A

Doppler US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do we treat a hydrocele?

A

If it lasts > 12months, communicating, or symptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for a hydrocele?

A
  • Needle aspiration
  • Definitive tx: Hydrocelectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe a variocele.

A

Dilated, engorged, tortuous veins within the pampiniform plexus of scrotal veins.

MC on the LEFT SIDE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most surgically correctable cause of male infertility?

A

Variocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might an unilateral R variocele suggest in terms of underlying etiology?

A

IVC obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the S/S of a variocele?

A
  • Scrotal enlargement or heaviness
  • +/- dull aching pain
  • Infertility
  • Asymptomatic is possible too.

Can also be painless like a hydrocele.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does a variocele feel like on PE?

A

Bag of worms that may improve with supine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the primary imaging test that can confirm dx of a variocele?

A

Doppler US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the conservative approach to variocele treatment? Surgical tx?

A
  • Conservative: Scrotal support and NSAIDs
  • Surgical: only for severe s/s or fertility.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the surgical tx options for a variocele?

A
  • Embolization of spermatic vein
  • Injected ablation of spermatic vein
  • Surgical ligation of pampiniform plexus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a testicular torsion?

A

Twist in the spermatic cord causing compromised testicular blood supply.

EMERGENCY!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What age group are testicular torsion MC in?

A

12-18 yr old

65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for testicular torsion?

A
  • Trauma
  • Vigorous exercise or sex
  • Cryptorchidism
  • Bell-clapper deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of testicular torsion?

A
  • Sudden onset of severe, unilateral scrotal pain/swelling
  • +/- lower abd pain, N/V
  • +/- hx of intermittent symptoms
  • NO VOIDING SYMPTOMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the classic presentation of testicular torsion?

A
  • High-riding testis
  • Slightly larger than unaffected testis
  • Transverse lie in scrotum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Prehn’s sign?

A

Pain does not relieve with scrotal support

Negative Prehn’s sign

Seen in testicular torsion.
Negative prehn’s => torsion
Positive prehn’s => epididymitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the cremasteric reflex?

A

Stroke/pinching skin or upper thigh should cause ipsilateral rise of testis.

Lack of this reflex suggests torsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the test of choice for testicular torsion?
Doppler US
26
What is the alternative to doppler US for testicular torsion?
Radionuclide scintigraphy
27
What is the purpose of UA in testicular torsion?
R/o infection
28
How do we treat testicular torsion?
Detorsion and fixation of testes | Either manual or surgical.
29
How is manual detorsion done?
Medial-to-lateral primarily. | Opening a book motion.
30
How quickly must surgical detorsion be performed?
6 hrs! | If > 12 hrs, you might lose your balls
31
What are the 5 criteria for the TWIST scoring system?
* Testicular swelling - 2 * Hard testicle - 2 * Absent cremasteric reflex - 1 * N/V - 1 * High-riding - 1 | 5+ high risk, 3-4 medium: do doppler US.
32
What is the most likely testicular appendage to be twisted?
Appendix testes | Also MC in younger patients!
33
What are the 4 possible testicular appendages that can undergo torsion?
* Appendix testis * Appendix epididymis * Paradidymis * Vas aberrans
34
How does testicular appendage torsion present?
* Similar to testicular torsion but less severe. * Blue dot sign * Normal blood flow
35
What is the treatment for testicular appendage torsion?
Conservative
36
What is phimosis and the MCC?
* Contracted foreskin that can't retract. * MCC: chronic infection from poor hygiene.
37
What demographic is pathological phimosis common in?
Diabetic older men with chronic balanoposthitis
38
What are the S/S of phimosis?
* If infected, edema, erythema, and tenderness of prepuce can be present. * Ballooning of prepuce during urination
39
What are the treatment options of phimosis underlying etiologies?
* Fungal: topical clotrimazole or nystatin or oral fluconazole * Bacterial: Topical bacitracin, oral metronidazole * Cellulitis/shaft: cephalexin
40
What are the temporary treatment options for phimosis?
* Hemostat dilation * Catheterization * Topical steroids * Frenar stretch * Surgical dorsal slits
41
When might circumcision be recommended for phimosis?
* Recurrent/persistent * Chronic balanitis or balanosthitis
42
What are the two dangerous complications of phimosis?
* Preputial calculi * Squamous cell carcinoma
43
What is paraphimosis?
Inability to reduce previously retracted foreskin. | Much more severe than phimosis.
44
What parasite is a cause of paraphimosis?
Plasmodium falciparum (malaria)
45
What happens if paraphimosis persists?
Necrosis, gangrene, and autoamputation.
46
What are the S/S of paraphimosis?
* Swollen, erythematous, tender foreskin proximal to the glans. * Donut sign * Flaccid penis proximal to foreskin ## Footnote Its like a penis ring
47
How do you perform manual reduction of paraphimosis?
* Pressure for 5 mins on glans to reduce edema. * Push glans proximally while pulling prepuce distally.
48
What are the 3 options after manual reduction of paraphimosis fails?
* Needle decompression * Dorsal slit to foreskin * Osmotic agents | Circumcision after inflammation subsides.
49
What is priapism?
Prolonged and painful pathologic erection
50
What is the MC etiology of priapism? 2nd MC?
* #1: idiopathic * MC known cause is intracavernous injection ED treatment.
51
What diseases can cause priapism?
Leukemia, SCD, cancer ## Footnote In children, SCD is the MCC.
52
What is high flow priapism?
* Nonischemic, presenting without pain. * Characterized by loss of penile arterial regulation. * Treated with embolization for aneurysms. | High flow = arteries
53
What is low flow priapism?
* Ischemic, more common and painful. * Characterized by **venous drainage** * Results in impotence | veins = slower
54
What are the S/S of each priapism?
* High flow: painless, prolonged * Low flow: several hours of painful erection * Low flow: glans penis and corpus spongiosum are soft and uninvolved. * Low flow: Corpora cavernosa - tense, congested blood, tender. * Low flow: urologic emergency.
55
What are the treatment options for priapism?
* Anesthesia * SubQ terbutaline * Corporal aspiration of viscous blood with irrigation
56
What are the treatment options for refractory priapism?
* Winter procedure: fistula * Excision of tunica albuginea * Shunts ## Footnote Shunt options: Cavernosa-spongiosum Saphenous vein-cavernous
57
What is Peyronie's disease?
* Fibrosis of **dorsal covering sheaths**, aka tunica albuginea. * Makes a curved penis when erect. * MC in middle-aged men and older.
58
What are the primary causes of Peyronie's disease?
* Trauma during sex * Vasculitis or CT disease * DM and hypercholesterolemia * Smoking, ETOH, Dupuytrens * Genetic predisposition
59
How does Peyronie's look like?
* Painful erection and curved penis * Poor erection distal to the curvature * No pain if not erect. | looks like someone just bent half of it
60
What is the initial treatment for Peyronie's?
Observe it
61
If we do decide to treat Peyronie's, what are the options?
* Vit E, colchicine, para-aminobenzoic acid * Intralesional injections of PTH, verapamil, etc * Radiation therapy * Excision of the plaque * Penile prosthesis
62
What is the MCC type of penile cancer?
Squamous cell carcinoma | MC in underdeveloped countries.
63
What age is typical for penile cancer to present?
Around 60 yo
64
What two viruses are risk factors for penile cancer?
* HPV * HIV
65
What are the S/S of penile cancer?
1. MC: skin abnormality or palpable lesions 2. Inguinal LAN 3. Metastatic symptoms ## Footnote Symptoms: Bone pain Cough Skin lesions
66
How do we initially treat penile cancer? 2nd?
* ABX if s/s of infection are present. * Biopsy if no improvement or no s/s of infection.
67
What are the two surgical treatment options for penile cancer?
* Low risk of recurrence: limited excision * High risk of recurrence: partial or total penile amputation
68
Who is STD epididymitis MC in?
* Men < 40, associated with urethritis. * N. gono * Chlamydia
69
Who is non-STD epididymitis MC in?
* Men > 40 * Associated with UTI or prostatitis * G- rods
70
What medication is most often implicated in causing epididymitis?
Amiodarone
71
What are the S/S of epididymitis?
* Post strain * Fever * Pain/swelling in scrotum (normal early) * +/- hydrocele * +/- inguinal LAN * Positive Prehn's (elevating scrotum will help, unlike torsion)
72
What would we see on an urethral swab for epididymitis if it is an STD?
* Gonorrhea: G- intracellular diplococci * Chlamydia: WBC without visible organisms.
73
What lab could we order to help confirm if a STD is causing epididymitis?
PCR
74
What is the empiric ABX regimen for epididymitis?
* Rocephin + Doxy | 10d, gono + chlamydia coverage
75
What is the ABX regimen for epididymitis if STD is highly UNlikely?
* Levofloxacin * Bactrim DS | 10d, G- rod coverage?
76
What are the usual causes of orchitis?
* Bacterial: complication of epididymitis * Granulomatous: autoimmune response to sperm * Viral: **MUMPS**, EBV, coxsackie, VZV, echovirus | Orchitis typically co occurs.
77
What are the S/S of orchitis?
* Swelling, tenderness, and erythema of testis * Scrotal pain (gradual onset with less pain than torsion) * Fever, +/- N/V * +/- inguinal LAN
78
What is the only difference in treatment for orchitis compared to epididymitis?
If anal sex is occurring, rocephin + levofloxacin is used.
79
What disease might predispose someone to a epididymal cyst?
Von-hippel lindau syndrome
80
What is a spermatocele?
A giant epididymal cyst > 2cm.
81
What cancer is the MC in males 20-35?
Solid testicular tumors | 90-95% are germ cell tumors.
82
What are the risk factors for testicular cancer?
* Cryptorchidism (**surgery doesn't reduce cancer risk**) * Exogenous estrogen during pregnancy * Infertility * Whites, but everyone else has increased mortality risk.
83
What is the MC symptom of testicular tumor?
Painless enlargement of testis. ## Footnote 10% can be asymptomatic.
84
Where is the MC site of metastases for testicular cancer?
Retroperitoneal abdominal lymph nodes
85
What labs can be tested as a biomarker for testicular cancer?
* AFP * hCG * LDH | Germ cell tumors can secrete hCG
86
What is the initial imaging modality for testicular cancer?
Scrotal US | Staging is with CT or CXR.
87
What is the definitive diagnostic modality for testicular tumors?
Radical inguinal orchiectomy. | Cannot simply biopsy.
88
What are the treatment options for testicular tumors?
* Inguinal exploration + vascular control of spermatic cord. * Radical inguinal orchiectomy
89
How often should followup be for testicular cancer?
* Monthly for 1st 2 years! * CXR/CT * Tumor markers at every visit | 80% relapse in 1st 2 yrs
90
What is the prognosis for testicular tumors?
90% 5-year survival rates

GU (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions