male gu disorders

Question 1

what is a hydrocele?

Answer 1

Abnormal, painless collection of fluid in tunica vaginalis that leads to swelling of scrotum

Question 2

what are the 2 types of hydrocele’s?

Answer 2

communicating and non-communicating

Question 3

what is a communicating hydrocele?

Answer 3

Congenital, most common in children <12 yo
Secondary to a patent process vaginalis
Congenital patent processus vaginalis which allows peritoneal fluid to travel into the tunica vaginalis

Question 4

what is a non-communicating hydrocele?

Answer 4

Acquired
No defects
Imbalance in rates of fluid secretion and reabsorption w/in a closed tunical vaginalis
MC in adults
Iatrogenic
acute epidymitis
viral dz
malignancy
torsion
trauma

Question 5

what are the S/S of a hydrocele?

Answer 5

painless swelling n groin or scrotum
may be described as heaviness
may increase in size through out the day

Question 6

what would you want to ask a person in HPI about with hydrocele?

Answer 6

ask about onset
Hx of prior panful swelling in groin or scrotum
hx of surgeries

Question 7

what is the diff on PE between communicating vs non-communicating?

Answer 7

comm: fluctuant that can be manually reduced
non-comm: fluctuant that cannot be manually reduced
Can transilluminate will glow soft red color

Question 8

what is the tx for hydrocele?

Answer 8

in children watchful waiting
or surgery
in adults surgery

Question 9

what is a vericocele?

Answer 9

dilated vein of spermatic cord

MC correctable cause of infertility in men

Question 10

what is the etiology of varicocele

Answer 10

valve insufficiency

pathogensis increased pressure in veins d/t valve insufficiency

Question 11

what are s/s of varicocele

Answer 11

often asymptomatic

occasionally painful or heavy sensation that is worse w/ prolonged standing and improved when supine

Question 12

what will the PE findings be like for a varicocele?

Answer 12

bag of works appearance

increases w/valsalva, decrease when supine

Question 13

what labs/imagining would you want to order?

Answer 13

Scrotal US w/doppler used to assess for venous reflux and assess testicular volume for hypoplasia
semen analysis
consider Abdominal US if varicocele does not decrease when supine

Question 14

what are the Grade I,II,III varicocele classification

Answer 14

I: palpable during valsalva only
II: palpable w/o valsalva
III: visible from distance

Question 15

what is Tx for varicocele

Answer 15

symptomatic scrotal support, analgesics

surgery venous ligation or embolization

Question 16

what is a spematocele?

Answer 16

Benign cystic accumulation of sperm that arises from the head of the epididymis
Can develop on the testicle itself or anywhere along the vas deferens

Question 17

what is the epidemiology of spermatocele

Answer 17

prevalance unknown

30% of cases identified on US that is being performed for other reasons

Question 18

what are the signs/symptoms

PE findings?

Answer 18

typically asymptomatic accidentally found on exam
PE: arise from head of epipdidymis therefore they are superior to testicle and are round and smooth cyst will transilluminate

Question 19

how is a spermatocele dx

Answer 19

clinical dx based on hx and exam and confirmed by US

Question 20

what is the tx for a spermatocele

Answer 20

if asymptomatic no tx just monitor

if symptomatic, progressively enlarging or bothersome to pt then surgical excision or sclerotherapy

Question 21

what is the prevalence of epididymitis

Answer 21

600,000
MC in men 18-35
Bi-modal distribution 16-30 years old and 51-70yrs old

Question 22

what is the etiology of epididymitis

Answer 22

men35 UTI MC ecoli

Question 23

what are Rf for epididymitis

Answer 23

sexually active

pubertal boys and men>35: recent urinary tract surgery, BPH, cysts

Question 24

what are signs/symptoms of epididymitis?

Answer 24

fever/chills
testicular pain and swelling
dysuria, urgency, frequency
hematuria

Question 25

what are the PE finding like for epididymitis?

Answer 25

scrotal erythema pain may be releaved with testicular elevation may have suprapubic tenderness or CVA if UTI urethral d/c

Question 26

what is the tx for epididymitis?

Answer 26

tx empirically do not delay while waiting for culture symptomatic scrotal elevation ice and rest Abx: if STD ceftriaxone or doxy if enteric organism: Levofloxacin or ofloxacin Follow up 2-7 days after tx may take upto 4 wks

Question 27

what is orchitis

Answer 27

acute inflammatory rxn of the testes secondary to infx | most cases are associated with viral mumps, other viruses or bacteria can cause this

Question 28

what is epidemiology of orchitis

Answer 28

20% of prepubertal boys w/ mumps will develop orchitis happens primarily in boys under 10yrs old men> 50yrs old d/t obstruction

Question 29

what is the MCC of orchitis?

Answer 29

mumps

Question 30

s/s of orchitis?

Answer 30

acute onset testicular pain and swelling fever, chills, nausea, malaise, myalgia in mumps orchitis develops 4-7 days after parotitis

Question 31

PE findings of orchitis?

Answer 31

enlargement of testicle w/ induration testicular tenderness skin of scrotum erythematous and edematous

Question 32

diagnosis of orchitis

Answer 32

mumps- based of hx and PE alone sexually active males urethral cultures and gram stain and U/A culture US doppler r/o torsion and show inflammation

Question 33

tx for orchitis

Answer 33

``` supportive care: bed rest, hot/cold pack for pain scrotal elevation if viral mumps will reslove in 3-10days Abx start empirically based on bacteria ```

Question 34

what is testicular torsion?

Answer 34

Twisting of the spermatic cord causing obstructed blood flow (venous return) leading to compromised arterial flow and ischemia

Question 35

what types of torsion are there?

Answer 35

torsions of testes- spermatic cord occurs during neonatal period and puberty torsions of appendix- remnant of mullarian duct and located superior anterior

Question 36

Rf of testicular torsion

Answer 36

90% associated with bell clapper deformity of intravaginal torsion testicular tumor hx of undescended teste long intrascrotal portion of spermatic cord

Question 37

s/s of testicular torsion

Answer 37

severe unilateral scrotal pain scrotal swelling abdominal pain n/v

Question 38

PE findings of testicular torsion

Answer 38

``` epididymis diplaced teste not in norm position testicle may be higher in scrotum affected testicle may be enlarged cremater reflex absent ```

Question 39

PE for torsions of appendix testis

Answer 39

pain usually located at superior pole point tenderness blue dot cremaster reflex present

Question 40

testicular torsion dx

Answer 40

U/S doppler only if dx in question and low suspicion of torsion or pain >6hrs will show low echogenic lesion w/central hypoechoic area

Question 41

tx for testicular torsion

Answer 41

manual detorsion -quick, non-invasive pts is supine and provider rotates testis away from midline if successful immediate pain relief and still needs orchioplexy

Question 42

what causes urethritis

Answer 42

STD MC

Question 43

classifications of urethritis

Answer 43

gonorrhea urethritis non-gonococcal urethritis idopathic trauma related- catheter, FB

Question 44

epidemiology urethritis

Answer 44

men>25

Question 45

urethritis RF

Answer 45

incresed # of sex partners lack of condoms prior STD/Urethritis recent catheter or FB insertion

Question 46

s/s urethritis

Answer 46

``` urethral d/c: GCU opaque, yellow or white NGU:scant, mucoid, clear dysuria urethral pruritis hematuria painful intercourse/ejaculation ```

Question 47

urethritis PE findings

Answer 47

urethral meatus may be erythematous, tender w or w/o swelling Urethral discharge

Question 48

how to Dx urethritis

Answer 48

gram stain discharge PCR/ (NAAT) urine or urethral swab 1cm in urethra with a gentle twist

Question 49

urethritis TX

Answer 49

GCU: ceftriaxone 125mg IM or cefixime NGU: azithromycin or doxy Trichomonas: get metronidazole

Question 50

urethritis follow up

Answer 50

if recurrent symptoms retest in 3mths is recommended abstinance x 1wk following tx Tx all sexual partners