Male Pelvic Disease

Question 1

Indirect inguinal hernia

Answer 1

Goes through deep and superficial inguinal rings

Question 2

Direct inguinal hernia

Answer 2

May exit superficial inguinal ring, but doesn’t enter inguinal canal

Question 3

Incarcerated hernia

Answer 3

Tissue that has extruded and cannot return to NML position w/o surgery

Question 4

Strangulated hernia

Answer 4

Hernia with blood supply cut off

Question 5

Paraphimosis

Answer 5

The inability to replace the foreskin to its usual position after it has been retracted behind the glans > can lead to constriction > gangrene of glans penis

Question 6

Hypospadias

Answer 6

EUO is located on the ventral surface of the glans penis shaft or at the base of the penis

Question 7

Epispadias

Answer 7

EUO located on dorsal surface of shaft

Question 8

Syphilitic chancre

Answer 8

PAINLESS skin lesion associated with syphilis

Question 9

Herpes

Answer 9

PAINFUL STI caused by HSV

Question 10

Condyloma acuminata

Answer 10

PAINLESS genital warts caused by HPV

Question 11

Lymphogranuloma venereum

Answer 11

PAINLESS lesion caused by chlamydia

-present with fever and malaise

Question 12

Molluscum contagiosum

Answer 12

PAINLESS, benign skin infection caused by a poxvirus > umbilicated, smooth lesions

Question 13

Peyronie’s disease

Answer 13

Fibrous band in corpus cavernosum in tunica albuginea > interferes with expansion during erection

Question 14

Penile CA

Answer 14

PAINLESS ulceration that fails to heal

Question 15

Hydrocele

Answer 15

• collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis
• typically insidious onset of painless, transilluminating scrotal mass
• no tx unless symptomatic or communicating

Question 16

Communicating hydrocele

Answer 16

• patent processus vaginalis
• Found in infancy
• Disappear in recumbent position
• Concomitant indirect hernia
• Should be surgically corrected

Question 17

Spermatocele and Epididymal cyst

Answer 17

• Spermatocele = >2 cm
• Epididymal cyst = <2 cm
• benign fluid cystic masses
• painless, asymptomatic, intra-scrotal mass typically found on testicular self-exam or routine visit
• ultrasound should be done to be 100% sure
• no tx typical

Question 18

Varicocele

Answer 18

• dilation of pampiniform plexus vv.
• standing, valsalva make more prominent
• bag of worms
• No tx if asymptomatic or incidentally found
• surgery if: infertile with abnormal semen parameters, pain, or testicular atrophy

Question 19

acute epididymitis

Answer 19

• SEVERE swelling and EXCRUCIATING pain of epididymis and surrounding structures
• Fever, rigors, dysuria, urinary frequency/urgency
• (+) Prehn’s sign (better with scrotal elevation)
• Palpation reveals induration and swelling of the epididymis with exquisite tenderness
• tx = IV fluids and antibiotics OR NSAIDs, ice, oral antibiotics at home

Question 20

Chronic epididymitis

Answer 20

• Typically an ‘otherwise healthy’ male presenting with scrotal pain
• If ‘noninfectious’ may have hx of heavy physical exertion, bicycle or motorcycle riding, trauma
• epididymal tenderness and induration to lesser degree than acute
• Infectious tx: oral antibiotics + NSAIDs, ice, scrotal elevation
• Noninfectious tx: elevation, rest, warm baths, NSAIDs

Question 21

Orchitis

Answer 21

• typically co-exist with epididymitis
• tender, enlarged, indurated testicle
• if viral (mumps) treat symptoms

Question 22

Testicular torsion

Answer 22

• Twisting of the spermatic cord that is allowed due to inadequate fixation of the testis to the tunica vaginalis
• young presentation with sudden, severe onset of pain with N/V (not sick with fever, etc. JUST PAINFUL)
• asymmetric, high-riding testes
• profound testicular swelling
• absent cremasteric reflex, absent Prehn’s
• tx with manual detorsion