Penis and testicles

Question 1

What is balanitis? When is it seen most commonly?

Answer 1

Acute inflammation of glans and foreskin
Associated with strep and staph infections
More common in diabetics
Often seen in young children with tight foreskin

Question 2

Treatment of balanitis?

Answer 2

Antibiotics, circumcision and hygiene advice

Question 3

What is phimosis?

Answer 3

Occlusion of the meatus by the foreskin
In young boys this causes balanitis and ballooning
In adults - painful sex, infection and ulceration

Question 4

What is paraphimosis?

Answer 4

Occurs when tight foreskin is retracted and becomes irreplaceable
Impairs venous return - leading to oedema and ischaemia of glans

Question 5

Treatment of paraphimosis

Answer 5

Ask patient to squeeze glans
Apply a glucose-soaked swab - oedema may follow osmotic gradient
Ice packs and lidocaine gel
May require aspiration, dorsal slit or circumcision

Question 6

Features of acute prostatitis?

Answer 6

UTIs
Retention 
Pain 
Haematospermia 
Swollen/boggy prostate on DRE

Question 7

Treatment of acute prostatitis?

Answer 7

Levofloxacin and analgesia

Question 8

Features of chronic prostatitis?

Answer 8

Those of acute but present for >3months
UTI
Retention 
Pain 
Haematospermia
Swollen/boggy prostate on DRE

Question 9

Lump in testicle

Answer 9

Cancer until proven otherwise

Question 10

Acute, tender enlargement of testicles

Answer 10

Torsion until proven otherwise

Question 11

Can you get above the scrotal mass?

Answer 11

If you can’t - inguinoscrotal hernia or hydrocele extending proximally

Question 12

Scrotal mass separate from the testis and cystic

Answer 12

Epididymal cyst

Question 13

Scrotal mass separate from the testis and hard

Answer 13

Epididymitis or varicocele

Question 14

Scrotal mass which is testicular and cystic

Answer 14

Hydrocele

Question 15

Scrotal mass which is testicular and solid

Answer 15

Tumour
Haematocele 
Granuloma 
Orchitis 
Gumma

Question 16

What are epididymal cysts?

Answer 16

Usually develop in adulthood - contain clear or milky (spermatocele) fluid
Lie above and behind the testis
Remove if symptomatic

Feel separate and cystic

Question 17

What are hydroceles?

Answer 17

Fluid within tunica vaginalis

Feel testicular and solid

Question 18

Two types of hydrocele

Answer 18

Primary is associated with patent processus vaginalis - more common - larger and usually in younger men - can resolve spontaneously
Secondary to testis tumour/trauma/infection

Question 19

Treatment of hydrocele

Answer 19

Drainage - aspiration
May need repeating
Surgery - plicating tunica vaginalis

Question 20

What is epididymo-orchitis?

Answer 20

Infection of testes and epididymus

Question 21

Causes of epididymo-orchitis?

Answer 21

Chlamydia, e.coli, mumps, gonorrhoea, TB

Question 22

Features of epididymo-orchitis?

Answer 22

Sudden-onset tender swelling
Dysuria
Sweats and fever

Question 23

Treatment of epididymo-orchitis?

Answer 23

Doxycycline - covers chlamydia
Ceftriaxone if gonorrhoea suspected
For 2-4 weeks

Question 24

What is varicocele?

Answer 24

Dilated veins of the pampiniform plexus

Left sided more commonly affected

Question 25

Presentation of varicocele

Answer 25

Often visible as distended scrotal blood vessels that feel like a "bag of worms" May complain of dull ache Associated with subfertility Separate and solid - examination

Question 26

What is haematocele

Answer 26

Bleeding in tunica vaginalis following trauma May need drainage/excision Feels testicular and solid

Question 27

Incidence of testicular tumours

Answer 27

Most common malignancy in men aged 15-44 | 10% occur in undescended testis, even after orchidopexy

Question 28

Incidence of contralateral testicular tumour

Answer 28

5%

Question 29

Signs of testicular tumour

Answer 29

Painless lump - found after trauma/infection (when feel for it) Can also get haematospermia, secondary hydrocele, pain Lung mets - dyspnoea

Question 30

Risk factors for testicular tumour

Answer 30

Undescended testis Infant hernia Infertility

Question 31

Staging of testicular tumour

Answer 31

1) No evidence of mets 2) Infradiaphragmatic node involvement - spread via para-aortic 3) Supradiaphragmatic node involvement 4) Lung involvement - haematogenic spread

Question 32

Tumour markers in testicular tumour

Answer 32

Alpha-fp | Beta-hCG

Question 33

Treatment of testicular tumour

Answer 33

Radical orchidetomy Radiotherapy post-op Do close follow up

Question 34

Treatment of non-seminomatous germ cell tumour (335)

Answer 34

Bleomycin, etoposide and cisplatin

Question 35

Surgery and salvage rate in torsed testicle

Answer 35

If 24 hrs then 0-10%

Question 36

Symptoms of torsed testicle

Answer 36

Rapid onset of pain in one testis Makes walking uncomfortable Pain in abdomen, nausea and vomiting

Question 37

Signs of torsed testicle

Answer 37

Inflammation of one testis - tender, hot and swollen | May lie high and transversely

Question 38

When is testicule torsion most common

Answer 38

age 11-30

Question 39

Treatment of torsed testicle

Answer 39

Possible orchidectomy - ask consent Bilateral fixation - untwist testis If colour looks good - return to scrotum and fix both

Question 40

What is epididymal appendage?

Answer 40

Occurs 7-12 Less pain than torsion Tiny blue nodule under scrotum

Question 41

Incidence of undescended testis

Answer 41

3% - 30% if premature | Uni:bilateral = 4:1

Question 42

What is cryptorchidism?

Answer 42

Complete absence of testis from scrotum

Question 43

What is anorchism?

Answer 43

Absence of both testis from scrotum

Question 44

What is retracile testis?

Answer 44

Excessive cremasteric reflex - testicle found at external inguinal ring

Question 45

Maldescended testes

Answer 45

Found anywhere from abdomen to groin

Question 46

Complications of undescended testis

Answer 46

``` Infertility x40 increased risk of testicular cancer - in cryptorchidism may be decreased if surgery performed before age 10 Testicular torsion Hernias Other UT abnormalities ```

Question 47

Treatment of maldescended and ectopic testis

Answer 47

Restores spermatogenesis | Orchidopexy - brought down into scrotum