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Urology > Penis, scrotum, testes > Flashcards

Penis, scrotum, testes Flashcards

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1
Q

Balanitis is?

A

Inflammation of glans penis

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2
Q

Balanoposthitis is?

A

Inflammation of glans penis and/or foreskin

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3
Q

Balanitis and Balanoposthitis is commonly due to?

A

Candida albicans related to poor hygiene

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4
Q

Common complication of phimosis is?

A

Balanitis and Balanoposthitis

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5
Q

TXT of Balanitis and Balanoposthitis

A

swab/TXT w/ appropriate ABX

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6
Q

Phimosis is?

A

Contracted foreskin that cannot be retracted back over glans

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7
Q

What can develop under foreskin esp if phimosis is present?

A

Smegma
Calculi
SCC

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8
Q

Phimosis presentation

A

pain or TTP of foreskin

chronic yeast infections

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9
Q

TXT of phimosis

A

circumcision may be indicated (only after inf TXT’d)

If infection > broad spectrum ABX

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10
Q

Paraphimosis is?

A 
retracted foreskin is trapped behind glans penis which causes > 
- vascular congestion
- swelling glans
- pain
May lead to arterial occlusion/necrosis
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11
Q

Is paraphimosis a medical emergency?

A

Yes!

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12
Q

Paraphimosis TXT

A

1st try - manual reduction

Failure > immediate urology referral (incision w/ local)

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13
Q

Following a successful reduction of paraphimosis pts req?

A

urological referral for circumcision (PVT recurrence)

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14
Q

MC congenital malformation is a?

A

ABNL urethral meatus location

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15
Q

Hypospadias is?

A

Meatus opens on ventral aspect of penis/scrotum/periuneum

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16
Q

Epispadias is?

A

Meatus opens on dorsal aspect of the penis

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17
Q

Which penis malformation is MC and has a better prognosis?

A

Hypospadias

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18
Q

Hypospadias is ass/w?

A

Feminization OR

Chordee (ventral curvature)

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19
Q

Hypospadias repair should be repaired by?

A

Prior to 18mo (typically done at 6mo)

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20
Q

Should you circumcise infants w/ Hypospadias?

A

NO - can be used as a graft to fix Hypospadias

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21
Q

What is a common finding w/ Epispadias?

A 
Urinary inontinence (improper development of urinary sphincter)
Dorsal curvature
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22
Q

Chordee is?

A

ABNL congenital ventral curvature of penis due to short urethra or fibrosis tissue around corpus spongiosum

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23
Q

Peyronie Dz is?

A

Fibrous D/O of the tunica albuginea w/ varying degrees of penile pain, curvature, deformity

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24
Q

What type of malformation is Peyronie Dz?

A

Acquired malformation (sexual accident)

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25
What causes Peyronie Dz?
Most likely - minor penile trauma > Inflammation of corpora cavernosa > ABNL collagen disposition
26
Peyronie Dz MC affects what pop?
Middle aged/older men
27
Peyronie Dz can impair?
Sexual fx and impact self-esteem
28
Pts w/ Peyronie Dz present how?
W/ painful erections (no pain when flaccid)
29
Peyronie Dz PE reveals?
Palpable dense fibrous plaque involving tunica albuginea near dorsal midline.
30
Peyronie Dz may require what type of imaging?
U/S to visualize extent of a deep plaque
31
Peyronie Dz is ass/w what other condition?
Dupuytren contractures of the hand
32
Peyronie Dz TXT
10% spon improvement Medical therapies -Collagenase clostridial histolyticum inj (FDA approved) -CCB or interferon intraplaque inj Surgery if sex dysfx due to severe curve or instability
33
What is a priapism?
Erection lasting >4hrs - not ass/w sexual arousal/desire
34
Priapism etiology is often?
Idiopathic - Leukemia - SCA - Pelvic tumors/infections - Penile trauma - Spinal cord trauma - Rx
35
Two types of priapism
Non-ischemic and ischemic
36
Non-ischemic priapism notes
High-flow priapism AV shunting > unregulated high blood flow Due to perineal/spinal cord trauma Erectile Fx spared
37
Ischemic priapism notes
``` Low-flow priapism Venous congestion and arterial inflow cessation > -ischemic injury to corpora cavernosa Painful erection Req emergent TXT to PVT fx loss ```
38
Causes of ischemic priapism?
RBC dyscrasias Drug use ED treatments
39
TXT of ischemic priapism?
``` Large bore - needle blood aspiration Adrenergic meds (phenylephirine ```
40
Both non-ischemic/ischemic priapisms req?
Urology consult
41
Which priapism type has spared erectile fx?
Non-ischemic
42
Which priapism type may not req TXT?
Non-ischemic
43
Which priapism type is ass/w high flow AV shunting?
Non-ischemic
44
Which priapism type is ass/w low flow (venous congestion/arterial cessation)?
Ischemic
45
Which priapism type is characterized w/ painful erections?
Ischemic
46
MC age range of penile cancer?
6th decade
47
RF's pf penile cancer?
Uncircumcised (poor hygeine) Phimosis HPV infections (PVT = Gardasil vaccine)
48
How to PVT HPV infections?
Gardasil vaccine
49
Penile cancer morphology is typically?
SCC - seen on glans
50
Bowens disease is?
SCC in situ (red plaque on shaft)
51
Erythroplasia of Queyrat is?
Velvety red lesion w/ ulcerations on glans | AKA - bowen disease of the glans
52
Penile cancer W/U?
Bx is mandatory to R/O benign conditions such as - | -syphilis, chancroid, condylomata
53
Penile cancer TXT depends on?
Pathology/location
54
Proper eval of scrotum req?
Testes palpated between fingertips of both hands
55
NL testes dimensions
4.5 x 2.5 cm and rubbery
56
Where does epidiymis lie in relation to testis?
Posteriolateral w/ varying degrees of testicular detachment
57
How to distinguish between Solid vs Cystic lesions of the scrotum?
Transillumination
58
MC referral scrotum referral to urologist is?
Mass eval
59
Most important aspect of eval masses within the scrotum?
Determine if lesion is related to epididymis/cord structures OR confined to scrotum
60
Masses arising from testes are usually?
Malignant
61
Masses arising from epididymis/spermatic cord are usually?
Benign
62
S/S of malignant Testes are?*
Painless Firm/solid lesions located w/in the substance of testicle Does NOT transilliuminate*
63
Scrotal vs Testicular mass reflex if in doubt?
U/S - good if pt is in anxiety
64
Types of scrotal/testicular masses?
``` HaVE SHiT H- hydrocele V- varicocele E- epidiymal cyst S- spermatocele H- hernia T- testicular cancer ```
65
Hydrocele is
Collection of fluid between 2 layers (parietal/visceral) of tunica vaginalis
66
Hydrocele is 2/2?
Congenital causes (patent processus vaginalis) Infection (Epididymitis) Trauma/testicular torsion Tumors (testicular cancer)
67
MC age range of Hydrocele
1st yr of life
68
Hydrocele presents how?
Painful - if LRG/Infected
69
Hydrocele Dx?
``` Transillumination Testicular exam (R/O tumors ass/w Hydrocele) ```
70
If in doubt of Hydrocele Dx reflex?
Scrotal U/S
71
Hydrocele TXT?
Observe w/ regular F/U Surgery - excise hydrocele sac DO NOT aspirate*
72
Do you aspirate a Hydrocele?
NO!
73
Epididymal cyst is?
<2cm Cysts occuring at caput of the epididymis distinct from testicle
74
TXT of Epididymal cyst is?
No TXT req > can reassure pt w/ U/S
75
Spermatocele is?
>2cm Benign cystic accumulation arising from the head of the epididymis
76
Spermatocele S/S?
Asymptomatic OR | if LRG > heaviness or pain
77
Spermatocele is palpable where?
Upper pole of testicle
78
In doubt of Spermatocele Dx reflex?
U/S
79
Spermatocele TXT?
Observe | Symptomatic > surgery
80
Varicocele is?
ABNL dilation of pampiniform plexus of spermatic veins
81
Varicocele represents what percentage of scrotal masses?
25%
82
Varicocele is MC found on which side?
Left (33% bilateral)
83
Varicocele presents as?
Asymptomatic OR > Dull ache (pain worsens w/ activity) Increased size when upright Decreased size when supine
84
Varicocele may be ass/w?
Hx of infertility - Increased scrotal temp > increases apoptosis - Testicular atrophy
85
Varicocele PE?
Bag of worms feels - Increased w/ valsalva - Decreased while supine
86
Varicocele is usually Dx with?
PE (however U/S possible)
87
Varicocele further eval req - warning signs *
Right sided and Unilateral Lesion remains dilated while supine Sudden onset or Enlarges rapidly
88
Sudden onset of R Varicocele may indicate?
R spermatic vein obstruction due to retroperitoneal malignancy *
89
Varicocele further eval W/U?
careful abdominal exam | CT Scan
90
Varicocele TXT
Initially- symptomatic management - Observe - Scrotal support - Activity modification - PRN NSAIDs
91
Varicocele ass/w infertility and/or pain req what TXT?
Surgery - ligation of gondadal vein via inguinal canal - laparoscopy - microsurgery
92
Types of hernias?
Indirect/direct
93
Indirect hernias notes
Men - due to congenital patent processus vaginalis | Protrudes through deep or internal inhuinal ring into inguinal canal and may extend into scrotum
94
Direct hernia notes
Acquired | Arises from protrusion of ABD viscera through a weakness of the posterior wall of inguinal canal
95
Hernia PE
Palpable bulge which may increase w/ valsalva
96
Hernia Dx
U/S or CT
97
Hernia TXT
Refer to general surgery for repair | herniorrhaphy -open/laproscopic
98
Testicular masses usually are?
Malignant masses arising from w/in the testicle
99
If there is doubt to whether or not a mass is w/in or outside the testicle reflex?
Scrotal U/S and urologic referral
100
Essentials of Dx testicular cancer
MC neoplasm in men 15-35yo Pt identified, Painless mass typically Orchiectomy necessary for Dx
101
What is necessary for testicular Dx cancer Dx?
Orchiectomy
102
Testicular cancer is ass/w what S/S?
Painless palpable mass +- heavy sensation 10% ass/w hyrdocele
103
MC cell type of primary testicular tumor?
Germ cell tumors - Seminoma and non-seminoma - Arising from spermatogenic cells w/in seminiferous tubules
104
What side is testicular cancer MC on?
Right side
105
RFs of testicular cancer?
Cryptorchidism Testicular trauma/torsion Infection related testicular atrophy Chemical exposure/pollutants
106
Testicular cancer labs?
``` Increased > -HcG -AFP (alpha-fetoprotein) -LDH Advanced Dz = Anemia w/ CBC and LFT for Mets ```
107
Testicular cancer imaging?
Scrotal U/S - intra-testicular vs extra-testicular | CT/PET after orchiectomy for staging
108
Doubt of Testicular cancer Dx reflex?
Scrotal U/S
109
TXT of Testicular cancer?
Radical orchiectomy | - further TXT depends on histology/staging
110
Testicular cancer prognosis?
Stage I-III - 95% 5 year survival rate | Bulky retroperitoneal malig/advanced Mets 68%
111
Testicular cancer 2/2 are?
Rare MC - lymphoma other causes - (prostate, lung, melanoma, renal)
112
Is Testicular selfexams recommended?
No per USPSTF > grade D
113
Testicular torsion - age range?
Can occur w/ any age | - MC neonates and post-pubertal boys
114
Testicular torsion occurs due to?
Inadequate fixation of testis onto tunica vaginalis (peritoneal sac)
115
Testicular torsion will have irreversible damage when?
Ischemic >12hrs
116
Testicular torsion presents as
Sudden onset pain - often after vigorous exercise or minor trauma ABD pain N/V
117
Testicular torsion can occur after?
vigorous activity minor trauma cremasteric contraction during REM sleep
118
Testicular torsion PE?
Classic sign = high-riding testis w/ long axis oriented transversely (AKA bell clapper deformity) Early sign - profound testicular swelling Later sign - 12hr (reactive hydrocele/scrotal erythema) Exquisite TTP Absent cremasteric reflex on affected side Negative Prehn sign - elevation of scrotum fails to relieve pain
119
Most sensitive physical finding of Testicular torsion is?
Absent cremasteric reflex
120
Prehn sign distinguishes?
Testicular torsion (Neg) vs epididymitis (Pos)
121
Cremasteric reflex is performed how?
Stroking ipsilateral inner thigh = testicle elevation through a contraction
122
Testicular torsion SOC?
Color doppler U/S (do not delay surgery if no access)
123
Testicular torsion TXT
``` Surgical emergency (urgent evacuation) - detorsion/fixation(orchipexy to PVT reoccurence) ```
124
Testicular torsion TXT if surgery is not immediately available?
Manual detorsion maybe effective
125
Manual detorsion how to -
Open book - Right testicle > attempt counterclockwise detorsion - Left testicle > Attempt clockwise detorsion
126
Manual detorsion indicators of success?
Relief of pain Resolution of transverse testis axis Testis returns to lower position NL arterial pulse returned via Doppler U/S
127
After a manual detorsion for Testicular torsion what doe the pt req?
Surgery
128
MC scrotal pain in adults is?
Epididymitis and epididymo-orchitis
129
Epididymitis and epididymo-orchitis is MC due to?
Infectious etiology
130
Infection types causing Epididymitis and epididymo-orchitis
sexually transmitted and non-sexually transmitted
131
Sexually transmitted infectious type causing Epididymitis and epididymo-orchitis NOTES
Men <40yo ass/w urethritis N. Gono/Chlamydia
132
Non-sexually transmitted infectious type causing Epididymitis and epididymo-orchitis NOTES
Older men ass/w UTI's and prostatitis GNB
133
Epididymitis/epididymo-orchitis acute presentation?
Post physical strain, trauma, or sexual activity -Fever -Exquisite TTP -Swelling of epididymis, testicle, scrotum Irritative voiding S/S
134
Epididymitis/epididymo-orchitis PE
Induration, Edema, TTP | -epididymo-orchitis also will have testicular edema, pain w/ scrotal wall redness, reactive hydrocele
135
Prehn sign w/ Epididymitis/epididymo-orchitis?
Positive - scrotal elevation relieves pain
136
Epididymitis/epididymo-orchitis how?
PE
137
Epididymitis/epididymo-orchitis labs?
CBC - ^WBC w/ Left shift UA - Non-STI = pyuria, bacteriuria, hematuria UA Cx STI > Gram stain
138
In doubt of Epididymitis/epididymo-orchitis Dx?
Scrotal U/S
139
Epididymitis/epididymo-orchitis TXT of STI cause?
Ceftriaxone 250mg IM once + Doxycycline 100mg BID 10d's | TXT partner as well
140
Epididymitis/epididymo-orchitis TXT of Non-STI cause?
Ciprofloxacin OR levofloxacin for 3wks | Eval urinary tract for UC
141
Epididymitis/epididymo-orchitis TXT of viral or non-infectious causes?
Symptomatic care
142
Non-infectious cause of Epididymitis/epididymo-orchitis is?
Vasectomy
143
All Patients w/ Epididymitis/epididymo-orchitis will receive this TXT protocol?
Bed rest and Scrotal elevation (tight undergarments)
144
Severe testicular injury due to trauma MC from?
Combat trauma (direct blow) or straddle type injury
145
Trauma of testicles result in?
Hematocele/rupture
146
Trauma of testicles W/U?
U/S and surgical referral
147
Torsion of appendix testis NOTES
Rare in adults Similar S/S to testicular torsion (gradual onset) Blue dot on scrotum- infarct/necrosis of appendix testis Req U/S
148
TXT of Torsion of appendix testis?
Conservative | Rest, Scrotal elevation, Analgesics
149
Blue dot on scrotum skin may indicate?
Torsion of appendix testis
150
Referred pain DDx?
``` Stones UTI Pyelonephritis Low back pain AAA Post surgical (herniorrhaphy) ```
151
Mumps and acute testicular pain NOTES
Anti-vaxers Causes orchitis (preceding fever/parotitis) TXT symptomatically
152
Fourniers Gangrene NOTES
Necrotizing fasciitis of peineum and scrotal skin MC - DM TXT = urgent surgical debridement
153
Post-vasectomy pain syndrome (PVPS) NOTES
Chronic pain following vasectomy Painful granuloma palpable at site of Vas dissection FOB Rxn Uncommon
154
Chronic orchalgia Dx is?
A dx of exclusion

Urology (7 decks)

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