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Surgery > Prostate & Testes > Flashcards

Prostate & Testes Flashcards

1
Q

MC nondermatological malignancy in males

A

Prostate cancer (adenocarcinoma)

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2
Q

MCC of cancer-related death in males

A
  1. Lung
  2. Prostate
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3
Q

Typical location/zone of prostate that cancer develops

A

Peripheral zones

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4
Q

RFs for prostate cancer

A
  1. Age - Most important (31-40) < (81-90)
  2. Prostatitis
  3. FHx of prostate cancer
  4. High fat diet
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5
Q

Sxs of Prostate cancer

A
  1. Asymptomatic (early bc of peripheral location)
  2. Urinary retention
  3. Weak urine flow
  4. Frequency
  5. Hesitancy
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6
Q

MC site of prostate cancer metastasis

A

Bone (Vertebrae) –> Pain & Fractures

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7
Q

Tx of non-metastatic prostate cancer

A
  1. External beam radiation
  2. Brachytherapy (radioactive seed implants)
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8
Q

Tx of extensive prostate cancer

A

Radical Prostatectomy - retropubic, perineal, laparoscopic or robotic

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9
Q

MC complications of radical prostatectomy

A

Impotence & Incontinence

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10
Q

Tx of metastatic prostate cancer

A
  1. GnRH agonist - Leuprolide
  2. Androgen receptor antagonist- Flutamide, Bicalutamide
  3. Chemotherapy (not very effective)
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11
Q

Tx of prostate cancer in older men

A

Observation - slow growing

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12
Q

Monitoring Prostate treatment

A

PSA

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13
Q

Screening for Prostate cancer

A
  1. PSA - large or acute change
  2. DRE - asymmetrical, nodular, indurated
    - Abnormal –> Biopsy (ALWAYS)
  3. Alkaline phosphatase- elevated when the cancer has invaded
  • Controversy — Case based — 40-50 years — PSA & DRE
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14
Q

Definite diagnosis of prostate cancer

A

Needle core biopsy guided by transrectal ultrasound

  • CT for extent & treatment
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15
Q

RFs for BPH

A

Increasing age (>50)

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16
Q

MC location of BPH

A

Peri-urethral/ transition zone –> Obstruction

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17
Q

Sxs of BPH

A
  • Hesitancy
  • Weak urine stream
  • Frequency
  • Urgency
  • Dysuria
  • Nocturia
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18
Q

Relation of BPH & Prostate cancer

A

BPH doesnt predispose to cancer

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19
Q

Diagnostic workup of BPH

A
  1. History
  2. Physical
    - DRE - uniform, enlarged, rubbery
  3. Mild PSA elevation
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20
Q

Complications of untreated BPH from urinary obstruction

A
  1. B/l hydronephrosis
  2. Bladder diverticula & smooth muscle hypertrophy
  3. Infection - urine stasis
  4. Infarction - painful, enlarged, firm gland w. increased PSA
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21
Q

Tx of BPH

A

Behavior modification
1. Avoid liquids before bed
2. dec. caffeine & alcohol
3. Double voiding to completely empty bladder

Medication
1 Mild- moderate –> Alpha blocker (Tamsulosin, terazosin)
2. Severe –> alpha blocker + 5-alpha-reductase inhibitor (Finasteride)

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22
Q

Tx of Refractory BPH

A

TURP (Transurethral Resection of the Prostate)

or

Transurethral needle ablation (cant undergo surgery)

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23
Q

Recommended studies to evaluate pts. w. lower UT symptoms

A
  1. Urinalysis - Infection or blood
  2. Serum PSA
24
Q

SxS of testicular torsion

A
  1. Acute testicular/ abdo pain
  2. N&V
  3. High-riding testicle w/ horizontal line
  4. Absent cremasteric reflex
25
Q

RFs for testicular torsion

A
  1. Adolescent or puberty –> Hormonal change –> Inc testicular weight
  2. Vigorous exercise
  3. “Bell Clapper” deformity- b/l defect in processus vaginalis –>inadequate anchoring of testis to posterior scrotal wall –> testes hang freely & horizontally
26
Q

Cremasteric reflex

A

Superficial reflex –> stroking of superomedial thigh –> cremasteric muscle contraction–> testis elevation

Sensory & motor innervation of Genitofemoral nerve

27
Q

Diagnosis of testicular testis

A
  1. Clinical
  2. Color doppler US of scrotum –> Dec perfusion
28
Q

Tx of testicular torsion

A
  1. Emergent b/l orchiopexy w/i 4-6 hours
  2. Manual detorsion –> Surgery
    - Med –> Lat then Lat –> Med
29
Q

Appendix testis/ Epididymis torsion

A
  1. Children (7-12)
  2. Palpable nodule 1/ blue dot
  3. Intact cremasteric reflex
  4. Normal or Inc perfusion on doppler
  5. Supportive treatment - analgesia, rest, ice
  6. Spontaneous recovery in 1-2 weeks
30
Q

MC solid malignancy in males 15-35 years

A

Testicular cancer

31
Q

RFs for testicular cancer

A
  1. Cryptorchidism
  2. Testicular cancer in c/l testicle
  3. Klinefelter syndrome
32
Q

How does correction of Cryptorchidism affect the risk of testicular cancer?

A

Doesn’t remove risk - allows for better surveillance

33
Q

Classification & types of testicular cancer

A
  1. Germinal cell tumors
    a. Seminoma
    b. Non-seminoma
    - Embryonal
    - Yolk sac
    - Choriocarcinoma
    - Teratoma
  2. Stromal cell tumors
    - Leydig cell
    - Sertoli cell
  3. Testicular lymphoma
34
Q

CFs of testicular cancer

A
  1. PAINLESS mass
  2. Weight loss
  3. Pain in lower abdomen, perineum or scrotum
  4. Gynecomastia
  5. Hyperthyroidism
35
Q

Symptoms of testicular metastasis

A
  1. Lings - cough, dyspnea
  2. Bones- pain
  3. Iliac or caval veins - obstruction –> leg swelling
  4. GI - N&V, hemorrhage
36
Q

Lab. investigation for diagnosis of testicular cancer

A

US- hypoechoic intratesticular mass

Test to determine histology & extent
- CT/MRI of abdo & pelvis
- Serum tumor markers
- Radical inguinal orchiectomy - definite diagnosis & treatment
- Retroperitoneal lymph node dissection

37
Q

What test should never be performed in suspected testicular cancer?

A
  1. Trans-scrotal biopsy
  2. Trans-scrotal orchiectomy
    - can cause local recurrence and/or metastasis
38
Q

Important tumor markers in testicular cancer

A
  1. B-hCG –> Embryonal & Choriocarcinoma
  2. AFP –> Yolk sac
  3. LDH

Measure markers before and after treatment

39
Q

Treatment of testicular cancer

A

Early stage seminomas
- Orchiectomy +/- Chemo & radiation

Early stage non-seminomas
- Orchiectomy +/- chemo & radiation + Retroperitoneal lymph node dissection

40
Q

Common Chemotherapy used in testicular cancer (BEP)

A

Bleomycin
Etoposide
Platinum-containing – Cisplatin

41
Q

MC type of testicular cancer in males >50

A

Testicular lymphoma

42
Q

Spermatocele

A

Cystic structure containing sperm within the epedidymis

43
Q

SxS of Spermatocele

A
  1. Painless scrotal swelling - asymptomatic
  2. Palpable mass separate from testis
  3. Transilluminates
44
Q

Tx of Spermatocele

A
  • Support
  • Excision if symptomatic
45
Q

Varicocele

A

Dilation of pampiniform veins that surround the spermatic cord

46
Q

Causes of Varicocele

A
  1. Blockage of Left spermatic vein as it enters the left renal vein
  2. Inc venous pressure
47
Q

Symptoms of Varicocele

A
  1. Asymptomatic
  2. Scrotal swelling
  3. Aching scrotal pain
  4. Sense of fullness in scrotum
  5. Testicular atrophy

Worse with standing; better by lying down

48
Q

PE of Varicocele

A
  1. “Bag of worms”
  2. Inc in size w/ Valsalva
  3. Dec in size when supine
  4. NO transillumination
49
Q

Management of Varicocele

A

Supportive

Surgery if:
1. Dec sperm count
2. B/l
3. Pain

50
Q

Complication of Varicocele

A

Infertility
- Testicular atrophy
- Hypogonadism <– Inc scrotal temp

51
Q

Hydrocele

A

Collection of peritoneal fluid between the visceral & parietal layers of tunica vaginalis

52
Q

Types of Hydrocele

A
  1. Communicating
    - Develops from closure defect of processus vaginalis
  2. Non-communicating
    - Local secretion of fluid
    - Closed processus vaginalis –> No fluid in abdominal cavity
53
Q

Symptoms of Hydrocele

A
  1. Painless scrotal swelling
  2. Scrotal fullness
  3. Worsening throughout the day
54
Q

PE findings of Hydrocele

A
  1. Transillumination
  2. Com - Inc in size with standing or Valsalva
  3. NC- No dec or change in size
55
Q

Diagnosis of hydrocele

A
  1. Palpation
  2. Transillumination
  3. US
56
Q

Management of Hydrocele

A

Support
Surgery - symptomatic or present >1 year

57
Q

How does spermatocele affect fertility?

A

No effect

Surgery (10 decks)

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