reproductive system conditions Flashcards
(17 cards)
what is the cremasteric reflex
when stroking the inner thigh in a male leads to contraction of the cremaster muscle leading to the ipsilateral testicle retracting upward
what is Prehn’s sign
when lifting a painful testicle relieves pain
what is the commonest cause of epididymo-orchitis in sexually active younger males?
STI eg chlamydia or gonorrhoea
most common cause of epididymo-orchitis in older males
UTI related - e. coli
other causes of epidydimo-orchitis
mumps
TB
main differential diagnosis of epididymo-orchitis
testicular torsion
what is the presentation of epidydimo orchitis
The primary symptom of epididymo-orchitis is acute scrotal pain. Additional signs and symptoms can include:
- Testicular swelling and tenderness
- Fever
- Dysuria (painful urination)
- Urethral discharge
- Prehn’s positive (lifting up testicle relieves pain due to inflammation)
- Cremasteric reflex is intact (this helps differentiate clinically from torsion)
what are the main features that help differanciate testicular torsion from epididymo-orchitis
Testicular torsion: Sudden onset of severe testicular pain, often with nausea and vomiting,
and a horizontal and superior lie to the testicle on physical examination, (testicle is lifted)
with Prehn’s sign negative and no cremasteric reflex.
investigations for epididymo- orchitis
Investigations are typically guided by the age of the patient
in younger adults assess for sexually transmitted infections (STI)
in older adults with a low-risk sexual history send a mid-stream urine (MSU) for microscopy and culture
management of epididymo-orchitis if STI is the suspected cause
if an STI is the most likely cause advise urgent referral to a local specialist sexual health clinic
if the organism is unknown BASHH recommend: ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days
management of epidydimo orchitis if if enteric organisms are the most likely cause
send an MSU as above
treating empirically with an oral quinolone for 2 weeks (e.g. ofloxacin)
if a case of epididymo- orchitis is reviewed after 2 weeks and symptoms are still ongoing what is done?
if ongoing symptoms consider ultrasound imaging +/- urology referral
what is testicular torsion
twist of the spermatic cord resulting in testicular ischaemia and necrosis.
at what ages is testicular torsion most common?
10-30 (13-15 peak incidence )
testicular torsion features
pain is usually severe and of sudden onset
the pain may be referred to the lower abdomen
nausea and vomiting may be present
on examination, there is usually a swollen, tender testis retracted upwards. The skin may be reddened
cremasteric reflex is lost
elevation of the testis does not ease the pain (Prehn’s sign)
management of testicular torsion
Urgent surgical exploration is crucial to confirm the diagnosis and to attempt to salvage the testicle
If the testicle is viable, bilateral orchidopexy should be carried out!!!! — always on both sides to reduce the risk of recurrence on the other side
If it is not viable, it should be removed (an orchidectomy)
what is a scrotal swelling which you cannot ‘‘get above’’
its inguinal hernia
