Scrotal and Testicular Disorders

Question 1

Cryptorchidism

Answer 1

Undescended or absent testes
Incidence related to birth weight and gest age
Can be in full-term infants as well

Question 2

When doe spontaneous descent usually occur?

Answer 2

Often in first 3 months

Rarely after 6 months

Question 3

Changes in undescended testi

Answer 3

Delay in germ cell development
Changes in spermatic tubules
Reduced number of leydig cells

Question 4

undescended testicles increase risk of?

Answer 4

Infertility

Malignancy

Question 5

Hydrocele

Answer 5

Excess fluid btw tunica vaginalis

Usually peritoneal fluid

Question 6

Primary congenital hydrocele

Answer 6

Associated w/ indirect inguinal hernia

Usually close spontaneously

Question 7

Secondary hydrocele

Answer 7

Trauma
Infection
torsion
orchitis
CA

Question 8

Hydrocele dx

Answer 8

Transillumination

US

Question 9

Hydrocele in young man with no apparent cause =

Answer 9

CA until proven otherwise

Question 10

Hydrocele tx

Answer 10

If needed, surgery

Treat underlying condition

Question 11

Hematocele

Answer 11

Accumulation of blood in tunica vaginalis
Looks dark red or purple
Can compromise testicle

Question 12

Spermatocele

Answer 12

Painless, sperm containing cyst forming at end of epididymis
Seperate from testis
Freely movable, should transilluminate

Question 13

Varicocele

Answer 13

Varicosities of the pampiniform plexus
Sperm count and mobility decreased
Common in men btw 15 and 35 yrs

Question 14

Which side os more common for varicocele?

Answer 14

Left side

L spermatic vein enters L renal vein at R angle

Question 15

Varicocele usually dissapears in ____ position.

Answer 15

supine position

Question 16

Varicocele looks like a bag of?

Answer 16

worms

Question 17

varicocele tx

Answer 17

Surgical ligation of gonadal vein

NSAIDS and scrotal support

Question 18

Testicular torsion

Answer 18

Twisting of the spermatic chord
Usually presents before 18
Acute emergency

Question 19

COngenital/neonate torsion

Answer 19

Less common
FIrm, smooth and painless scrotal mass
Scrotal skin appears red

Question 20

Torsion rarely seen after age

Answer 20

30

Question 21

S/S of torsion

Answer 21

Severe distress/pain
N/V, tachycardia
Large, firm, tender testes
Pain radiates to inguinal area

Question 22

Torsion tx

Answer 22

manual detorsion (open a book)
Surgical detorsion
Orchiectomy

Question 23

Epididymitis

Answer 23

Can be STI (young) or non-STI (old)
Associated w/ urethritis
Almost always bacterial

Question 24

Non-STI epididymitis bugs

Answer 24

E-coli

Pseudomonas

Question 25

Epididymitis S/S

Answer 25

``` Unilateral pain and swelling in testis Erythema and edema can be large Tenderness in groin and abdomen Fever dysuria ```

Question 26

Epididymitis tx

Answer 26

Bedrest Scrotal support Abx Oral alangesics

Question 27

Orchitis

Answer 27

Infection of the testes | Caused by GU infxn

Question 28

Orchitis S/S

Answer 28

Mumps can cause Urinary symptoms are absent No treatment Some have impaired spermatogenesis for life

Question 29

Carcinoma of SCROTUM is ?

Answer 29

Rare

Question 30

ALmost all tumors of testicles are?

Answer 30

Malignant

Question 31

Scrotal CA

Answer 31

Mean presentation of 60 yrs Small wart like thing that ulcerates Preceded by many years of irritation More than 1/2 cases metastasize to lymph nodes

Question 32

Testicular CA

Answer 32

Most common cause of CA in 15 - 35 yo age group. | Highly curable if discovered early

Question 33

Testicular CA risks

Answer 33

Cryptorchidism (strongest) Genetics Disorders of testicular development Trauma NOT known precipitant

Question 34

95% of malignant tumors are ___ cell tumors

Answer 34

Germ cell tumors

Question 35

Seminoma

Answer 35

``` Most common type of testicular tumor Most are confined to testicle Grow slowly, don't spread rapidly Most frequent in 4th decade Almost never occurs in kids ```

Question 36

Nonseminomas (NSGCT's)

Answer 36

Most commonly in 20-30 age group Less differentiated than seminomas More likely to spread in bloodstream

Question 37

S/S of testicular CA

Answer 37

``` Slight enlargement of testicle May be discomfort Aching of abdomen and groin Solid, painless mass Non-transilluminating ```

Question 38

Testicular CA metastatic sites

Answer 38

Lymph nodes Liver Lung Brain

Question 39

Dx and Tx of testicular CA

Answer 39

No biopsy US or MRI Excision to confirm

Question 40

Tumor markers for testicular CA

Answer 40

Alpha-fetoprotein (AFP) hCG Lactic dehydrogenase (LDH)