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Flashcards in the BALLS!!!!!! Deck (66)
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1

low testosterone
< 150-200 ng/dL

Hypogonadism

2

Hypogonadism etiology

Primary: testicular failure
Mumps orchitis
Secondary: hypogonadotropic hypogonadism
Age-related (ADAM), chronic opiates

3

Hypogonadism epidemiology

increasingly diagnosed

4

Hypogonadism presentation

decreased energy/fatigue, ED, decreased force of ejaculation, decreased libido

5

Hypogonadism work - up

Free and total testosterone
Exam
If low – DEXA scan (< 100 ng/dL)

6

Hypogonadism tx

Androgen (testosterone) supplementation
Gels, injections, pellets

7

Hypogonadism follow up monitoring

PSA, hemogram (H&H), testosterone, review of urinary symptoms, DRE
3, 6 and 12 months after initiating, then annual
Counsel prostate Ca monitoring; CV risks, infertility.

8

basic questionnaire can be very useful for men to describe the kind
and severity of their low testosterone symptoms.

ADAM Questionnaire

9

testis (testes) not in scrotum
Possibly absent; possibly non-palpable (20%); if palpable, won’t come down

Cryptorchidism

10

Cryptorchidism etiology

not well understood
Normal descent is androgen-independent, mediated by “descendin;” passage through inguinal canal begins 28 weeks

11

Cryptorchidism epidemiology

rare

12

Cryptorchidism work up

good physical exam (don’t forget penis), possible scrotal U/S, urologist may pursue further studies (MRI, diagnostic laparoscopy)

13

Cryptorchidism tx

hormonal manipulation (GnRH injection); orchidopexy

14

testi at Inguinal canal -

between internal and external rings

15

testi Intra-abdominal (10%) -

proximal to inguinal ring

16

Absent testis (20%)-

truly absent, probable vascular event

17

Ectopic testis -

below the internal ring but out of normal path

18

Retractile testis -

reflects exuberant cremasteric reflex
Follow patient until puberty

19

Most descend spontaneously in first __ months

3

20

If undescended at __months, descent is unlikely

6

21

what percent of term infants have cryptorchidism

3

22

what percent of premes have cryptorchidism

30

23

what percent of Cryptorchidism is bilateral

10

3 percent have one or both missing

24

Cryptorchidism risk factors

Twins, low birth weight, pre-term delivery, family history, Prune Belly syndrome

25

Cryptorchidism cancer risk

Increased risk of testicular cancer (1/2500 versus 1/100,000)
Cancer risk may be reduced by orchidopexy, certainly facilitates examination
Contralateral testis at increased risk also, even if descended (10-25% of cancers on this side)

26

Cryptorchidism fertility effect

decreased

27

t/f torsion risk is 10 x higher

t

28

benign accumulation of serous fluid between layers of tunica vaginalis

Hydrocele

29

infant Hydrocele presentation

infant/toddler with hemiscrotal enlargement; volume/size waxes and wanes during day

30

infant Hydrocele etiology

patent processus vaginalis (communicating hydrocele)