urethra, penis and scrotum part 1

Question 1

what is an epididymal cyst ?

Answer 1

An epididymal cyst, is a collection of spermatic fluid within the epididymis.

Question 2

how may an epididymal cyst present ?

Answer 2

Not associated with tumours,

May present as a painless scrotal swelling.

Question 3

How would you manage an epididymal cyst ?

Answer 3

Excision if significant symptoms but may re-occur

Question 4

What is a varicocele ?

Answer 4

varicosities of the pampiniform plexus (i.e. spermatic vein), most commonly occurring on the left side and poor flow is more common.

Question 5

what are the s/s of varicoceles ?

Answer 5

• May be asymptomatic or feel like a bag of worms on palpation when standing
  Comes as a dragging sensation and ache.

Question 6

What is the management of varicoceles with regards to the Ff:

• conservative
• surgical (2)

Answer 6

Conservative: scrotal support
Surgical:
1. Radiological embolisation of left vein
2. Ligation/Division of testicular veins

Question 7

What are 2 most common causes of a Urethral Stricture ?

Answer 7

1. Most have an iatrogenic cause

2. traumatic catheter insertion or long-term catheterisation

Question 8

what is a hydrocele ?

Answer 8

A hydrocele is a collection of fluid within the tunica vaginalis which normally sits anterior to the testis.

Question 9

What are the congenital causes of urethral stricture

Answer 9

Meatal and bulbar stricture

Question 10

State 2 trauma causes of a urethral stricture

Answer 10

.Straddle injury and pelvic fracture.

Question 11

state infective cause of urethral strictures

Answer 11

Gonococcal/non-gonococcal urethritis,

Question 12

State 2 other causes of urethral strictures not mentioned

Answer 12

Balanitis xerotica obliterans and invasive tumours.

Question 13

Describe the presentation of urethral stricture

Answer 13

Obstructive voiding and filling symptoms:
Filling: increase in frequency, urgency and nocturia
Voiding: urinary retention, poor intermittent stream, hesitancy and straining

Question 14

To differentiate between scrotal swellings:,

if you can get above it, what is it.

Answer 14

Tumour, hydrocele, spermatocele

Question 15

To differentiate between scrotal swellings:,

if you cannot get above it, what is it.

Answer 15

hernia

Question 16

To differentiate between scrotal swellings:

If its one lump or two, what is it ?

Answer 16

spermatocele and hernia

Question 17

To differentiate between scrotal swellings:

if its not one lump or two ?

Answer 17

Tumour and hydrocele

Question 18

To differentiate between scrotal swellings:

If its transilluminable, What is it?

Answer 18

hydrocele

Question 19

To differentiate between scrotal swellings:

if its not transilluminable, What is it?

Answer 19

tumour, spermatocele and hernia

Question 20

What is phimosis ?

Answer 20

Phimosis is narrowing of the pre-pupital orifice.

Question 21

state the 2 causes of phimosis ?

Answer 21

1. congenital, chronic balanitis and 2.traumatic forcible retraction of the foreskin.

Question 22

How does phimosis present in children ?

Answer 22

In children, it can present as poor urine stream and ballooning of foreskin.

Question 23

How does phimosis present in Adults?

Answer 23

In adults, it can present with inability to retract foreskin and pain during intercourse.

Question 23

what is paraphimosis ?

Answer 23

Paraphimosis is the inability to pull the foreskin forward and as a result it is trapped behind the glans.

Question 24

what is paraphimosis associated with ?

Answer 24

Associated with not replacing the foreskin following urethral catheterisation or sexual intercourse.

Question 25

What are the symptoms associated with para-phimosis ?

Answer 25

pain, swelling of the glans, and flaccidity proximal.

Question 27

what is the mnemonic and the causes of a hydrocele ? 😭

Answer 27

TIT; tumour, infection and trauma

Question 28

how may a hydrocele present ? 😭

Answer 28

It may present as a scrotal swelling with or without pain

Question 29

what age group is TT more common in ?

Answer 29

Is most common in adolescents; 12-18 years old

Question 30

what are the 2 main symptoms ?

Answer 30

1. Sudden, intense pain in the testes radiating to the lower abdominal pain (T10) 2. May be associated Nausea and vomiting,

Question 31

Signs of a testicular torsion (3)

Answer 31

1. Red, hot, swollen and extremely tender testis 2. Absent cremaster reflex 3. Testis may retract, I.e, lie higher or transversely

Question 32

what are differentials for DDx

Answer 32

Differential diagnosis:epididymitis or torsion of the testicular appendage.

Question 33

How is a diagnosis of testicular torsion made ?

Answer 33

Diagnosis should be clinical, and if in doubt the patient is sent for surgical exploration. Doppler USS can identify the anatomy of the lesion to confirm/reject diagnosis.

Question 34

what is Epididymo-orchitis?

Answer 34

Epididymo-orchitis is an acute infection due to an ascending of pathogens through the vas deferens.

Question 35

what age group is Epididymo-orchitis common in ?

Answer 35

more common in men over the age of 20

Question 36

what are the most common causes of epididymo-orchitis ?

Answer 36

In younger men: Chlamydia and Gonorrhoea (STI) | In more elderly men: E.Coli, and other UTI-causing pathogens.

Question 37

How is the diagnosis of epididymo-orchitis made ? (2)

Answer 37

Urinalysis + STI screen

Question 38

Describe the presentation of epididymo-orchitis

Answer 38

Sudden pain and swelling of epididymis History of urethritis/discharge dysuria (UTI),

Question 39

Describe the management of a hydrocele

Answer 39

USS of scrotum to rule out cancer Conservative management: 1. Scrotal support 2. May resolve spontaneously

Question 40

What is the management of testicular torsion ?

Answer 40

Surgery

Question 41

How would you manage epididymo-orchitis ? (2)

Answer 41

1. Abx: 6 weeks ciprofloxacin or doxycycline if chlamydia | 2. Analgesia

Question 42

What test would be positive in a male with epididymis-orchitis ?

Answer 42

Positive Phren’s test