Urology 1- Disorders of Male Genitalia

Question 1

Definition of which condition?

Collection of fluid around the testicle b/w the parietal tunica vaginalis and the visceral tunica vaginalis

Answer 1

Hydrocele

Question 2

What are 3 possible etiologies of hydroceles discussed in lecture?

Answer 2

1. Epididymitis
2. Torsed Appendix testis
3. Idiopathic (Majority)

Question 3

Presentation of which condition?

• Unilateral scrotal enlargement
• +/- pain
• +/- history of GU trauma
• Transillumination

Answer 3

Hydrocele

Question 4

How do you treat a hydrocele if the pt is asymptomatic or minimally symptomatic?

Answer 4

reassurance and monitoring

Question 5

What are the 2 treatment options for a hydrocele that is bothersome?

Answer 5

Elective tx:

• Needle aspiration w/ injection of sclerosing agent- done in office but my recur
• Hydrocelectomy- Definitive tx (not likely to recur) but done in OR

Question 6

Definition of which condition?

• Dilated veins of the pampiniform plexus

Answer 6

Varicocele

Question 7

The following are effects of which condition?

• Pain (usu. asymptomatic)
• Testis damage- decreased spermatogenesis
• Testis atrophy
• Infertility

Answer 7

Varicocele

Question 8

What condition is described as feeling like a “bag of worms” on physical exam?

Answer 8

Varicocele

Question 9

What is considered a Grade I Varicocele?

Answer 9

• Small size
• Not grossly visible
• Only palpable during valsalva

Question 10

What is considered a Grade II Varicocele?

Answer 10

• Size: moderate
• Not Grossly visible
• Palpable while standing

Question 11

What is considered a Grade III Varicocele?

Answer 11

• Large size
• Grossly visible

Question 12

Is a varicocele usually on the left or the right?

Answer 12

LEFT

If on the right side (and rapid onset)–> sign of renal malignancy

Question 13

How do you manage a young male patient with a palpable varicocele w/ normal semen analysis?

Answer 13

Semen analysis every 1-2yrs

Question 14

How do you you manage a varicocele in a Child or pre-sexual adolescent w/ nml testis size?

Answer 14

Measure testicular size annualy

(to detect decrease)

Question 15

What are the 3 indications for surgical management of a varicocele?

(surgery= ligation of vein to redirect venous outflow via open or laporoscopic sx)

Answer 15

• Symptomatic
• Palpable varicocele w/ abnormal semen analysis (in eval of infertile couple)
• Varicocele with small testis

Question 16

T/F: Surgical repair can reverse atrophy in a patient that has a varicocele w/ small testis

Answer 16

TRUE

Question 17

____ to ____ months after varicocele repair, improvement in semen quality is seen in 70% of men?

Answer 17

3 to 6 months

Question 18

What is the difference b/w Phimosis and Paraphimosis? Which is an emergency?

Answer 18

• Phimosis- Prepuce stuck distal to glans
• Paraphimosis- Prepuce stuck proximal to glans, unable to be reduced–> EMERGENCY

Question 19

If paraphimosis is left untreated, what can result?

Answer 19

Penile necrosis

UROLOGIC EMERGENCY

Question 20

What is the tx for phimosis?

Answer 20

Circumcision

Question 21

How do you treat Paraphimosis?

Answer 21

REDUCTION

• +/- pain meds/ sedation, topical anesthetic/penile block
• Squeeze edema out of glans
• Push w/ thumbs (glans), pull w/ fingers (prepuce)

**If reduction not successful–> dorsal slit or circumcision

Question 22

What is the main complication of paraphimosis?

Answer 22

Fournier’s Gangrene (Urologic Emergency)

Question 23

What are the 2 main risk factors of testicular torsion?

Answer 23

1. Cryptorchidism (undescended testis)
2. “Bell Clapper” deformity

Question 24

What age is testicular torsion MC in?

Answer 24

12-18 y/o

Question 25

Which condition? * **Acute onset** * Severe testicular pain * **_NO scrotal swelling_**

Answer 25

**_Testicular torsion_** (epididymitis would also be painful but would have assoc. swelling)

Question 26

What is seen on Physical exam in testicular torsion? (7)

Answer 26

1. Tender, firm testis 2. High riding testis **3. Horizontal lie** 4. \*\*\*\*_**Absent cremaster reflex\*\*\*\*\***_ **5. No pain relief with elevation** 6. Thick/knotted sperm cord 7. Epididymis not posterior to testis

Question 27

Which urologic condition has an absent cremaster reflex?

Answer 27

Testicular torsio

Question 28

How do you dx testicular torsion? (3)

Answer 28

* **Clinical suspicion** * **Doppler ultrasound** (decreased blood flow on affected side) * **Nuclear testicular scan** (decreased radiotracer activity)- not usu done

Question 29

What is seen on doppler ultrasound in testicular torsion vs acute epididymitis/orchitis?

Answer 29

* Testicular torsion: **minimal** blood flow * Acute epididymitis/orchitis: **increased** blood flow

Question 30

What is seen on **nuclear testicular scan** in testicular torsion vs acute epididymitis/orchitis?

Answer 30

Testicular torsion: **Decreased** radiotracer activity Acute epididymitis/orchitis: **Increased** radiotracer activity

Question 31

How do you tx Testicular Torsion?

Answer 31

* EMERGENCY (must detorse w/in 6hrs) * Tx= **Surgery** (if testis viable- orchiopexy of both sides; not viable- orchiectomy and orchiopexy of contralateral testis) * **Manual detorsion**: "Open the book"

Question 32

Testicular Torsion: * If detorsion \<\_\_\_\_hrs, most viable * If detorsion \>\_\_\_hrs, most non-viable

Answer 32

* If detorsion **_\<6_** hrs, most viable * If detorsion **_\>24_** hrs, most non-viable

Question 33

T/F: Hydroceles can be reactive, associated with inflammatory conditions and **resolve with resolution of underlying condition**

Answer 33

True