Urology Flashcards
How are testicular tumours treated and how do they present?
Always with orchidectomy (inguinal approach) followed by radiotherapy
Painless nodule, sometimes associated with hydrocele
What are the 2 tumour markers of testicular tumours?
AFP and B HCG
How does acute epididymis-orchitis present and which pathogen is the cause in most cases?
Hx of Dysuria and uretheral discharge. Swelling may be tender and eased by elevating the testis
Caused by Chlamydia and Gonorrhoea
What is the difference between orchitis and epididymis-orchitis?
Orchitis is viral
Often caused by underlying viral infections e.g. Mumps
What are the two types of testicular torsion and how are they treated?
Torsion of spermatic code: ABSENT cremasteric reflex
Torsion of testicular appendages: preserved reflex
Both treated by urgent surgical exploration
How do hydroceles present?
- Non-painful
- Soft fluctuant swelling
- Transilluminates
- Can get above it
- Cannot palpate the testes
What is a secondary hydrocele?
Hydrocele not caused by genetic abnormality such as:
- Trauma (e.g. torsion)
- Infection
- Tumour
How can you differentiate between a hydrocele and epididymal cyst?
Epididymal cysts can be palpated separate to the testes
How are hydrocele’s managed?
In children where its due to a patent processus vaginalis, an inguinal approach is used to ligate the processus
In adults, scrotal approach to excise or plicate the sac (Jaboulay’s procedure)
Which condition are varicoceles associated with?
Renal cell carcinoma
This is why US kidneys is required as a follow up in at risk groups
What age group is mainly affected by testicular cancer and what is the most common type?
Affects men 20 - 30 years old
Most common are germ-cell tumours (Seminoma and Non-seminoma germ cell tumours)
What is the most common type of Germ cell tumour and how does it present?
Seminoma tumours (50%)
- Avg age of Dx 40 years
- LDH and HCG can be elevated (10-20%)
- AFP is usually normal
- Pathology shows sheet like cells containing lymphocytic inclusions and granulomas
What are the types of Non-seminomatous germ cell tumours and how do they present?
Types:
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
- Mixed germ cell tumours
- Affects 20-30 yr olds
- AFP and HCG elevated in most cases
- may contain ectopic tissue (i.e. hair)
In a patient 60yrs + with enlarged testes and CD20, what is the likely diagnosis?
Lymphoma
What childhood development issue is associated with testicular tumours?
Undescended testes
How is epididymis-orchitis managed?
Abx
Doxycycline +/- Ciprofloxacin
How are seminomas managed?
Orchidectomy + radiotherapy
How are non-seminomas managed?
Affect pts 20-30years, most commonly teratomas
Managed by Orchidectomy + chemotherapy
What are the 3 classifications of priapism?
Low flow:
- due to vent-occlusion and is MOST COMMON and often PAINFUL. >4hrs presentation requires emergency treatment
High flow:
- Due to unregulated arterial blood flow
Recurrent priapism:
- typically seen in sickle cell disease
What is the management of priapism?
- Ice packs/cold showers
- if due to low flow, blood may be aspirated from corpora
What is the medical management of BPH?
Tamsulosin (alpha blocker): relaxes bladder and prostate muscles. Works fast but NOT BE USED IN HYPOTENSIVE PTs
Finasteride (5-a-reductase inhibitors): causes prostate to shrink but takes time to work
What are the surgical managements of BPH?
- TURP: indicated by renal insufficiency / Failure of medical management / Recurrent cystitis / Urinary retention (intractable)
- Open Prostatectomy: for men with prostates too large for TURP +/- significant bleeding
How can prostate ca and BPH be clinically differentiated?
BPH: smooth enlarged prostate
Prostate ca: irregular and hard enlarged prostate
What can cause a false positive raised PSA?
Prostatitis // UTI // BPH // vigorous exercise or DRE
