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Flashcards in Urology Path Deck (72)
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A 12-year old boy comes to the pediatrician complaining of genital pain (at the tip of his penis) with the erections he now experiences. Based on the exam below, what is his diagnosis and treatment?

Narrowing of prepuce--> impairs retraction over glans

Paraphimosis: (below) narrow prepuce retracted, can strangulate glans (due to infection, trauma)
- Both cured by cirumcision



A 55 year old chronic alcoholic has an acute episode of pancreatitis. On hospital admission he begins complaining of abdominal swelling and the following is revealed. What is his diagnosis?

Scrotal edema caused by pancreatitis

Other causes of scrotal edema:
1. Hydrocele= serous fluid collection in scrotal sac between two layers of tunica vaginalis
- Congenital: most common cause of scrotal swelling in infants, associated with inguinal hernia
- Acquired: secondary to infection, tumor, trauma; U/S or transluminate fluid--> can lead to testicular atrophy or fluid can become infected and cause periorchitis

2. Hematocele: accumulation of blood between tunica vaginalis layers due to trauma, hemorrhage into hydrocele, tumor, infection

3. Spermatocele: Cyst in efferent ducts (widened) of rete testis or epididymis
- Ressembles paratesticular nodule or fluid-filled mass
- Cyst is lined with cuboidal epithelium with spermatozoa in various degenerative stages

4. Varicocele: Dilation of testicular veins
- Cause infertility, oligospermia (most asymptomatic)

5. Scrotal inguinal hernia: protrusion of intestines into scrotum through inguinal hernia



What is the diagnosis of this patient's itching in his penis and the complications of this infection?

Balanitis: Balanoposthitis due to Candida

Balanitis: Glans, due to poor hygeine

Balanoposthitis: glans and foreskin; bacteria, fungi

Complications: meatal stricture, phimosis, paraphimosis


What is the diagnosis of this patient's penile disfigurement and what is a complicaiton of it?

Balanitis xerotica obliterans
Chronic inflammatory syndrome of subepithelial connective tissue
Xerotica= fibrosis
Obliterans= sclerosis

Glans= white, indurated
- Can cause strictures, phimosis
Equivalent to lichen sclerosis atrophicus of vulva



A 30 year old man with a recent bout of Salmonella comes to his PCP because of concerns of a new STD (see below). Additionally he has visible conjunctivitis and symptoms of arthritis in his knees. What is his diagnosis and is there treatment?

Circinate balanitis:
Circular, linear, or confluent plaque-like discolorations of glans, superficial ulcerations
Seen in Reiter syndrome

Reiter syndrome= urethritis, conjunctivitis, arthritis in weight-bearing joints
- can also see circinate balantitis, cervicitis, skin eruptions
- Effects adults with HLA-B27 haplotype
- Symptoms after chlamydia, Shigella, Salmonella, Campylobacter
- Inappropriate immune reaction- spontaneously resolves


Plasma cell balanitis:
aka Zoon balanitis
Chronic disease of unknown origin--> macular discoloration/painless papules on glans
- Infiltration of plasma cells, lymphocytes, epithelial thickening


A 30-year old man comes to the physician with his wife after difficulty conceiving. On physical exam, he is noted to have slight gynecomastia, sparse facial and body hair, and small testes. Sperm analysis reveals few sperm with abnormal motility. Based on the histologic specimen of his testes below, what is his diagnosis?

Klinefelter's syndrome infertility (47XXY)
- Hyalinzed seminiferous tubules
- Prominent Leydig cells
- Results in infterility

Below: normal seminiferous tubules, Leydig cells


What abnormalities are noted in the sample of seminiferous tubules below?

Germ cell morphologic alterations:

- Maturation arrest (front)
- Germ cell aplasia ("Sertoli cell only syndrome")- below


Spermatic cord torsion

• Twisting of the spermatic cord with compromise of the testicular blood supply
• Etiology: abnormal fixation of the testis and spermatic cord
• Seen in children and young adults during vigorous activity
• Clinically presents as abrupt onset of pain and swelling

Below: Histo of testicular infarct following testicular torsion


Below is an orchectomy specimen from a man who developed chronic UTIs. What type of changes have occured in his testicules?

Granulomatous orchitis

• Gram-negative bacterial orchitis is the most common form, often secondary to urinary tract infection
• Syphilitic orchitis
• Mumps orchitis unilateral
• Granulomatous orchitis type IV (cell-mediated) hypersensitivity reaction and tuberculosis
• Malakoplakia

: Multinucleated giant cells (green arrows) and poorly formed granulomas with necrosis
Below: Ziehl Neelsen stain with acid fast bacilli (black arrow) in RED for tuberculosis


• Cause: coliform uropathogens, but often cannot be determined
• May cause elevated serum prostate-specific antigen (PSA)
Types of Prostatitis:
• Acute Prostatitis • Chronic Bacterial Prostatitis • Nonbacterial Prostatitis • Granulomatous Prostatitis


A 72 year old African American man with increasing issues of urinary hesitancy and feeling of incomplete emptying is autopsied following a massive MI. His prostate is removed (below). Based on the gross appearance of his prostate and his symptoms, what was the pathology and how would he have been treated if his symptoms had progressed? What we he at risk for developing?

Benign prostatic hyperplasia:
1. Mechanical Component
- Glandular proliferation
2. Dynamic Component
- Baseline tonicity of smooth muscle (activated by alpha receptors)

** Prostate enlargement in BPH driven by androgens= dihydrotestosterone (DHT)

Obstructive symptoms:
- Decreased force of stream
- Feeling of incomplete emptying
- Intermittency (double voiding)
- Hesitancy (delay of onset of voiding)
- Need to strain to empty bladder

- Frequency of urination
- Urgency (strong desire to void)
- Nocturia (waking to urinate)
- Dysuria (pain during urination)
- Hematuria (blood in urine)

1. Assess symptoms: AUA symptom score:
- 7 questions: Incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia
- Each question has severity (1-5)
- Mild= 0-7; moderate= 8-19; severe= 20-35
2. Labs: serum creatinine, PSA, urinalysis, urine culture
3. Check PVR (post-void residual)
- Remaining volume after micturation
- Transabdominal U/S or catheterization
4. Renal ultrasound:
- Check for hydronephrosis, cortical thinning

1. Observation
2. Medical management
- Alpha blockers
- 5-alpha reductase inhibitors
3. Surgery
- Various methods of clearing bladder outlet (TURP, etc)

Indications for surgery:
- Refractory urinary retention (may require catheters.
- Recurrent UTI
- Renal Insufficiency
- Bladder calculi
- Recurrent gross hematuria from prostate

Risks of surgery:
- bleeding, bladder neck contracture
- Retrograde ejaculation (30-97%)- usually indicator of treatment effectiveness
- Tranurethral syndrome: absorption of hypotonic solution used in TURP procedure (hyponatremia)