UROLOGY - Penis and Testicles Flashcards by Izzy Burns

What is Phimosis

Narrowing of the prepubital orifice

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Causes phimosis (4)

Idiopathic
Congenital
BXO
Traumatic forcible retraction of foreskin

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PS phimosis in children

Ballooning of the foreskin + poor stream during urination

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PS phimosis in adults

Pain during intercourse + inability to retract foreskin

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Tx phimosis

Circumcision

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What is paraphimosis

Pulling a tight foreskin over glans, obstructing vv return- –> swollen, painful glans
Then cannot replace foreskin

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Causes paraphimosis

After erection

Forgetting to replace foreskin after catheter

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Tx paraphimosis

LA + P to glans

Or slitting foreskin dorsally

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Prevention of recurrence paraphimosis

Circumcision

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What is 50% of carcinoma of the penis associated with?

HPV 16/18

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Who is > at risk of carcinoma penis

Smokers

Immunosuppressed

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PS carcinoma of the penis

Persistent red patch on penis –> ulcer

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What type of cell tends to be penile cancer

Squamous cell carcinoma

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ix penile carcinoma?

Punch biopsy

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Mx early penile carcinoma

Radiotherapy

Or penis preserving excision

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Mx late penile carcinoma

Radical excision

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What is priapism

Persistent erection of corpora cavernosum

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Causes priapism (4)

Idiopathic (mostly)
Trauma
Sickle cell disease
Intracvernosal injections for impotence

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Tx priapism

Ice packs 
Alpha agonists 
Selective emobilization 
Aspiration of corpus cavernosum 
Surgical intervention

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What is Peyronie’s disease

Upward curvature of penis when erect

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What % of men are affected by Peyronies

Up to 3%

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Cause Peyronies

Unknown

Potentially related to fibrous scarring post trauma

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Tx Peyronies

Mx assoc depression

Surgical intervention

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What is an ectopic testis

Testies that has strayed from its normal line of descent

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Most common site of ectopic testis

Superior inguinal pouch

Mx ectopic testis

Orchidopexy @6m

What is an undescended tstis

Testis has stopped short of scrotum

Why does undescended testis occur

Local defect in devlopment

Mx undescended testis

orchidopexy @6m

What is retractile testes

Normal testes w/ XS cremasteric reflex

Tx retractile testes

No Tx

Complications of maldescent testes (4)

Defective spermatogenesis Incr risk torsion Incr risk malignancy Incr risk indirect inguinal hernia

GO OVER APPROACH TO SCROTAL SWELLING

DO IT U POO

Cremasteric reflex + torsion

Absent

Phren's sign

Scrotal elevation relieves pain in epididymitis

What is epididymal cyst due to?

Cystic degeneration of epididymal structures

What 2 conditions are epididymal cysts associated with?

PKD | CF

Fl in epididymal cyst

Clear or milky

Mx epidiymal cyst

Excise if signif Sx

What is the most common cause of scrotal enlargement

Hydrocele

What is a hydrocele

Excessive collection of serous fluid in tunica vaginalis

Why do hydrocele's occur (2)

Problem w/ absorbing fl | Or too much fl = being produced

Congenital hydroceles

Assoc w/ hernia sac + patent processus vaginalis

Mx congenital hydroceles

Most spontaneously resolve <1y

Who gets 1' hydroceles

Younger men

What is a 2' hydrocele

Fluids collecting due to underlying inflamm in epididymis/testes/ underlying cancer

Ix hydrocele

USS

Mx troublesome hydrocele

Excision

What is a varicoele

Varicosities/dilation of pampiniform plexus, most commonly on the left

What % of men have a varicoele

10%

PS varicoele

Pt complains of dragging sensation + ache | Bag of worms on palp

Varicoele + infertility

assoc w/ reduced spermatogenesis + subfertility

Which testicle > likely to have varicoele + why

L | Because L renal v drains at right angle vs R testicular vv which drains obliquely into IVC

Mx varicoele

Reassurance

What is the most common solid malignancy in men aged 15-44

Testicular tumour

RF testicular cancer (4)

Underscended/ectopic testes Infertility Hypospadia F/PHx

What are the 2 main types of testicular tumours

Seminomas | Non-seminomatous germ cell tumours

What are the 3 types of NSGCT's

Teratomas Yolk sac tumours Choriocarcinomass

Where do seminomas arise from

Cells of seminiferous tubules

What age groups - seminomas

30-40y/o

Macroscopic appearance seminoma

solid appearance

Where does teratoma arise from

Totipotent germ cells

What age group - teratoma

20-30y/o

Macroscopic appearance teratoma

Cystic

Spread testicular cancer

Lymphatic --> para-aortic nodes | Blood bourne - lungs + liver

PS testicular cancer (5)

``` Painless lump in testes Hydrocele Haematospermia Sx mets Rarely - gynaecomastia ```

Ix testicular cancer

Scrotal USS Tumour markers CT CAP

Tumour markers NSGCT's (2)

Prod AFP | Some prod bHCG

Tumour markers Seminomas (2)

Never prod AFP | 10% prod bHCG

Mx testicular tumours

Orchidectomy +/- retroperitoneal LN dissection Sperm banking

post surgery Tx seminomas

post sugrical radiotherapy

post surgery Tx NSCGTs

post surgical chemotherapy

What is testicular torsion usually due to

Congenital abnormality

What age does testicular torsion tend to PS in

12-18y/o

Sx tsticular torsion

Sudden onset severe pain groin/lower abdo T10 | +/- vom

O/E testicular torsion

Unilateral hot swollen tender testes | Absent cremasteric reflex

DDx testicular torsion (4 )

Epididymitis Torsion of testicular appendage Mumps Cancer

Salvage rate if op'd on within 6hrs testicular torsion

80%

PS torsion testicular appendage

< painful that torsion | Small blue nodule visible under scrotum

What is Epididymo-orchitis

Acute infection arising due to ascending infection via vas deferens

Causes epididymo-orchitis (4)

Gonococcal/non-gonococcal urethritis UTI/E.coli Mumps TB

PS epididymo-orchitis (4)

Painful swelling of epididymis +/- 2' hydrocele Hx discharge/dyusria +ves Phren's test

Ix epididymo-orchitis

1st catch urine MCS + STI sscreen | USS

Tx epididymo-orchitis

6w cipro | Analgesia + scrotal support

PS acute bacterial prostatitis (5)

``` Fever/rigors Perianal pain Difficulty voiding UTI Sx Pain on ejaculation ```

PR - acute bacterial prostatitis

Tender + enlarged

Def impotence

Inability to achieve, or sustain an erection for sexual intercourse

Causes impotence (9)

``` Neurogenic Vascular (HTN/aa disease) DM Pit failure Alochol Anti-HTN Oestrogens Tranqs Psychogenic ```

Ix importence

Hx Exam Urine dip Hormone screen

Tx impotence

``` Tx med/hormonal cause Stop smoking/reduce alc intake Sildenafil PEG1 injection Vacuum condom ```

C/I sildenafil

If on HoTN drugs

UROLOGY - Penis and Testicles Flashcards

(91 cards)