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Year 3 > Week 18 - testicular cancer, testicular torsion, urinary tract calculi, UTI > Flashcards

Week 18 - testicular cancer, testicular torsion, urinary tract calculi, UTI Flashcards

1
Q

where do testicular cancers arise from

A

the germ cells in the testes

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2
Q

what are germ cells and what do they produce

A

are cells that produce gametes (sperm in males)

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3
Q

what is the highest incidence of age in testicular cancer

A

Testicular cancer is more common in younger men, with the highest incidence between 15 and 35 years.

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4
Q

what are the two types of testicular cancer

A

Seminomas

Non-seminomas (mostly teratomas)

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5
Q

what are the risk factors for testicular cancer

A

Undescended testes
Male infertility
Family history
Increased height

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6
Q

what is the typical presentation of testicular cancer

A

painless lump on the testicle and can occasionally present with testicular pain

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7
Q

what are the characteristics of the lump

A

Non-tender (or even reduced sensation)
Arising from testicle
Hard
Irregular
Not fluctuant
No transillumination

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8
Q

what can rarely be a presentation of testicular cancer, particularly in a rare type of tumour called a Leydig cell tumour

A

gynaecomastia can be a presentation

about 2% of patients presenting with gynacomastia have a testicular tumour

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9
Q

what is the usual initial investigation to confirm the diagnosis of testicular cancer

A

scrotal ultrasound

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10
Q

what are the 3 tumour markers for testicular cancer

A

Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas)

Beta-hCG – may be raised in both teratomas and seminomas

Lactate dehydrogenase (LDH) is a very non-specific tumour marker

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11
Q

what is the staging system used for testicular cancer

A

the Royal Marsden Staging System

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12
Q

what are the stages of the RMSS for testicular cancer

A

Stage 1 – isolated to the testicle
Stage 2 – spread to the retroperitoneal lymph nodes
Stage 3 – spread to the lymph nodes above the diaphragm
Stage 4 – metastasised to other organs

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13
Q

where are the 4 most common places testicular cancer metastasises to

A

lymphatics
lungs
liver
brain

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14
Q

what are the four things that treatment can involve for testicular cancer

A

Surgery to remove the affected testicle (radical orchidectomy) – a prosthesis can be inserted

Chemotherapy

Radiotherapy

Sperm banking to save sperm for future use, as treatment may cause infertility

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15
Q

what are the side effects of testicular cancer treatment

A

Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Lasting kidney, liver or heart damage
Increased risk of cancer in the future

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16
Q

what is the prognosis for testicular caner

A

early testicular cancer prognosis is good, with a greater than 90% cure rate

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17
Q

is metastatic testicular cancer curable

A

yes often

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18
Q

what kind of testicular cancers have better prognosis

A

Seminomas have a slightly better prognosis than non-seminomas.

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19
Q

what does testicular torsion refer to

A

the twisting of the spermatic cord, with rotation of the testicle.

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20
Q

what is testicular torsion often triggered by

A

an activity, such as playing sports

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21
Q

how does testicular torsion present

A

with an acute rapid onset of unilateral testicular pain, and may be associated with abdominal pain and vomiting

22
Q

what are the examination findings in testicular torsion

A

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position

23
Q

what is Bell-Clapper deformity

A

one of the causes of testicular torsion

Normally, the testicle is fixed posteriorly to the tunica vaginalis. A bell-clapper deformity is where the fixation between the testicle and the tunica vaginalis is absent. The testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position. It is also able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.

24
Q

what is the management of testicular torsion

A

Testicular torsion is a urological emergency, and there is an urgent requirement for treatment. Any delay in treatment will prolong the ischaemia and reduce the chances of saving the testicle.

The management of testicular torsion involves:
Nil by mouth, in preparation for surgery
Analgesia as required
Urgent senior urology assessment
Surgical exploration of the scrotum
Orchiopexy (correcting the position of the testicles and fixing them in place)
Orchidectomy (removing the testicle) if the surgery is delayed or there is necrosis

25
Q

what confirms diagnosis of testicular torsion

A

a scrotal ultrasound confirms the diagnosis.

however, any investigation that will delay the patient going to theatre is not recommened.

26
Q

what will an ultrasound show in testicular torsion

A

Ultrasound can show the whirlpool sign, a spiral appearance to the spermatic cord and blood vessels.

27
Q

what is a hydrocele

A

a collection of fluid within the tunica vaginalis that surrounds the testes.

28
Q

what is the tunica vaginalis

A

The tunica vaginalis is a sealed pouch of membrane that surrounds the testes. Originally the tunica vaginalis is part of the peritoneal membrane, but during development of the fetus it becomes separated from the peritoneal membrane and remains in the scrotum, partially covering each testicle.

29
Q

what is a simple hydrocele

A

Simple hydroceles are common in newborn males. They occurs where fluid is trapped in the tunica vaginalis. Usually this fluid gets reabsorbed over time and the hydrocele disappears.

30
Q

what is a communicating hydrocele

A

Communicating hydroceles occur where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.

31
Q

what is found on examination of a testicular hydrocele

A

cause a soft, smooth, non-tender swelling around one of the testes.

the swelling will be in front of and below the tesicule.

simple hydroceles remain one size, whereas communicating hydroceles can fluctuate in size depending on the volume of fluid from the peritoneal cavity

32
Q

what are the key features to remember when examining a hydrocele

A

they transilluminate with light. To transilluminate the hydrocele, hold a pen torch flat against the skin and watch as the whole thing lights up like a bulb.

33
Q

how is a communicating hydrocele managed

A

Communicating hydroceles can be treated with a surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis).

34
Q

what do lower urinary tract infections involve (UTI’s)

A

involve infection in the bladder, causing cystitis

35
Q

what is cystitis

A

inflammation of the bladder

36
Q

what is pyelonephritis

A

refers to inflammation of the kidney resulting from bacterial infection

the inflammation affects the kidney tissue (parenchyma) and the renal pelvis (where the ureter joins the kidney)

37
Q

why are UTI’s more common in women

A

Urinary tract infections are far more common in women, where the urethra is much shorter, making it easier for bacteria to get into the bladder.

38
Q

what is the primary source of bacteria for UTI’s

A

faeces.

normal intestinal bacteria such as E.coli can easily journey to the urethral opening from the anus.

39
Q

how do lower urinary tract infections present

A

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Frequency
Urgency
Incontinence
Haematuria
Cloudy or foul-smelling urine
Confusion is commonly the only symptom in older and frail patients

40
Q

what are the triad of symptoms also present in pyelonephritis

A

fever
loin or back pain (bilateral or unilateral)
nausea or vomiting

41
Q

what is seen on a urine dipstick that suggests bacteria in the urine

A

nitrates on a dipstick test suggest bacterial in the urine

42
Q

why do nitrates on a dipstick test suggest bacterial in the urine

A

Gram-negative bacteria (e.g., E. coli) break down nitrates (a normal waste product in urine) into nitrites.

43
Q

what is sent for microscopy in relation to UTI’s and why

A

A midstream urine (MSU) sample sent for microscopy, culture and sensitivity testing will determine the infective organism and the antibiotics that will be effective in treatment. Not all patients with an uncomplicated UTI require an MSU. An MSU is important in:

Pregnant patients
Patients with recurrent UTIs
Atypical symptoms
When symptoms do not improve with antibiotics

44
Q

what is the most common cause of UTI’s

A

E.coli which are gram-negative. anaerobic, rod-shaped bacteria

they are part of the lower intestinal microbiome and can easily spread from faeces to bladder

45
Q

what are the two initial antibiotics given in UTI’s

A

Nitrofurantoin (avoided in patients with an eGFR <45)

Trimethoprim (often associated with high rates of bacterial resistance)

46
Q

what are the 3 typical durations of antibiotics for UTI’s

A

3 days of antibiotics for simple lower urinary tract infections in women

5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function

7 days of antibiotics for men, pregnant women or catheter-related UTIs

47
Q

how is pylenephritis treated in the community according to the NICE guidlines

A

NICE guidelines (2018) recommend the following first-line antibiotics for 7-10 days when treating pyelonephritis in the community:

Cefalexin
Co-amoxiclav (if culture results are available)
Trimethoprim (if culture results are available)
Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)

48
Q

what can UTI’s in pregnancy increase the risk of

A

Urinary tract infections in pregnancy increase the risk of pyelonephritis, premature rupture of membranes and pre-term labour.

49
Q

what is the management of UTI’s in pregnancy

A

Urinary tract infection in pregnancy requires 7 days of antibiotics. All women should have an MSU for microscopy, culture and sensitivity testing.

The antibiotic options are:

Nitrofurantoin (avoided in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin (the typical choice)

50
Q

why should nitrofurantoin be avoided in the third trimester

A

because there is a risk of neonatal haemolysis

51
Q

why should trimethoprim be avoided in the first trimester

A

as it works as a folate antagonist. Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.

52
Q
A

Year 3 (63 decks)

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