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Urology > 1: Disorders Testes, Scrotum and Penis > Flashcards

1: Disorders Testes, Scrotum and Penis Flashcards

1
Q

What are 6 differential diagnosis of testicular pain

A
  1. Testicular torsion
  2. Epidiymo-orchitis
  3. Hydatid of Morgagni
  4. fournire gangrene
  5. strangulated inguinal hernia
  6. renal stones
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2
Q

What is Hydatid of Morgagni

A

Testicular appendage

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3
Q

What age does hydatid of morgagni occur in

A

3-5 year-olds

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4
Q

what is a sign unique to hydatid or Morgagni

A

Blue discolouration of the scrotum

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5
Q

what is testicular appendage

A

remnant of the mullerian duct

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6
Q

how does strangulated inguinal hernia present clinically

A
  • Recurrent inguinal-scrotal swelling

- Sudden-onset pain

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7
Q

what is testicular torsion

A

twisting of spermatic cord and its contents in the tunica vaginalis

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8
Q

what is the peak incidence of testicular torsion

A

15 -25 year-olds

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9
Q

aside from in adolescence, who may testicular torsion occur in

A

neonates (30d)

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10
Q

what type of torsion occurs in adolescents

A

Intra-vaginal (Within tunica vaginalis)

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11
Q

what are 4 RF for intra-vaginal torsion

A
  • FH
  • Previous torsion
  • Cryptorchidism
  • Bell clapper deformity
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12
Q

what is bell clapper deformity

A

Spermatic cord joins higher on tunica vaginalis. This increases mobility of the testes and often means they lie horizontally

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13
Q

what type of torsion is extra-vaginal torsion

A

Neonatal torsion

- Occurs as tunica vaginalis is not yet fully attached to the scrotum and therefore is susceptible to tort

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14
Q

how does testicular torsion present clinically

A
  • Sudden-onset unilateral scrotal pain and swelling
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15
Q

how will the testes present on examination

A

Erythematous and swollen

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16
Q

what will be absent on testicular examination

A

Phren sign

Cremasteric reflex

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17
Q

what is phren sign

A

where testicular pain is relieved by lifting the testes

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18
Q

what is phren sign indicative of

A

epidiymo-orchitis

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19
Q

what time frame can necrosis of testes occur post-torsion

A

6-12h

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20
Q

how is testicular torsion diagnosed

A

clinically

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21
Q

how should testicular torsion be managed

A

emergency surgical exploration and bilateral orchidpexy

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22
Q

what is time frame for orchipexy

A

4-6h

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23
Q

what should all patients undergoing orchiopexy be consented for

A

Orchidectomy

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24
Q

what is epidiymitis

A

inflammation epididymis

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25
Q

what is orchiditis

A

inflammation testis

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26
Q

what is epididymo-orchitis

A

inflammation epididymis and testis.

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27
Q

explain epidemiology of epididymo-orchitis

A

orchitis rarely ever occurs alone. Most cases of epididymo-orchitis turn out to be epididymitis

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28
Q

when is the peak incidence of epididymo-orchitis

A

15-30 year-olds

60 year-olds

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29
Q

what causes epididymal-orchitis

A

STI
UTI
Gastroenteritis

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30
Q

what is the biggest cause of epididymal-orchitis in men under 35

A

STI:

  • Chlamydia
  • Gonorrhoea
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31
Q

what is the biggest cause of epididymal-orchitis in men over 35

A

UTI:

E.Coli

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32
Q

what causes just orchitis

A

Mumps

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33
Q

what are two complications of mumps

A

Testicular atrophy

Infertility

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34
Q

what is a risk factor or epididymal-orchitis

A

Unprotected sexual intercourse
Multiple partners

Bladder outlet obstruction
Instrumentation

Immunocompromised

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35
Q

how does epididymal-orchitis present clinically

A

Unilateral scrotal pain and swelling
Fever, riggers
Preceding dysuria or discharge

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36
Q

how does epididymal-orchitis present on examination

A

Tender, erythematous

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37
Q

what signs are positive in epididymal-orchitis

A

Phren

Cremasteric reflex

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38
Q

what is phren’s sign

A

Pain is relieved on elevating testes

39
Q

what investigations should be ordered in epididymal-orchitis

A

NAAT on first void urine sample (Chlamydia and Gonorrhoea)

Urinalysis

40
Q

how is epididymal-orchitis managed

A

Antibiotics
Analgesia
Bed-Rest

41
Q

what antibiotic is given if suspected E.coli is cause of epididymal-orchitis

A

Oxafloxacin

42
Q

what antibiotics are given if suspect STI as cause of epididymal-orchitis

A

Ceftriaxone and Doxycycline

43
Q

what foes epididymal-orchitis increase risk of

A

Hydrocele

Abscess

44
Q

how can scrotal swellings be divided

A

Extra-testicular

Intra-testicular

45
Q

name 5 extra-testicular scrotal swellings

A
  • Inguinal Hernia
  • Hydrocele
  • Epididymitis
  • Epididymal cyst
  • Varicocele
46
Q

what age do epididymal cysts occur in

A

Middle-Age

47
Q

how do epididymal cysts present clinically

A

Smooth fluctuant nodules above and separate to testis, may be multiple. Usually asymptomatic

48
Q

what are features of epididymal cysts on examination

A

Transilluminable

49
Q

what is one of the most common causes of scrotal pain in adults

A

epididymitis

50
Q

what is a distinctive feature of inguinal hernias as a cause of scrotal swelling

A

cannot get above the swelling!

51
Q

what can exacerbate scrotal swelling if an inguinal hernia

A

coughing

52
Q

when may lump disappear if an inguinal hernia

A

lying down

53
Q

what are 4 testicular lumps causing scrotal swellings

A
  • Testicular cancer

- Torsion

54
Q

how does testicular cancer present

A

painless irregular lump of testis

55
Q

if suspecting testicular cancer describe investigations

A
  • Testicular USS
  • AFP, LDH and bHCG

do NOT, under no circumstances, biopsy! at this can seed the cancer

56
Q

what is a varicocele

A

abnormal dilation of pampiniform plexus

57
Q

what are the causes of varicocele

A
  • Primary (Idiopathic)

- Secondary = lymphoma or RCC

58
Q

what side do 90% of varicoceles occur on and why

A

Left

: left testicular vein drains into renal vein

59
Q

how do varicoceles present clinically

A

Dull-ache sensation : worse on standing

Bag of worms - swelling that may disappear on lying down

60
Q

what are 3 red flags of testicular varicocele

A
  • Right sided
  • Acute - onset
  • Remains on lying flat
61
Q

what does right sided testicular varicocele indicate

A

usually abdominal mass such as lymphoma or RCC

62
Q

what should all individuals with varicocele be offered and why

A

abdominal exam - due to risk of RCC

63
Q

what investigations are ordered in varicocele

A

USS

Semen analysis

64
Q

why is a semen analysis offered in varicocele

A

As can compromise fertility

65
Q

what are two management options for varicocele

A

Conservative

Embolisation

66
Q

when is testicular embolisation offered

A

Pain

Infertility

67
Q

what are two complications of varicocele

A

Testicular atrophy

Infertility

68
Q

what is a hydrocele

A

collection fluid between visceral and parietal layers of tunica vaginalis

69
Q

how does a hydrocele present

A

painless fluctuant swelling

70
Q

how are hydrocele’s and inguinal hernias differentiated

A
  • hydroceles = can get above

- inguinal hernia = cannot get above

71
Q

what is a key feature of hydroceles on examination

A

transilluminable

72
Q

what causes congenital hydroceles

A

patent processus vaginalis

73
Q

in patients 20-40 years with suspected hydrocele what should be done

A

USS - to exclude testicular cancer

74
Q

if congenital hydrocele when do they typically resolve by

A

6-months

75
Q

when are congenital hydroceles operated on

A

1-year

76
Q

what is balanitis

A

inflammation glans penis

77
Q

what is balanoposthitis

A

inflammation glans penis and foreskin

78
Q

what are features of candiasis balanitis

A

Itching following intercourse

White discharge

79
Q

what are features of contact or allergic dermatitis balanitis

A

Painful
Itchy
Clear discharge
No other region affected

80
Q

what are features of eczema or psoriais dermatitis balanitis

A

Itchy

Other regions skin affected

81
Q

What usually causes bacterial balanitis

A

Staphylococcus

82
Q

How does bacterial balanitis present

A
  • Painful
  • Itchy
  • Yellow discharge
83
Q

How does aerobic balanitis present

A

Offensive yellow discharge

84
Q

What are features of lichen plants balanitis

A
  • Wickhams striae

- Violaceous papules

85
Q

What is lichen sclerosis balanitis called

A

Balanitis xerotica obliterans

86
Q

How does balanitis xerotica obliterans present clinically

A

Itchy
white plaques
scarring

87
Q

what can balanitis xerotica obliterans cause

A

urethral stricture

88
Q

how does plasma cell balanitis of zoon present

A

well circumscribed erythematous lesions

89
Q

what is circinate balanitis associated with

A

retir syndrome

- presents as painless erosions

90
Q

what is used to manage balanitis

A

Saline wash out - was under foreskin

Topical hydrocortisone

91
Q

how is balanitis xerotica obliterans managed

A

Circumscion

Topical corticosteroids

92
Q

what are 4 indications for circumscision

A
  • Recurrent balanitis
  • Balanitis xerotica obliterans
  • Phimosis
  • Paraphimosis
93
Q

what are 3 advantages of circumscion

A
  • Reduce risk penile cancer
  • Reduce risk UTI
  • Reduce risk STI
94
Q

what organism is the most common cause of epididymo-orchitis

A

chlamydia

Urology (14 decks)

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