1. Male repro. clinical conditions

Question 1

P presents with severe sudden onset testicular pain and absent cremasteric reflex. What is the likely diagnosis? How should this be treated?

Answer 1

TESTICULAR TORSION

• medical emergency where spermatic cord twists on itself
• can lead to occlusion of testicular a. resulting in testes necrosis
• onset of pain often during physical activity

Treatment = suture wall of testes to scrotum on both sides (risk of recurrence)

Question 2

which abnormality pre-disposes Ps to testicular torsion

Answer 2

BELL-CLAPPER DEFORMITY: tunica vaginalis is overdeveloped posteriorly (normally only present anteriorly and laterally) causing lack of normal posterior fixation of testis

Question 3

why is catherisation more complex in males - how can this be dealt with

Answer 3

2 angles: infrapubic and prepubic

prepubic angle can be removed by holding penis upwards during catheterisation

Question 4

what is the difference between BPH and prostatic carcinoma - how can these be differentiated

Answer 4

1. BPH
   - androgen-dependent non-cancerous increase in size of prostate, more common with advancing age - involves hyperplasia of TRANSITIONAL ZONE cells
   - presents with urinary frequency, urgency and difficulty initiating micturition (large nodules compress bladder and urethra and partially obstruct urine flow)
2. Prostatic carcinoma
   - malignant cells commonly originate from PERIPHERAL ZONE - so don’t present with urinary symptoms until advanced disease stage
   - DRE may reveal a hard irregular gland

Question 5

why and where do prostatic carcinomas commonly metastasise

Answer 5

venous drainage from prostate is valveless so malignant cells will commonly metastasise via Batson venous plexus to vertebral bodies

Question 6

how is testicular torsion differentiated from other causes of scrotal swelling

Answer 6

• loss of cremasteric reflex
• elevation of affected testicle
• pain enhanced on lifting of testis

Question 7

what is the difference between a hydrocoele and a haematocoele - how can these be differentiated

Answer 7

1. HYDROCOELE:
   - collection of serous fluid between visceral and parietal layers of tunica vaginalis, most commonly due to failure of processus vaginalis closure
   - often get bigger in young boys when coughing/crying due to increased abdominal pressure
2. HAEMATOCOELE:
   - collection of blood in tunica vaginalis
   - can be differentiated from hydrocoele by transillumination (light is applied to testicular swelling)

Question 8

P presents with testicular swelling resembling ‘bag of worms’ - what is the likely diagnosis

Answer 8

VARICOCOELE: gross dilation of pampiniform plexus of veins draining testes due to blood flow obstruction

Question 9

which testis do varicocoeles more commonly affect

Answer 9

L testis as L testicular v. drains into L renal v. at a perpendicular angle, and renal v. can get compressed between SMA and aorta causing increased reflux

R-sided varicocoele more worrying as R testicular v. drains into IVC, suggesting blockage of IVC

Question 10

P presents with scrotal swelling and pain, which is relieved on lifting testis - what is the likely diagnosis

Answer 10

epididymitis - inflammation of epididymis, usually caused by bacterial or viral infection