1 - Penile, Scrotal, Testicular Disorders Flashcards
Trazadone has been associated with this penile disorder.
- priaprism
This is defined as a dilatation of the pampiniform plexus of spermatic veins.
- Varicocele
Nonischemic priaprism results from what?
- a fistula between the cavernosal artery and corpus cavernosum
23 y.o. African American male with sickle cell disease presents to your emergency department complaining of penile pain and sustained erection. What should you be concerned for?
- priaprism
What is the difference between phimosis and paraphimosis?
- phimosis = tight foreskin that cannot be retracted
- paraphimosis = retracted foreskin in an uncircumcised patient that cannot be returned to normal position
This is defined as a sustained erection lasting more than 4 hours.
- priaprism
Balantitis can be the first sign of this systemic disease.
- diabetes mellitus
This condition is defined as an acquired, localized fibrotic disorder of the tunica albuginea.
- Peyronie’s disease
What is the difference between balantitis and balanoposthitis?
- balantitis = inflammation of the glans penis
- balanoposthitis = inflammation of the glans and foreskin
If a patient presents with testicle torsion and is unable to have surgery in the next 2 hours what is the immediate treatment?
- manual detorsion
“open the book”
A negative cremasteric reflex and Bell Clapper deformity should have you concerned for this emergency.
- Testicular torsion
What is the treatment for phimosis? (3 options)
- manual stretching (with topical medicine)
- circumcision
- preputioplasty
What lab test can help differentiate between ischemic and non-ischemic priaprism?
- cavernosum aspirate for blood gas
this is defined as a painless, cyst arising from the head of the epididymis that is > 2 cm.
- spermatocele
Ischemic priaprism is believed to be d/t what?
- defect in nitric oxide mediated pathway
What is the main cause of balantitis?
- inadequate personal hygiene in uncircumcised males (candidal infection most common)
How are hydroceles diagnosed?
- physical exam with transillumination
- u/s to confirm
What is the first line treatment for Peyronie’s disease if the patient has moderate curvature for <12 months without compromising sexual function?
- pentoxifylline
What is the definitive treatment for a hydrocele if it is necessary?
- hydrocelectomy
What are the treatment options for ischemic priaprism? (3 options)
- phenylephrine injection (sympathomimetic)
- aspiration
- surgical shunt creation (last resort)
This is defined as a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis.
- hydrocele
What are the infectious causes of epididymitis if the patient is under or over 40 years old?
- <40 = GC or chlamydia
- >40 = enteric bacteria (E. coli)
What is the diagnostic criteria for varicoceles using ultrasound?
- veins > 3mm or reversal of flow with valsava
What is a positive Phren’s sign? What does it indicate?
- relief of pain with elevation of the testicle
- sign for epididymitis
What is the antibiotic treatment for epididymitis if the patient practices insertive anal intercourse?
- Ceftriaxone IM
- OR Levofloxacin
What is the treatment for paraphimosis?
- manual reduction
or preputioplasty/circumsion if manual reduction is unsuccessful
What is the antibiotic treatment for epididymitis if the patient is >35 and has a low STI risk?
- Levofloxacin
What are the 2 empiric treatment options for candidal infection in a patient with Balantitis?
- clotrimazole
- miconazole
What is the antibiotic treatment for epididymitis if the patient is <35 and has a STI risk?
- Ceftriaxone IM
- OR Doxycycline
There is irreversible damage if a testicular torsion lasts longer than ____ hours.
> 12 hours
What muscle contracts to regulate the temperature of the testes?
Cremasteric muscle
What is the ideal temperature for the testes?
35-36 C
Where is sperm stored and mature?
Epididymis
This structure transports sperm from the epididymis to the ejaculatory duct and urethra.
Vas deferens
This structure secretes a significant portion of fluid that ultimately becomes semen
Seminal vesicles
These cells found adjacent to the seminiferous tubules in the testicle secrete hormones called androgens
Leydig Cells
Leydig cells secrete androgens in response to what hormone?
LH
The function of this cell is to nourish developing sperm through stages of spermatogenesis by providing nutrients.
Sertoli cells
What hormone stimulates spermatogenesis and Sertoli cell function?
FSH
The testes lack these 2 enzymes which results in them not being able to synthesize glucocorticoids or mineralcorticoids.
- 21 B hydroxylase
- 11 B hydroxylase
The tests have this additional enzyme which allows the conversion of androstenedione to testosterone.
17 B Hydroxysteroid dehydrogenase
