Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

a_GYNGU > 11/18- Benign Diseases of the GU system > Flashcards

11/18- Benign Diseases of the GU system Flashcards

1
Q

Describe components of the upper urinary tract

A
  • Kidneys (retroperitoneal); collecting system begins here
  • Forms the renal pelvis
  • Concentrically narrows at ureteropelvic junction (UP)
  • Becomes the ureter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do they kidneys lie? Adjacent structures?

A

Retroperitoneal

  • Ribcage
  • Retroperitoneal fat
  • Perirenal fat within Gerota’s capsule
  • Overlying viscera
  • Right: liver, colon, duodenum, adrenal
  • Left: spleen, colon, adrenal, pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe components of the lower urinary tract

A
  • Urinary bladder
  • Male urethra begins within the pelvis and courses inferiorly through the GU diaphgram the external genitalia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are adjacent structures of the male urethra?

A
  • Bony pelvis
  • Colon: posteriorly
  • Uterus in females
  • Perivesical fat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the course of the urethra in male/female

A

The urethra begins as a funneling of the urinary bladder at the bladder neck

  • Courses through the prostate
  • Widens after exiting the GU diaphragm
  • Male: exits through the penis
  • Female: exits in the anterior vaginal wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the epidemiology of Urinary Calculus Disease

  • __% in all individuals
  • __% of the population during their lifetime
  • Recurrence
  • Ethnicity
  • Gender
A
  • 3% in all individuals
  • ~ 12% of the population during their lifetime
  • Recurrence rates approach 50% at 10 years
  • White males have the highest incidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the etiology of urinary calculus disease?

A
  • Solutes in amounts too high to stay dissolved (supersaturated) in urine
  • Solutes precipitate and aggregate to form stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 5 primary subtypes of Urinary Calculus Disease (from most -> least common)

A
  • Calcium oxalate
  • Uric acid
  • Struvite (magnesium ammonium phosphate
  • Calcium phosphate
  • Cysteine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Ca oxalate?

  • Describe stone formation
  • Treated/inhibited by what
A
  • Chemically may be monohydrate or dehydrate
  • Thought to be initial formation of calcium phosphate
  • Forms in a Randall’s plaque in the urinary collecting system
  • Exposed calcium phosphate then encrusted by calcium oxalate once exposed to urine
  • May be inhibited by citrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is uric acid?

  • Produced when
  • Solubility factors
  • Asociated conditions
A
  • Byproduct of purine metabolism
  • Solubility determined by urine pH
  • 100 X more soluble in urine pH > 6 than < 5.5

• Most common in patient with persistently acidotic urine or acidotic states

  • Renal tubular acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is struvite?

  • Produced when
  • Solubility factors
A

•Result of urease producing bacterial infections

  • PROTEUS followed by Klebsiella, Enterobacter, and Pseudomonas
  • Urease cleaves urea into insoluble ammonium
  • H+ in release reducing ammonia to ammonium further alkalinizing the urine
  • Ammonium is less soluble in basic urine and binds to phosphate creating and growing stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Calcium Popshate?

  • Produced when
  • Process of stone formation
A
  • Phosphate metabolism and excretion is governed by parathyroid hormone
  • Phosphate tends to precipitate in alkaline urine
  • Initial nidus for many forms of calcium stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is cystine?

  • Produced when
  • Labs
  • Solubility factors
A
  • Recessive genetic trait involved in amino acid transport
  • Amino acid of cysteine-S-S-cysteine
  • Excessive excretion of cystine, > 200 mg/day vs. <100 mg/day in normal individual
  • Cystine is more soluble in extremely basic urine, pH > 9.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are symptoms of Urinary Calculus Disease?

A
  • Acute, colicky flank pain radiating to the groin or scrotum
  • Ureter – pain may localize to the abdomen overlying the stone
  • Considered among the most severe pain experienced by patients
  • Female stone patients describe the pain as more intense than that of childbirth

• Ureterovesical junction – lower quadrant pain

  • urinary urgency, frequency, and dysuria
  • mimics bacterial cystitis

• Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is typical history of someone with Urinary Calculus Disease?

A
  • Family history of renal calculi - 55% of patients with recurrent stones
  • 3 X more likely in men with a + family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are physical exam findings of Urinary Calculus Disease?

A
  • Distressed patient, often writhing,
  • Patient typically cannot get comfortable
  • Acute abdomen patients lie very still
  • Costovertebral angle or lower quadrant tenderness
  • Vagina Exam
  • Ureterovesical junction stone may be palpable on vaginal examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are lab/diagnostic techniques for Urinary Calculus Disease?

A

Laboratory exam

  • Urinalysis- gross or microscopic hematuria
  • Blood tests
  • CBC – mild or significant leukocytosis
  • Chemistries – may show electrolyte disturbances and evidence of renal injury

Imaging

• Unenhanced, helical computed tomography (CT)

  • Positive and negative predictive values of CT: 100% and 91%

• Older imaging techniques include intravenous urography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is seen here?

A

Unenhanced, helical CT

  • Good positive and negative predictive values for CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DDx for Urinary Calculus Disease?

A
  • Renal or ureteral stone
  • Hydronephrosis (ureteropelvic junction obstruction, sloughed papilla)
  • Bacterial cystitis or pyelonephritis
  • Acute abdomen (bowel, biliary, pancreas or aortic abdominal aneurysm sources)
  • Gynecologic (ectopic pregnancy, ovarian cyst torsion or rupture)
  • Radicular pain (L1 herpes zoster, sciatica)
  • Referred pain (orchitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Indications for intervention in Urinary Calculus Disease?

A
  • Obstructed upper tract with infection
  • Impending renal deterioration
  • Pain refractory to analgesics
  • Intractable nausea/vomiting
  • Patient preference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

There’s a flowchart for UCD mgmt that I’m deliberately ignoring

A

Oops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

15% of antibiotic prescriptions in US are the result of UTI; this does not account for complicated UTIs for pts with complex urologic problems. Problem?

A

Broad-spectrum antibiotic use is rising

  • Esp fluoroquinolones and cephalosporins
  • Results in “collateral damage” and co-resistance to other Abx classes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a UTI (def)?

  • Uncomplicated
  • Complicated
A

UTI- An inflammatory response of the urothelium to bacterial invasion that is usually associated with bacteriuria and pyuria

Uncomplicated UTI-

  • An infection in a healthy patient with a structurally and functionally normal urinary tract
  • Often female patients with isolated or recurrent cystitis or acute pyelonephritis

Complicated UTI-

  • An infection is associated with factors that increase the chance of acquiring bacteria and decrease the efficacy of therapy
  • The urinary tract is structurally or functionally abnormal, the host is compromised, and/or the bacteria have increased virulence or antimicrobial resistance
  • The majority of these patients are men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are temporal relationships of UTIs?

A
  • First or isolated – a first time infection in a person or development of a new infection remote from a previous infection
  • Unresolved – an infection that has not responded to antibiotic therapy
  • Recurrent – an infection that begins after documented, successful resolution of a prior infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is cystitis?

  • Symptoms
A

A clinical syndrome of dysuria, frequency, urgency, and occasionally suprapubic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is acute pyelonephritis?

  • Symptoms
A
  • A clinical syndrome of chills, fever, and flank pain that is accompanied by bacteriuria and pyuria
  • Must have flank pain present to be termed pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the epidemiology of adult UTIs

  • Affected population
  • Nosocomial
A
  • 150 million UTIs occur world wide annually
  • Incidence 0.5-0.7 persons/annually in US

Nosocomial infections

  • UTIs account for 40% infections in health care setting
  • 1 million catheter associated UTIs (CAUTI) annually
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are host risk factors for adult UTIs?

A
  • Reduced urinary flow
  • Promoters of colonization
  • eg. sexual activity, ↓ estrogen concentration in vaginal tissue

• Facilitate inoculation

  • eg. catheterization, fecal incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are bacterial pathogenic factors for adult UTIs?

A

• Increased adhesion

  • Pili – type I in cystitis, P in renal infections (pyelonephritis)
  • Increased colonization
  • Tissue invasiveness
  • e.g: hemolysin
30
Q

Describe the host defenses to adult UTIs

A

• Periurethral and urethral

  • Normal flora – lactobacilli, coag ‒ staph, Corynebacterium, streptococci

• Chemical urinary factors

  • Low pH
  • High osmolality
  • High urea concentration

• Bladder

  • Toll like receptors (TLRs) – innate cellular components that initiate immune/inflammatory responses

• Kidney

  • Local immunoglobulin/antibody synthesis
31
Q

What are symptoms of uncomplicated UTI

  • Differential diagnosis
  • Risk factors
A

Symptoms – dysuria, frequency, and urgency

  • Predict a UTI with 90% probability
  • In absence of vaginal discharge

Differential Diagnosis

  • Sexually transmitted infection
  • Vaginitis
  • Painful bladder Syndrome/interstitial cystitis

Risk factors

• Genetic, Biologic, Behavioral

32
Q

Describe the history, exam, and lab of uncomplicated UTI

A

Historical components

• Number of past UTIs, urinary tract abnormalities or surgery, pediatric UTIs, neurogenic bladder, immunologic state

Examination

  • Focused on abdominal, back, and pelvic exam
  • STIs, urethral and bladder palpation

Laboratory

  • Dip stick or microscopic urinalysis
  • Not necessary to perform urine culture in initial or isolated UTI
33
Q

What are common pathogens causing uncomplicated UTI?

A
  • Escherichia coli (85%)
  • Staphylococcus saprophyticus (10-15%)
  • Klebsiella pneumoniae (4%)
  • Proteus mirabilis (4%)
34
Q

Treatment for uncomplicated UTI?

A
  • TMP-SMX – caveat in population areas with resistance > 10-20%
  • Nitrofurantoin
35
Q

How to diagnose/evaluate uncomplicated recurrent UTI?

A

Must differentiate uncomplicated from complicated

Primary focus is on prevention

Evaluation

  • Historical components are similar to uncomplicated isolated UTI
  • Lab: urine culture is more important but not required
  • Imaging: KUB and renal/bladder ultrasound may be considered to evaluate for anatomic abnormality
  • Cystoscopy: considered to evaluate for sources of infection
36
Q

How do you treat an uncomplicated recurrent UTI?

A
  • Suppressive therapy
  • Self-start therapy
  • Urine culture obtained prior to self-initiation of antibiotics

• Post-coital prophylaxis

  • Typically 1-2 pill regimen

• Non-antibiotic therapy

  • Urinary acidification – Vitamin C
  • Methenamine salts – Converted to formaldehyde in the urine
  • Probiotics: vaginally administered vs. oral
  • Cranberry: controversial with no firm data to support
37
Q

What are important factors in the determination of complicated UTIs?

A
  • Functional or anatomic abnormality of urinary tract
  • Male gender
  • Pregnancy
  • Elderly patient
  • Diabetes
  • Immunosuppression
  • Childhood UTI
  • Recent antimicrobial agent use
  • Indwelling urinary catheter
  • Urinary tract instrumentation
  • Hospital-acquired infection
  • Symptoms for more than 7 days at presentation
38
Q

Describe the presentation/evaluation/labs of a complicated UTI?

A

Presentation

  • Must be associated with symptoms: dysuria, frequency, urgency, flank pain, fever, etc.
  • Wide variability in clinical symptoms: UTI in a man with LUTS to pending sepsis from pyelonephritis

Urine cultures – Defined bacterial counts

  • Women = ≥ 105 colony forming units (CFU)/mL
  • Men = ≥ 104 CFU/mL
  • Catheterized specimen = ≥ 104 CFU/mL
  • Multiple bacterial pathogens with larger spectrum than uncomplicated UTI
  • Enterobacter predominate
  • Escherichia Coli are still the most common
  • Non-fermenting gram negative bacteria, e.g. Pseudomonas

Microscopy

• Pyuria ≥ 10 WBC/hpf in resuspended urine

39
Q

Describe evaluation of complicated UTI in a pre-menopausal woman

A

Urine culture is required

Imaging should be strongly considered

  • KUB
  • Renal Ultrasound
  • CT scan in patients with suspected renal stone or obstruction

Cystoscopy

  • Recent history of pelvic surgery, urinary fistula, or incontinence surgery
  • Evaluate for urethral anatomic abnormalities

Adjuvant tests

  • Measurement of residual urine by ultrasound
  • Uroflowmetry
40
Q

Describe the management of a complicated UTI

A

Resolve sources of urinary stasis, surgical excision of diverticulum or obstruction

Treat urolithiasis

Antibiotics

  • Urinary concentration – cabrenicillin > cephalexin > ampicillin > TMP/SMX > ciprofloxacin > nitrofurantoin
  • 7-14 days (Same as pyelonephritis)
  • 3-5 days after defervescence or control/elimination of complicating factor (drainage, surgery)
  • Fluoroquinolone
  • Aminopenicillin/BLI
  • Cephalosporin – parenteral
  • Cefodizime, cefotaxime, ceftriaxone
  • Aminoglycoside
  • TMP-SMX5
  • In case of initial failure (<3 days)
  • Fluoroquinolone (if not initially used)
  • Piperacillin/BLI
  • Cephalosporin – parenteral
    • Cefoperazone, ceftazidime
  • Carbapenem + Aminoglycoside
  • Fluconazole
  • Amphotericin B
41
Q

What is the definition of Benign Prostatic Hypertrophy?

A

Constellation of voiding symptoms that occur in aging men

• Obstructive: ↓ force of stream, hesitancy, straining to void, incomplete bladder emptying

Irritative: Frequency, urgency, dysuria

Similar set of symptoms occur in others without enlarged prostates

• More accurately termed Lower Urinary Tract Symptoms (LUTS)

42
Q

Describe the epidemiology of BPH

  • Age
  • Percent
  • Natural history
A

Development begins around age 30

• 10% of men by age 40 have histologic evidence

Near universal condition in older men

  • 80% of men will develop benign prostatic hypertrophy (BPH)
  • 30% of men will receive treatment for symptoms

Natural history of BPH

• Incidence of urinary retention or significant emptying issues is 2% per year

43
Q

Describe the diagnosis of BPH

  • Objective
  • Subjective
A

Objective measures

  • Prostate size on physical examination
  • Measurement of urinary flow rate
  • Measurement of post-void residual volume

Subjective measures

  • International prostate symptom score (IPSS)
  • Mild symptoms 0-7
  • Moderate symptoms 7-15
  • Severe symptoms > 15
44
Q

What is medical therapy for BPH?

A

5 α reductase inhibitors

  • Finasteride, Dutasteride
  • Mechanism of action
  • Inhibit the conversion of testosterone to dihydrotestosterone – 5X more potent
  • Reduces growth or causes apoptosis of acinar glands in the prostate
  • Can results in up to 50% reduction in prostate size over time

α adrenergic blockers

  • Terazosin, doxazosin, tamsulosin, and alfuzosin
  • Mechanism of action
  • Relax smooth muscle of the prostate and bladder neck
  • Reduces outflow resistance in the central prostate

Combination therapy is more effective than individual therapy in many patients

• 67% reduction in BPH progression for combined versus 30% for each drug independently

45
Q

What is procedural or surgical therapy for BPH?

A

Minimally invasive treatments

• Transurethral microwave therapy (TUMT)

  • Reduces intermittency, straining, frequency, and urgency

• Transurethral needle ablation (TUNA)

  • Low-level radiofrequency energy to ablate the prostatic tissue
  • Improves urinary flow. Fewer side effects than traditional therapies

Surgical therapies

• Transurethral resection of prostate

  • Endoscopic treatment where the prostate is resected through a resectoscope
  • Electrified wire loop is used to cut the prostatic tissue out to physically remove the obstruction
  • Considered the gold standard for BPH symptom management

• Transurethral laser surgery

  • Similar to TURP except laser energy is used for tissue ablation rather than resection
  • Typically less blood loss than resection surgery
  • Two types of lasers contact and non-contact, similar outcomes between the two

• Open prostatectomy

  • Through an infraumbilical surgical incision the prostate capsule is incised and the adenoma is removed
  • Reserved for patients with very large prostates or bladder stones

•Peripheral prostatic tissue and prostate capsule remain insitu

46
Q

What is urinary incontinence (def)?

  • Subtypes
A

Urinary incontinence: complaint of involuntary loss of urine

  • Stress urinary incontinence (SUI): complaint of involuntary loss of urine on effort or with physical exertion or on sneezing or coughing
  • Urgency urinary incontinence: complaint of involuntary loss of urine associated with urgency
  • Mixed urinary incontinence: complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing

Nocturnal enuresis: complaint of involuntary loss urinary loss of urine which occurs during sleep

Continuous urinary incontinence: complaint of continuous involuntary loss of urine

Insensible urinary incontinence: complaint of involuntary loss of urine where the patient has been unaware of how it occurred

47
Q

Describe the epidemiology of urinary incontinence

  • Female
  • Male
A

Females:

  • Prevalence of urinary incontinence over age 20: ~50%
  • Stress urinary incontinence – 49.8%
  • Urge urinary incontinence – 15.9%
  • Mixed urinary incontinence – 34.3%
  • Estimated annual cost in 2000 was $19.5 billion

Male

  • Typically the result of surgery on the prostate
  • Contemporary series report incidence of 10%
  • Other causes are less well reported in men
48
Q

Describe the etiology of urinary incontinence

A

Bladder dysfunction

  • Urge urinary incontinence
  • Overactive blader
  • Overflow incontinence

Urethral related incontinence

  • Referred to as “stress incontinence”
  • Urethral hypermobility
  • Urethral related incontinence
49
Q

What is the etiology of bladder dysfunction causing urinary incontinence?

A

• Urge urinary incontinence

  • Occurs with increases in bladder pressure sufficient to overcome outflow resistance
    • Bladder neck and urinary sphincter
  • Detrusor overactivity
    • Result of intermittent bladder contractions
      • Non-neurogenic origin (i.e. idiopathic)
      • Neurogenic origin (result of neurogenic disease)
  • Poor compliance of the bladderLoss of viscoelastic properties of the bladder wall
    • Often the result of neural regulatory activity
      • Associated with sudden, insuppressible sensation or urge to void

• Overactive bladder – condition with frequency and urgency with or without incontinence

• Overflow incontinence

  • Result of overwhelming the viscoelastic properties of the bladder at extreme bladder volumes
  • Loss of urine is the result of inherent elevation of detrusor pressure
  • Associated with urinary obstruction or poor bladder contractility
50
Q

What is the etiology of Urethral Related Incontinence causing urinary incontinence?

A
  • Referred to as stress incontinence
  • Urethral hypermobility
  • Proximal urethral is displaced below the pelvic floor causing loss of pressure transmission
  • Results in displacement of the urethral sphincter unit
  • Intrinsic Sphincteric Deficiency (ISD) – loss of resistance in the urethra resulting from poor sphincter coaptation
  • Other causes – myelodysplasia, trauma, radiation
51
Q

Describe the H&P evaluation of urinary incontinence?

A

History

  • Onset, frequency, severity, pattern
  • Symptoms
  • Overactive bladder
  • Obstruction
    • Incomplete emptying, hesitancy, straining, weak stream

• Associated problems

  • Neurologic symptoms, bowel function, medications/medical therapy

• Physical exam

  • Abdominal, pelvic, rectal, and neurologic assessment
  • Specifics pelvic exam
    • Quality of the vaginal mucosa, pelvic organ prolapse, urethral hypermobility
  • Rectal exam to note sphincter tone and perineal sensation
52
Q

Describe the lab exam for urinary incontinence

A

Urinalysis and urine culture

53
Q

Describe adjuvant testing for urinary incontinence

A
  • Post void residual volume
  • Voiding diary
  • Urodynamic testing
  • Evaluates bladder compliance, contractility, and stress incontinence
54
Q

What is the treatment for urge urinary incontinence?

A

• Behavior modification

  • Timed voids – keeping the bladder empty (voids q 1-2 hours) to prevent urge episodes
  • Modification of fluid intake
  • Dietary modification – limiting intake of bladder irritants, e.g. Caffeine, spices, acidic foods

• Medical Therapy

  • Anti-muscarinic agents
    • Decrease bladder pressure by blocking muscarinic receptors
    • Side effects – dry mouth, constipation, nausea, blurred vision, confusion, drowsiness
      • Contraindicated in narrow angle glaucoma, especially untreated

• Surgical intervention

  • Neuromodulation with sacral nerve stimulators
  • Onabotulinumtoxin
  • Bladder augmentation, urinary diversion
55
Q

What is the treatment for stress incontinence?

A

Non-surgical therapy

• Pelvic floor exercises

  • Augment closure strength of the urinary sphincter with pelvic floor musculature
  • Requires intensive training sessions at specialized centers
  • With adequate instruction good long term success rates

• Medical therapy

  • α – agonist therapy – increases smooth muscle tone at the bladder neck/proximal urethra
  • Tricyclic antidepressants – act as combined α – agonist and antimuscarinic
  • Pessaries
  • Surgical management
  • Sling procedures
    • Restore the anatomic “hammock” of the urethra and pelvic floor/bladder neck complex
    • Pubovaginal sling
      • Treats ISD and anatomic incontinence by coapting the proximal urethra and supporting the bladder neck
    • Mid urethral slings
      • Retropubic and trans-obturator approach
      • Functions by “kinking” or compressing the mid urethra
  • Artificial urinary sphincter
    • Often used in male patients with post-prostatectomy incontinence
    • Inflatable cuff surrounds the bulbar urethra (male) or proximal urethra (female)
56
Q

What is the treatment for mixed urinary incontinence?

A

Pelvic floor physical therapy

• Biofeedback

Tricyclic antidepressants (imipramine)

Surgical treatment of stress component

• Relieves urge component in 70% of patients

57
Q

What is the treatment for overflow incontinence?

A

Procedures to assist with emptying the bladder

  • e.g.: TURP for men with BPH

Intermittent catheterization

  • Ideal for patients with poor detrusor contractility

Chronic indwelling catheters are useful only in specific situations

58
Q

What is acute scrotum (def)? Etiologies?

A

Acute onset of severe pain or swelling in the scrotum or scrotal wall

Etiology:

  • Ischemia
  • Trauma
  • Infection
  • Inflammation
  • Hernia
  • Acute change of chronic conditions
59
Q

What are ischemic causes of acute scrotum?

A

Testicular torsion

60
Q

What is the presentation of testicular torsion?

  • Physical or lab findings consistent with infection?
A
  • Rapid onset of severe testicular pain and swelling
  • No correlation with activity or trauma
  • Physical exam findings
  • High lying testicle with abnormal lie
  • Severe tenderness to palpation
    • Initially, cord and testicle can be palpated separately
  • Late presentation often has significant scrotal wall edema and confluence of intrascrotal structures

• No physical or laboratory findings consistent with infection

  • Normal CBC
  • Afebrile
  • Normal urinalysis
61
Q

Describe the diagnosis of testicular torsion

A
  • Physical exam and history are key
  • Scrotal ultrasound with Doppler flow to assist with diagnosis
  • Identification of flow is key finding
62
Q

What is treatment for testicular torsion?

A
  • Surgical exploration of the scrotum
  • Manual detorsion of the testicle and cord are mandatory
  • Non-viable testicles are removed

• Orchiopexy to prevent reoccurrence

  • Contralateral side undergoes same procedure

• Outcomes

  • Salvage rage ~ 100% if caught early ( <6 hours)
  • Salvage < 20 % if found at ~ 12 hours, 0 % salvage > 24 hours
63
Q

What are testicular and epididymal appendages (involved in testicular torsion)

A

Testicular and epididymal appendages

  • Mullerian and Wolffian remnants
  • Testicular exam is usually normal but symptoms are similar
  • Ultrasound is valuable to confirm diagnosis and demonstrate a normal testicle
64
Q

Describe testicular injury leading to acute scrotum

A

• Penetrating and blunt mechanism

  • 40-60% of genitourinary gunshot wounds involve the genitalia

• Anatomic considerations

  • Rupture of the tunica albuginea is the key finding
    • Absolute indication for exploration
  • Collection of blood around the testicle (hematocele) may not require intervention
65
Q

What is the managemetn for testicular injury causing acute scrotum?

A

Contusion/hematoma

  • Intratesticular hematoma or small hematoceles
  • Observation: compression, ice, elevation

Rupture

  • Scrotal exploration with exposure of scrotal cord structures and testicle
  • Debridement of non-viable tissue
  • Surgical closure of the tunica albuginea
66
Q

What are infectious causes of acute scrotum/

A
  • Epididymitis and Epididymoorchitis
  • Scrotal wall infections
  • Acute changes of chornic conditions
67
Q

What is the etiology of Epididymitis and Epididymoorchitis?

A
  • Men < 35yr often STI – chlamydia, gonorrhea
  • Men > 35yr often gram negative bacteria, similar to UTI organisms
68
Q

Describe the presentation of epididymitis and epididymoorchitis leading to acute scrotum

  • Diagnosis
  • Management
A
  • Gradual, progressive onset of symptoms
  • Dysuria, frequency, and urgency of urination may be present
  • Physical exam
  • Enlarged, edematous scrotum with painful, enlarged testicle

• Diagnosis

  • Scrotal ultrasound
  • Urine culture

•Management

  • Broad spectrum antibiotics, anti-inflammatory drugs, scrotal elevation
69
Q
A
70
Q

Describe scrotal wall infections

  • PE findings
  • Management
A
  • Cellulitis, abscess, and fasciitis (Fournier’s gangrene)
  • Fasciitis physical exam findings
  • Crepitus in skin, edema, open, necrotic wounds

• Management

  • Antibiotic therapy, surgical drainage or debridement
71
Q

Describe acute changes of chronic condition

  • Etiologies
  • Diagnosis
  • Management
A

Etiologies

  • Neoplasms, spermatocele, hydrocele
  • Neoplasms may develop necrosis and hemorrhage

Diagnosis

  • Physical exam
  • Ultrasonography

Management

• Antibiotics, surgical extirpation, drainage

a_GYNGU (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions