11. Urology Flashcards
What is testicular torsion?
Surgical emergency when twisting of spermatic cord causes constriction of vascular supply.
Two types
Intravaginal
Extravaginal - torsion occurs at the level of the external inguinal ring. seen in neonates.
Risk factors for testicular torsion?
Age under 25 years
Bell clapper deformity
How does testicular torsion present?
Painful Swollen, hot, tender scrotum Unilateral High riding testicle Absent cremasteric reflex (stroke thigh on right thigh, right testicle lifts and vice versa)
How do we treat testicular torsion?
Emergency exploration of scrotum within 6 hours surgically to twisted it back
If surgery unavailable, manual de-torsion
What is epididymitis and orchitis?
Inflammation of those structures. Can occurs at same time. Most cases are caused by bacterial infection, chlamydia most common under 35, klebsiella over this age.
Risk factor is unprotected sex, bladder outflow obstruction and UTIs
How do epididymitis or orchitis present?
Pain Swollen, hot, tender scrotum Unilateral Less acute than torsion Dysuria and urgency and penile discharge - symptoms of cause
How do we investigate epididymitis and orchitis?
Urine dipstick
Bloods
Colour duplex USS (if unsure)
Surgical exploration if torsion can’t be excluded
How to manage epididymitis and orchitis?
Bed rest
Scrotal elevation
Analgesia
Antibiotics
What is a variocele?
Dilated veins of the pampiniform plexus forming a scrotal mass.
Caused by increased hydrostatic pressure in left renal vein or incompetent veinous valves.
How do varicoceles present?
Asymptomatic
Stand patient up, see “bag of worms” appearance.
Fertility analysis (sperm count)
Retroperitonaeal USS
If anything’s abnormal, surgical repair but normally left alone with obs.
What is a hydrocele?
Excessive collection of serous fluid in the tunica vaginalis (so can occur in women)
Communicating - open so peritoneal fluid can flow freely - inflammation, trauma, cancer
Non-communication - closed so more fluid produced is absorbed - increased fluid e.g. ascites
Presentation of hydrocele and investigations?
Scrotal swelling
Enlarges with coughing etc.
Transilluminates
Urine dip, USS and bloods to exclude worrying causes. Observation is solution or surgery if bad.
What are the most common testicular cancers?
Seminomas - 50%
Non - 30%
Cryptochidism, ectopic testes, test atrophy and FHx are risk factors.
How do testicular cancers present?
Painless nodules Lymphadenopathy Gynaecomastia Backache Hydroceles
How to investigate testicular cancer?
FBCs U&Es LFTs Tumour markers - LDH, alpha fetoprotein, beta hcg Testicular ultrasound, CTAP, CXR
Treat with chemo or removal