241 - Benign Male Genital Disorders Flashcards
Which two mullarian duct remnants can torse?
Appendix testis
Prostatic utricle
The internal spermatic fascia is an extension of which layer of the abdominal wall?
Transversalis fascia
ICE - TIE
Which nerve supplies motor fibers to the cremaster muscle?
Genitofemoral
What are the boundaries of Hesselbach’s (aka the inguinal) triangle?
- Inguinal ligament (inferior)
- Inferior epigastric (lateral)
- Rectus abdominus (medial)
The dartos and smooth muscle is an extension of which layer of the abdominal wall?
Scarpa’s fascia
I think Scarpa’s fascia anteriorly, and Colle’s fascia closer to the perineum?
Which benign genital skin disorder may be associated with multi-segmented urethral stricture disease?
Balanitis Xerotica Obliterans
From which artery is the cremasteric artery derived?
Inferior epigastric artery
Why is surgery for torsion always bilateral?
If one torses, the other could too
Anchor the dartos to the tunica vaginalis on both sides to prevent
List 5 characteristics that make a testis prone to torsion
- Horizontal alignment
- High-riding
- Hypermobile
- Bell clapper deformity
- Undescended testis
What kind of varicocele warrants imaging of the retroperitneum?
Solitary right varicocele
- Right varicocele = suspicion for tumor impeding venous drainage*
- Left varicocele: can be explained by normal anatomy (SMA crushes renal vein against abdominal aorta, backs up into renal ven -> gonadal vein)*
What causes an indirect inguinal hernia?
Where is it located, relative to the inferiror epigastric vessels?
Patent processus vaginalis
Lateral to the inferior epigastric vessels in the inguinal triangle
Dysfunction in which structure results in a varicocele?
Pampiniform plexus of veins
Drains blood from the scrotum; if they are not draining, results in a varicocele
Left more common due to path of venous drainage
What are the differences between intravaginal and extravaginal testicular torsion?
- Intravaginal
- Tunica vaginalis not involved
- Most common in early purberty
- More common in general
- Testes may be salvageable - hurry!
- Extravaginal
- Tunica vaginalis involved
- Neonatal or perinatal event
- Often does not cause dystress
- Almost never salvageable
The cremasteric fascia is an extension of which layer of the abdominal wall?
Internal oblique
- ICE - TIE*
- Lecture table has transversus abdominis as contributing to cremasteric fascia and muscle, but the main one is internal oblique; usually (according to Cochard) transversus abdomins doesn’t do anything in the scrotum*
The tunica vaginalis is an extension of which layer of the abdominal wall?
Peritoneum
Management of a hydrocele?
Observation if not bothersome, may resolve
Aspiration (but recurrence likely)
Surgery
Describe the management of intravaginal testicular torsion
- Can diagnose on clinical suspician
- Doppler US can confirm, but not sensitive
- Pre-operative manual detorsion
- Saves fertility if within 6h, Leydig cell fx if within 10h
- Surgical fixation
- Anchor tunica albuginia to dartos on both sides
The external spermatic fascia is an extension of which layer of the abdominal wall?
External oblique
ICE - TIE
A spermatocele can be derived from which structures? (4)
- Rete testis
- Efferent ductules
- Head of epididymis
- Body of epididymis
Vs. cyss, come from body or tail
What are the features of each grade of varicocele?
- Grade 1: only perceptible with valsalva
- Grade 2: perceptible w/o valsalva
- Grade 3: visible through scrotal skin
How does the drainage of the left and right gonad differ?
Right gonad -> IVC
Left gonad -> left renal vein -> IVC
=> left renal vein can be compressed between abdominal aorta and superior mesenteric arteries
Which cells make the fluid found in a hydrocele?
Mesothelial cells
Which benign scrotal masses exhibit transillumination?
- Hydrocele
- Spermatocele
- Epididymal cyst
- Indirect inguinal hernia, if it contains fluid
Which branch of the internal iliac artery gives rise to the artery of the vas deferens?
Inferior vesical or superior vesical artery
Note: Artery to the vas is the most important collateral vessel to the gonad
What causes a diret inguinal hernia?
Where is it located, relative to the inferiror epigastric vessels?
Weakness in the transversalis fascia
Medial to the inferior epigastric vessels - sits in the middle of the inguinal triangle
Hesselbach’s triangle = inguinal triangle
