3.1.1 Men's Health Urology I Flashcards
What is phimosis?
Prepuce (foreskin) cannot be fully retracted
1% of adult non-circumcised population
What is physiological phimosis?
Normal non-retractability up to adolescence
50% at 1 year
10% at 3 years
1% at 17 years
What causes phimosis?
Poor hygiene leading to increased STD risk causing an accumulation of smegma
No images to save your eyes from burning
What can happen in phimosis if left untreated?
- Increased STD risk
- Pain on intercourse, splitting/bleeding
- Balanitis (inflamed glans)
- Posthitis (inflamed foreksin)
- Balanitis Xerotica Obliterans (BXO)
- Paraphimosis
- Urinary retention
- Penile cancer
What is paraphimosis?
Painful constriction of the glans penis by the retracted prepuce proximal to the corona-
Basically foreskin gets stuck when pulled back, oedema, tight ring forms
What causes paraphimosis?
Phimosis
Catheterisation (esp. elderly ensure its pulled back after in elderly)
Penile cancer
How is phimosis managed?
May be associated with other pathologies, so may have to deal with that
Circumcision is the best treatment
How is paraphimosis treated?
Needs reduction, usually achieved manually
May need dorsal slit
What type of cancer is penile cancer?
Squamous cell carcinoma
What are the risk factors for developing penile cancer?
Phimosis, hygiene problem- smegma
HPV 16 and 18
Who is affected by penile cancer?
20% < 50 years old
If left untreated most die within 2 years, almost all within 5 years
What are the key indications for paediatric and adult circumcisions?
Paediatric
-Religious
-Recurrent balanitis/UTIs
Adult
-Recurrent balanitis
-Phimosis
-Recurrent paraphimosis
-Balanitis xerotica obliterans
-Penile cancer
What are some causes of acute scrotal pain?
- Testicular torsion
- Epididymitis / Orchitis / Epididymo-orchitis
- Torsion of hydatid of Morgagni
- Trauma
- Ureteric calculi (rarely)
What causes epididymitis?
– Urinary tract infection (UTI)
– Sexually transmitted infection (STI)
– Mumps
What is the typical presenting history of testicular torsion?
- Usually younger patient ( < 30 y)
- SUDDEN onset e.g. woke from sleep
- Unilateral pain; may be nauseated/vomit; often no LUTS
What do you find on examination of testicular torsion?
Very tender testis
Lying high in scrotum with horizontal lie
How do you manage suspected testicular torsion?
Patient needs emergency scrotal exploration
Do not waste time with investigations
What is the typical presenting history for epididymo-orchitis?
- Age
– 20-40/50 – STI (esp Chlamydia)
– 40/50+ - UTI (esp. E. Coli) - Gradual onset
- Usually unilateral
- Often recent history of
– UTI
– Unprotected intercourse
– Catheter/urethral instrumentation
– Check for mumps history
What do you find on examination of epididymo-orchitis?
Pyrexial, can be septic
Erythematous scrotum
Enlarged testis/epididymis, tender
Fluctuat areas may represent abscess
May have reactive hydrocoele
What is forunier’s gangrene?
Rare complication of epididymo-orchitis
Necrotic area of scrotal skin
High mortality ~50%
What investigations are there for epididymo-orchitis?
Bloods
-FBC
-U&Es
-Cultures if septic
Urine
-MSU for MC&S
Radiology
-Scrotal USS if suspected abscess
How do you treat epididymo-orchitis?
Antibiotics
Abscess-surgical drainage and antibiotics
Fournier’s gangrene- emergency debridement & abx
What key questions should be asked about scrotal lumps?
Is it painful?
How quickly has it appeared?
Features of scrotal lump examination
*Can I get above it?
– If not, likely to be a hernia
*Is it in the body of the testis?
– If yes, could be a testicular tumour
*Is it separate to testis?
*Does it fluctuate and transilluminate?
What are some causes of painless scrotal lumps?
Testis tumour
Epididymal cyst
Hydrocele
Reducible inguino-scrotal hernia
What causes scrotal lumps that are painless/aching at the end of day?
Not tender
Varicocele-bag of worms
What causes painful-tender acute presentation with scrotal lumps?
Epididymitis
Epididymo-orchitis
Strangulated inguino-scrotal hernia- emergency
What is the typical history of a testicular tumour?
Usually painless
Germ cell tumours (seminoma/teratoma) men < 45
Older men- may be lymphoma
What increases the risk of testicular cancer?
History of undescended testis
What is found of examination of testicular tumours?
-Body of testis is abnormal
-Not tender
-Can get above
How do you manage suspected testicular tumours?
Refer via 2 week wait to urology
Urology will arrange USS to confirm diagnosis
Check for tumour markers aFP,hCG, LDH
Typical history of a hydrocele
Slow, sudden onset
Uni/bilateral scrotal swelling
What causes hydroceles?
Imbalance of fluid production and resorption between tunica albuginea and tunica vaginalis
What is found on examination of a hydrocele?
Testis not palpable separately
Can usually get above
Transilluminates
What is found on examination of an epididymal cyst?
Usually painless
Separate from testis
Can get above mass
Transilluminates
What is the typical history of a varicocele?
Dull ache at the end of the day
More likely to affect left than right
Associated with reduced fertility, especially if bilateral
What is present on examination of a varicocele?
Bag of worms above testis
NOT tender
Palpable abdominal/renal mass
How do you treat a testicular tumour?
Inguinal orchidectomy
How do you treat an epididymal cyst?
Reassure; excise if large
How do you treat an adult hydrocele?
If normal testis on USS, reassure
Surgical removal if large/symptomatic
How do you treat a varciocele?
Reassure
Radiological embolisation if symptomatic, infertility (slow motility of sperm), if present in adolescent and growth of testis affected
How do you treat an inguinio-scrotal hernia?
Surgery-emergency if strangulated
