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UROLOGY > 7: Peno-Scrotal Disease > Flashcards

7: Peno-Scrotal Disease Flashcards

1
Q

What are the various causes of erectile dysfunction

A
  • vascular
  • neurological: diabetes, CVA, spinal injury
  • venogenic/cavernosal
  • hormonal
  • medication: anti-depressants, beta-blockers
  • psychogenic
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2
Q

Why is erectile dysfunction important

A
  • sensitive marker of early vascular disease
  • important for GPs to address CVS risk factors
  • can potentially mitigate risk of MI, CVA
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3
Q

What are the 2 broad categories of erectile dysfunction and how can they be differentiated

A

Organic & psychological
1. Speed of onset: gradual = organic, sudden = psychological
2. Presence of early morning erections

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4
Q

What investigations are done in erectile dysfunction

A
  • address vascular risk factors e.g. BP, lipids, glucose, smoking status
  • early morning testosterone
  • prolactin, LH, FSH
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5
Q

What is involved in the management of erectile dysfunction

A
  • psychosexual counselling
  • PDE5 inhibitors (sildenafil) but contraindicated if requires nitrates for ischaemic heart disease
  • treat low testosterone
  • intraurethral PG pellets or topical gel
  • vacuum tumescence device
  • penile prosthesis inflatable or malleable
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6
Q

What is phimosis and what are the different types

A

Tight foreskin ( prepuce is not fully retractable)
- physiological phimosis
- pathological phimosis

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7
Q

What is physiological phimosis

A

Majority of babies have a non-retraction foreskin which gradually reduces with time

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8
Q

What is pathological phimosis and what is the consequence of this

A

scarring of the foreskin opening leading to symptoms and non-retractability of the prepuce
- usually due to balanitis xerotica obliterans (BXO)
- repeated infections leads to repeated scarring and tightening
- can cause difficulty passing urine, pain, cracking when the penis is erect

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9
Q

What is the treatment of phimosis

A

Topical steroids or circumcision

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10
Q

What is paraphimosis and why is it an emergency

A

When the foreskin becomes trapped behind the corona of the glans penis and is an urological emergency
- timely recognition is important and reduction due to the risk of glans necrosis

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11
Q

What is the cause of paraphimosis and how is it managed

A

Failure to replace foreskin in patients needing care, after catheterisation or self-neglect
- firm compression for 20 mins until swelling reduces prior to pulling back the foreskin
- very rarely patient may need a penile block +/- dorsal slit

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12
Q

What is Fournier’s gangrene

A

Polymicrobial necrotising fasciitis of the perineal, perianal or genital areas

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13
Q

What are the risk factors of Fournier’s gangrene (4)

A
  • poorly controlled diabetes
  • alcoholism
  • obesity
  • indwelling catheter
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14
Q

What is Peyronie’s disease

A

Non cancerous conditions resulting from fibrous scar tissue that develops on the penis and causes curved, painful erections
- similar to dupuytren’s contracture in hand
- penile curvature correction surgery can be offered

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15
Q

What are key causes of scrotal lumps

A
  • hydrocoele
  • varicocele
  • epididymal cyst
  • testicular cancer
  • inguinal hernia
  • testicular torsion
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16
Q

How do you distinguish scrotal lumps

A
  1. Can you get above it?
    • no = inguinal hernia
    • yes = next question
  2. Can you feel the testes?
    • no = hydrocoele
    • yes = next question
  3. Is it separate to the testicle?
    • yes = epididymal cyst or varicocele
    • no = testicular tumour
17
Q

What is a hydrocoele

A

Collection of fluid within the tunica vaginalis that surrounds the testes
- usually painless and present with a soft scrotal swelling

18
Q

What are the examination findings of hydrocoele

A
  • testicle is not always palpable within the hydrocoele
  • soft, fluctuating and may be large
  • irreducible and has no bowel sounds (differentiate from hernia)
  • transilluminated by shining torch through the skin
19
Q

What is a varicocoele

A

Veins in pampiniform plexus become swollen
- common affecting 15% men

20
Q

What might varicocele cause (2)

A
  • impaired fertility due to temperature disruption in affected testicle
  • testicular atrophy which reduces size and function in testicle
21
Q

What side do most varicoceles affect and why

A

Left due to increased resistance in the left testicular vein which drains into the left renal vein
- can indicate an obstruction of the left testicular vein caused by a RCC

22
Q

How might varicocele present

A
  • throbbing/dull pain or discomfort, worse on standing
  • dragging sensation
  • sub fertility or infertility
23
Q

What is the management of varicocele

A

Consider embolisation for pain, testicular atrophy or infertility

24
Q

What are the examination findings of epididymal cysts

A
  • soft, round lump
  • typically at top of testicle
  • separate from testicle
  • may be able to transilluminate large cysts appearing separate from the testicle
  • consider surgery to excise if large and symptomatic
25
Q

what is the most important initial management for a patient presenting with obstructive urinary calculi and signs of infection

A

nephrostomy tube to decompress + IV abx

26
Q

what is the most important initial investigation for varicocele

A

adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumour

27
Q

what is the most appropriate management for testicular torsion

A

Emergency bilateral orchidopexy

28
Q

what are medical indications for circumcision

A
  • phimosis
  • recurrent balanitis
  • balanitis xerotica obliterans
  • paraphimosis
29
Q

why are the testes and epididymis not affected by Fournier’s Gangrene

A

fasica act as barriers and prevent entry of infection to these areas
- dartos fascia of testes
- Colle’s fascia of perineum
- Scarpa fascia of anterior abdominal wall

UROLOGY (8 decks)

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