Andrology

Question 1

`

What can US demonstrate in scrotal trauma?

Answer 1

indicate perfusion
INtegrity of vascualr hilum
Areas of impaired blood flow
testicel haematoma and non-viable testicle

Question 2

In scrotal trauma, what is recommended in presence of large haematoma or haematocoele?

Answer 2

Scrotal exploration

Question 3

In scrotal trauma, how is small haematoma with tunica albuginea intact managed?

Answer 3

Can be managed conservatively, analgesia, anti-inflammatory and scrotal support

Question 4

How is testicle rupture managed?

Answer 4

Prompt exploration and surgical repair

Question 5

How are penetrating scrotal injuries managed if tunica albuginea are breached?

Answer 5

debridement of non viable seminiferous tubules and primary closure of tunica albuginea

Give tetanus
Broad spectrum antibiotics

Question 6

If genital mutilation with orchidectomy has occured within how long can replantation be consdered?

Answer 6

within 12 hrs

Question 7

What occurs in penile fracture?

Answer 7

Rupture of tunica albuginea during errection

Question 8

How often is there an associated urethral injury during penile fracture?

Answer 8

25% of cases

Question 9

What are the differential diagnosies for priapism?

Answer 9

superficial vein rupture,
superficial haematoma,
suspensory ligament rupture

Question 10

What are the halmarks of priapism?

Answer 10

Sudden severe penile pain
Simultaneous cracking or popping sound
Immediate detumescence

Question 11

In penile fracture, if the brising is limited to the penile shaft what is not breached?

Answer 11

Bucks fascia is in tact

Question 12

Penile fracture bruising extends to scrotum, peineum and lower abdominal wall, what is breached?

Answer 12

Bucks fascia

Question 13

Which imaging is helpful in penile fracture assessment?

Answer 13

Ultrasound of penis (with or without artificial erection test)

• identifies, location, extent of tunical rupture

MRI can help

Question 14

How soon should penile fracture be repaired?

Answer 14

Within 24 hrs (can be performed if delayed presentation

Question 15

Surgical repair rather than conservative maangement for penile fracture reduces incidence of fibrosis & curvature , and ED from what to what?

Answer 15

Surgical repair of penile fracture

Incidence of fibrosis & penile curvature 35% -> 5%

ED 62% -> 5%

Question 16

What sutures are used for peni;e fracture & associated urethral injury?

Answer 16

Penile fracture - 2/0 polydioxanone

Assc urethral 5/0 polyglactin sutures

Question 17

How dod you define priapism?

Answer 17

Prolonged penile erection >4 hrs which is maintained without sexual stimulation and persists despite ejaculation and orgasm

Question 18

What flow does ischaemic priapism have?

Answer 18

Low flow

Question 19

When do you get paradoxical increased doppler systlolic velocities in priapism?

Answer 19

these happen even after penile aspiration has taken place, can be sign of fibrosis developing

Question 20

What Ix can be used in pria[ism?

Answer 20

Penile shaft blood gas
US doppler
Penile MRI - viability of corpus cavernosum

Question 21

What are the two most common used shunts in priapism?

Answer 21

Winter shunt (biopsy)
T Shunt - 11 blade

Question 22

IF smooth muscle necrosis isidentified at priapism surgery how soon should penile prosthesis be considered?

Answer 22

Within 3 weeks

Question 23

What is diagnostic for ischaemic priapism on corporal blood gas?

Answer 23

pO2 hypoxia, acidosis and glucopenia

Question 24

If non ischaemic priapism is confirmed on corporal blood gas how should you confirm this?

Answer 24

Doppler USS

Question 25

Which sympathomimetic or alpha adrenergenic agonist is used in ischaemic priapism?

Answer 25

Phenylephrine
given in 200-250doses spaced 5 min intervals
max 1mg in hr

Cardiac monitoring

Question 26

WHat medication can you use in stuttering priapism?

Answer 26

etilefrine

Question 27

Which artery can you embolise in stuttering high flow priapism?

Answer 27

Cavernosal artery