Andrology Flashcards
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What can US demonstrate in scrotal trauma?
indicate perfusion
INtegrity of vascualr hilum
Areas of impaired blood flow
testicel haematoma and non-viable testicle
In scrotal trauma, what is recommended in presence of large haematoma or haematocoele?
Scrotal exploration
In scrotal trauma, how is small haematoma with tunica albuginea intact managed?
Can be managed conservatively, analgesia, anti-inflammatory and scrotal support
How is testicle rupture managed?
Prompt exploration and surgical repair
How are penetrating scrotal injuries managed if tunica albuginea are breached?
debridement of non viable seminiferous tubules and primary closure of tunica albuginea
Give tetanus
Broad spectrum antibiotics
If genital mutilation with orchidectomy has occured within how long can replantation be consdered?
within 12 hrs
What occurs in penile fracture?
Rupture of tunica albuginea during errection
How often is there an associated urethral injury during penile fracture?
25% of cases
What are the differential diagnosies for priapism?
superficial vein rupture,
superficial haematoma,
suspensory ligament rupture
What are the halmarks of priapism?
Sudden severe penile pain
Simultaneous cracking or popping sound
Immediate detumescence
In penile fracture, if the brising is limited to the penile shaft what is not breached?
Bucks fascia is in tact
Penile fracture bruising extends to scrotum, peineum and lower abdominal wall, what is breached?
Bucks fascia
Which imaging is helpful in penile fracture assessment?
Ultrasound of penis (with or without artificial erection test)
- identifies, location, extent of tunical rupture
MRI can help
How soon should penile fracture be repaired?
Within 24 hrs (can be performed if delayed presentation
Surgical repair rather than conservative maangement for penile fracture reduces incidence of fibrosis & curvature , and ED from what to what?
Surgical repair of penile fracture
Incidence of fibrosis & penile curvature 35% -> 5%
ED 62% -> 5%
What sutures are used for peni;e fracture & associated urethral injury?
Penile fracture - 2/0 polydioxanone
Assc urethral 5/0 polyglactin sutures
How dod you define priapism?
Prolonged penile erection >4 hrs which is maintained without sexual stimulation and persists despite ejaculation and orgasm
What flow does ischaemic priapism have?
Low flow
When do you get paradoxical increased doppler systlolic velocities in priapism?
these happen even after penile aspiration has taken place, can be sign of fibrosis developing
What Ix can be used in pria[ism?
Penile shaft blood gas
US doppler
Penile MRI - viability of corpus cavernosum
What are the two most common used shunts in priapism?
Winter shunt (biopsy)
T Shunt - 11 blade
IF smooth muscle necrosis isidentified at priapism surgery how soon should penile prosthesis be considered?
Within 3 weeks
What is diagnostic for ischaemic priapism on corporal blood gas?
pO2 hypoxia, acidosis and glucopenia
If non ischaemic priapism is confirmed on corporal blood gas how should you confirm this?
Doppler USS
Which sympathomimetic or alpha adrenergenic agonist is used in ischaemic priapism?
Phenylephrine
given in 200-250doses spaced 5 min intervals
max 1mg in hr
Cardiac monitoring
WHat medication can you use in stuttering priapism?
etilefrine
Which artery can you embolise in stuttering high flow priapism?
Cavernosal artery
