Benign Male GU Conditions Flashcards
mesonephric duct aka Wolffian duct
- becomes vas deferents and seminal vesicle
- degenerates in female
paramesonephric duct aka Mullerian duct
- becomes fallopian tubes, uterus, vagina
- degenerates in males
ureteral ectopia
- ureter doesn’t properly fuse into the bladder
- will almost always be above the true ureter and then dive under it
perinatal hydronephrosis
- swelling of a kidney in a fetus/infant caused by buildup of urine in the kidney d/t poor flow or blockage
- commonly revealed on screening US
first step when finding perinatal hydronephrosis
-refer to pediatric urologist prior to delivery
management of perinatal hydronephrosis
- document urine output
- if no urine in 24 hr then cath
- renal US w/i 24 hrs after birth
b/l vs. unilateral perinatal hydronephrosis
-b/l is worse - it could be a bladder obstruction
checking kidney function in perinatal hydronephrosis
-can’t check renal fxn for 48 hrs b/c it will be the same as moms
abx prophylaxis in perinatal hydronephrosis
- do this if you suspect ureteral reflux b/c they would be predisposed to infection
- no sulfa drugs
- must use cephalosporin or penicillin
imaging in perinatal hydronephrosis
- voiding cystourethrogram
- w/i 2-3 days of life
- r/o bladder obstruction and ureteral reflux
- if no reflux, dc abx
nuc med renogram in perinatal hydronephrosis
- document function and drainage
- if kidney fxns well, no need for surgery
- if poor, drainage and surgery may be needed
vesicoureteral reflux
- urine flows retrograde from the bladder into the ureters/kidneys
short term vs long term vesicoureteral reflux
- short: allows bacteria into kidney causing febrile infections
- long: repeated infections cause scarring and fxn loss
tx of vesicoureteral reflux
- grades 1-3: usually resolve spontaneously or:
- start abx and repeat studies
- grades 4-5: commonly need early intervention:
- hyaluronic acid bubble insertion surgery
- reimplantion of ureter
what is the MC cause of hydronephrosis in newborns?
ureteropelvic junction obstruction
ureteropelvic junction obstruction (UPJ)
- obstruction of the flow of urine from the renal pelvis to the proximal ureter
- aperistaltic segment of proximal ureter
- may resolve spontaneously
dx of UPJ obstruction is done by what?
nuclear renal scan
general principles of conservative management of hydronephrosis
- 50% of antenatal resolve postpartum
- unable to accurately diagnose true obstruction
- asymptomatic hydro could resolve spontaneously
dismembered pyeloplasty
- sx tx of hydronephrosis
- vertical incision into the ureter then approximation and closure of the pelvis
2nd MC cause of ESRD in children?
posterior urethral valves
what are posterior urethral valves?
- obstructive membranes that develop in the urethra and can obstruct or block the outflow of urine
- can be deadly
posterior urethral valves can cause what? (3)
- oligohydramnios
- b/l hydronephrosis
- abnl development of bladder: inability to empty and incontinenece.
cryptorchidism
- hidden testis
- failure of testis to descend into scrotum
- may be inhibited at any point along its pathway from abdomen to scrotum
fxn of the scrotum
-produce viable and mature spermatagonia, testis must be 1.5-2 degrees cooler than abdomen so they descend to the scrotum
embryology of descent of testes
- develop in abdomen week 6-8
- gubernaculum shortens
- testis pulled slowly into scrotum after month 7
- may not be until after birth
incidence of cryptorchidism
- one of the MC congenital anomalies found at birth
- more common in pre term babies
- usually descend spontaneously by 1 year
what is the principal determinant of cryptorchidism at birth and 1 yo?
birth weight
what is the cause of misdiagnosis of cryptorchidism at ages 2-7?
retractile testes secondary to cremasteric reflex
if cryptorchidism is b/l, what should you consider?
- intersex condition
- esp if hypospadias
- karyotype to determine
classifications of cryptorchidism
- abdominal (inside internal ring)
- canalicular (b/w internal and external rings)
- extracanalicular (supra or infra pubic)
- ectopic
what is the MC location for ectopic testes?
-w/i a superficial pouch b/w external oblique fascia and Scarpas
pt has b/l nonpalpable testis what test do you want to run?
FSH
if FSH is elevated in b/l nonpalpable testes, what do you suspect?
b/l anorchia
if FSH is non elevated in b/l nonpalpable testes, what are the following steps?
- give trial of hCG
- if no increase in testosterone, b/l anorchia
imaging in cryptorchidism
-NEVER do it
laparoscopy in cryptorchidism
- if vessels end blindly, testis absent
- if vessels enter inguinal canal, perform inguinal exploration
- if testis is intra-abdominal, perform orchiopexy
result of the length a testis is cryptorchid
- longer = more likely to be histologically abnl
- impaired spermatogenesis
- Leydig cells may or may not be affected
- higher testis CA rate
surgical correction options for cryptorchidism
- 1 stage open orchiopexy (for canalicular)
- 1 stage laparoscopic orchiopexy (for the peeping testis) lol
- 2 stage laparoscopic - consists of revascularization
non surgical options for cryptorchidism
- hCG
- on used in rare cases
what sx make up the presentation of an acute scrotum?
- acute scrotal pain
- scrotal tenderness to palpation
- swelling
- n/v
ddx in an acute scrotum
- testicular torsion
- epididymitis/orchitis
- incarcerated inguinal hernia
- torsion of testicular or epididymal appendage
hx to take in acute scrotum
- activity
- awakened from sleep
- onset of pain
- duration
- bowel habits
- dysuria
- referred pain
- previous similar episodes
- immunocompromised
manual detorsion of testicle
- gently elevate testis toward the ipsilateral inguinal ring
- use thumb and forefinger to turn testis laterally while stabilizing cord
- if not relieved, attempt turning medially
how would you know if manual detorsion was successful?
the spermatic cord will lengthen and the testis will assume nl anatomical position w/ nearly immediate relief of pain
cremasteric reflex is elicited by what?
light stroking of the superior and medial part of the thigh
nervous pathway of the cremasteric reflex
- sensory and motor fibers of L1 spinal n.
- sensory fibers of ilioinguinal n. –> spinal cord –> genitogemoral n. –> cremasteric contraction
conditions in which the cremasteric reflex is absent
- 100% of cases of testicular torsion
- in motor neuron disorders
- spinal injury of L1 and L2
when you think of testicular torsion, what imaging goes hand in hand?
US
US for testicular torsion
- color doppler US = gold standard
- shows diminished or blocked flow
what deformity is likely the cause of testicular torsion?
- bell clapper deformity
- lack of fixation to the testicular gubernaculum during descent
time frame for testicular torsion
-irreversible ischemic injury to testicular parenchyma w/i 4 hrs
tx of testicular torsion, reguardless if it was manually detorsed or not
-scrotal exploration and b/l testicular fixation (orchiopexy)
how can testicular torsion effect fertility?
-seriously interferes w/ 50% of pts fertility
possible causes of UTI
- infected stones
- chronic bacterial prostatitis
- fistulae (from gut)
- foreign bodies . . . i can’t find my swizzle stick . . .
- infected kidney
- instrumentation
- poor hygiene
predisposing factors for UTI
- urinary obstruction
- DM
- neurogenic bladder
- pregnancy
- ESRD
- immunosuppression
- congenital anomalies
absolute gold standard for a certain clean catch UA sample
suprapubic needle aspiration
pyocystitis commonly occurs in what pts?
dialysis pts w/ low UOP - bladder becomes one big abcess
emphysematous cystitis
- rare
- gas w/i bladder
- seen in DM, trauma, instrumentation, fistulae
what condition is often confused with chronic prostatitis?
-chronic pelvic pain syndrome
when you r/o testicular torsion, what is the likely diagnosis?
epididymitis or orchitis
-heaviness, aching, hemiscrotum, radiating pain upward, edema
common causes of epididymitis/orchitis
- < 35 yo: GC, chamydia
- > 35 yo: e. coli
what is the once instance that orchitis can be caused by something other than epididymitis
mumpt orchitis
tx of epididymitis/orchitis
- doxy 100 mg BID x 2-3 weeks
- bactrim x 4 wks
possible causes of urethritis in women
- STD
- vaginitis
big 3 causes of vaginits
- candidal
- bacterial
- trachomonal
microscopy findings for candida
-hyphae w/ sausage-link appearance
clinical findings for trichomonas
- strawberry cervix (only in 10% of infections)
- asymptomatic in men so if female has it tx both to prevent reinfection
microscopy for bacterial vaginosis
- clue cells (egg w/ pepper on it)
- predominance of coccobacilli
clinical diagnosis of pyelonephritis
- triad: chills, fever, flank pain
- UA consistent w/ UTI
renal abcess arise from . .
focus of pyelonephritis (e.coli) or hematogenous spread (staph)
size cutoff for renal abscess
> 3cm usually has to be drained
xanthogranulomatous pyelonephritis
- uncommon renal infection misdiagnosed as tumor
- unknown etiology
- persistent bacteriuria
- tx: nephrectomy
what ligaments provide external penile support?
- fundiform ligament:
- from Colles fascia
- superficial
- suspensory ligament:
- from Buck’s fascia
- attaches tunica to pubis
major causes of ED
- many are listed on slide but he mentions:
- arterial insuffeciency (men in 50s)
- venous leak syndrome
systemic diseases that are risk factors for ED
- HTN
- DM
- CRI
- CAD
- hyperlipidemia
- obesity
- liver failure
- endocrine disorders
- hypogonadism
- alcoholism
- neurologic dz
