Chapter 93: Male Genital Problems

Question 1

Five genitourinary emergencies

Answer 1

• Testicular torsion
• Fournier’s gangrene
• Paraphimosis
• Priapism
• GU trauma

Question 2

This is part of the penis that surrounds the urethra

Answer 2

Corpus spongiosum

Question 3

This is part of the penis that forms the shaft and a major erectile bodies

Answer 3

Corpus cavernosa

Question 4

Provide blood supply to penis

Answer 4

Internal pudendal artery

Question 5

The deep membranous layer (Scarpa’s fascia) of the abdominal wall extends into the perineum, where it is referred to as ____

Answer 5

The deep membranous layer (Scarpa’s fascia) of the abdominal wall extends into the perineum, where it is referred to as Colles’ fascia, and forms part of the scrotal wall

Question 6

Beneath the skin of scrotum are the smooth muscle and elastic tissue layers of Dartos’ fascia which is similar to?

Answer 6

Beneath the skin are the smooth muscle and elastic tissue layers of Dartos’ fascia, similar to the superficial fatty layer (Camper’s fascia) of the abdominal wall

Question 7

Each testis is encased in a thick fibrous tunica albuginea except ____

Answer 7

Each testis is encased in a thick fibrous tunica albuginea except posterolaterally, where it is in tight apposition with the epididymis

Question 8

True or False
The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum)

Answer 8

True
The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum)

Question 9

True or False

The prostate originates from the urogenital sinus at approximately the fifth month of embryonic life

Answer 9

False

The prostate originates from the urogenital sinus at approximately the third month of embryonic life

Question 10

Ultrasound findings of scrotal edema

Answer 10

• Easily compressible thickened scrotal wall
• Increased peritesticular blood floow
• Reactive hydrocele

Question 11

Major risk factor for Fournier’s gangrene

Answer 11

Diabetes and alcohol abuse

Question 12

Most important predictors of death in Fournier’s gangrene?

Answer 12

Age over 60 and complications during treatment

Question 13

The scrotal ultrasound of patient showed scrotal wall thickening, and “dirty shadowing,” suggesting air in the tissue. What is your diagnosis?

Answer 13

Fournier’s gangrene

Question 14

Inflammation of the glans and the foreskin that primarily caused by inadequate hygiene or external irritation

Answer 14

Balanoposthitis

Question 15

True or False

Balanoposthitis can be the sole presenting sign of diabetes

Answer 15

True

Balanoposthitis can be the sole presenting sign of diabetes

Question 16

Anaerobic medication for balanoposthitis

Answer 16

• Oral clindamycin, 300 milligrams three times per day for 7 days
• Metronidazole, 500 milligrams two times per day for 7 days

Question 17

Inability to retract the foreskin proximally and posterior to the glans penis

Answer 17

Phimosis

Question 18

Curative for phimosis

Answer 18

Circumcision

Question 19

Non surgical approach for phimosis

Answer 19

Topical steroid treatment (such as betamethasone, 0.05% to 0.10% twice daily) applied from the tip of the foreskin to the glandis corona for 1 to 2 months

Question 20

A true urologic emergency, is the inability to reduce the proximal edematous foreskin distally over the glans penis into its natural position

Answer 20

Paraphimosis

Question 21

Reduction method in paraphimosis

Answer 21

Tightly wrapping the glans with a 2-inch elastic bandage for 5 minutes will reduce edema

Question 22

The most common cause of fracture of the penis?

Answer 22

Sexual intercourse

Question 23

True or False

Surgery with fracture of the penis within 8 hours is recommended to minimize dysfunction

Answer 23

True

Surgery with fracture of the penis within 8 hours is recommended to minimize dysfunction

Question 24

Fibrotic disorder of the tunica albuginea

Answer 24

Peyronie’s disease

Question 25

True or False | Adult with priapism is related to hematologic disorder and in children are pharmacologic related

Answer 25

False | Adult priapism are pharmacologic related and children in hematologic disorder

Question 26

Classification of priapism

Answer 26

- Ischemic priapism (veno-occlusive, low- flow) | - Nonischemic priapism (arterial, high-flow)

Question 27

A recurrent subset of ischemic priapism

Answer 27

Stuttering priapism

Question 28

How to differentiate nonischemic from ischemic priapism

Answer 28

Blood gas analysis of the first corporal aspirate

Question 29

True or False Ischemic (low-flow) priapism is more common, is usually quite painful, and is characterized by the aspiration of dark acidic intracavernosal blood from the corpus cavernosum

Answer 29

``` True Ischemic (low-flow) priapism is more common, is usually quite painful, and is characterized by the aspiration of dark acidic intracavernosal blood from the corpus cavernosum ```

Question 30

Primary treatment methods for persistent priapism

Answer 30

- Corporal aspiration - Irrigation - α-adrenergic agonist (i.e., phen- ylephrine) injection

Question 31

May yield detumescence when narcotic medication fails to resolve priapism

Answer 31

Ketamine, 0.5 milligram/kg per dose for up to four doses

Question 32

True or False Testicular torsion presents in a bimodal age distribution, with extravaginal torsion occurring in the perinatal period and intravaginal torsion peaking during puberty

Answer 32

True Testicular torsion presents in a bimodal age distribution, with extravaginal torsion occurring in the perinatal period and intravaginal torsion peaking during puberty

Question 33

What symptoms other than lower abdominal quadrant pain and scrotal pain makes the diagnosis of testicular torsion more likely?

Answer 33

Vomiting

Question 34

Examination of testicular torsion

Answer 34

When examined early, the involved testis is firm, tender, and often higher than the contralateral testis and frequently with a transverse lie

Question 35

True or False | The most sensitive finding in excluding testicular torsion is the unilateral presence of the cremasteric reflex

Answer 35

True | The most sensitive finding in excluding testicular torsion is the unilateral presence of the cremasteric reflex

Question 36

Sign that relief of pain with elevation of the affected testicle

Answer 36

Prehn's sign which is positive for epididymitis

Question 37

How the detorsion done?

Answer 37

Detorsion initially should be done in a medial to lateral motion

Question 38

True or False If one were to stand at the patient’s feet, the patient’s right testis would be rotated in a counterclockwise fashion and the patient’s left testis in a clockwise fashion

Answer 38

True If one were to stand at the patient’s feet, the patient’s right testis would be rotated in a counterclockwise fashion and the patient’s left testis in a clockwise fashion

Question 39

Initial detorsion is how many degrees?

Answer 39

The initial attempt should include one and one-half rotations (540 degrees)

Question 40

What are the four testicular appendages?

Answer 40

- Appendix testis - Appendix epididymis - Paradidymis (organ of Giraldes) - Vas aberrans

Question 41

Symptoms of testicular and appendages torsion are the same except?

Answer 41

in appendages torsion do not have systemic symptoms like nausea and vomiting

Question 42

Pathognomonic for torsion of the appendix testis

Answer 42

Blue spot may be observed through the scrotal skin—the “blue dot sign.”

Question 43

Management of appendages torsion?

Answer 43

Analgesics, bed rest, supportive underwear, and reassurance, with the expected symptom resolution within 3 to 5 days

Question 44

Most common cause of epididymitis?

Answer 44

Infection, sexually active men should be treated with Gonorrhea and Chlamydia

Question 45

In older men the causative agent of epididymitis is?

Answer 45

E. coli and Klebsielka

Question 46

In elder men the causative agent of epididymitis is?

Answer 46

If with epididymitis and UTI consider BPH

Question 47

Although the 2015 Centers for Disease Control and Prevention recommendations direct the coverage of sexually transmit- ted infections based on an age cut-point of ____

Answer 47

Although the 2015 Centers for Disease Control and Prevention recommendations direct the coverage of sexually transmit- ted infections based on an age cut-point of 35 years

Question 48

Treatment for acute epididymis most likely caused by sexually transmitted chlamydia or gonorrhea

Answer 48

- Ceftriaxone 250 milligrams IM single dose, plus doxycycline 100 milligrams PO twice a day for 10 d

Question 49

Treatment for acute epididymitis most likely caused by enteric organisms

Answer 49

- Levofloxacin 500 milligrams PO every day for 10 d | - Ofloxacin 300 milligrams PO twice a day for 10 d

Question 50

This is associated with systemic infection such as mumps or other viral illneses

Answer 50

Orchitis

Question 51

True or False Mumps orchitis presents with unilateral involvement in 70% of cases, followed by contralateral involvement in 1 to 9 days

Answer 51

True Mumps orchitis presents with unilateral involvement in 70% of cases, followed by contralateral involvement in 1 to 9 days

Question 52

True or False | Viral orchitis is almost always associated with epididymitis

Answer 52

False | Bacterial orchitis is almost always associated with epididymitis

Question 53

Hallmark of testicular carcinoma

Answer 53

The hallmark of testicular carcinoma is an asymptomatic testicular mass with firmness or induration

Question 54

Most common etiologic cause of acute prostatitis

Answer 54

E. coli

Question 55

Initial treatment for acute prostatitis

Answer 55

Ciprofloxacin, 500 milligrams orally twice daily for 14 days

Question 56

Multidrug resistant management for acute prostatitis

Answer 56

Fosfomycin 3 grams daily for 7 days followed by 3 grams every 48 hours for 6 weeks