Clinical disease of the repro tract 2 (Male)

Question 1

Where can cryptorchid testicles be located?

Answer 1

Abdominal
Inguinal (Commonest)
Prescrotal

Question 2

What is the treatment for cryptorchidism and why?

Answer 2

Castration as the retained testicle is more susceptible to torsion and neoplasia (more likely malignant in these animals). These animals should also not be bred from as it is thought to be a sex-linked recessive trait

Question 3

What could cause enlarged testicles?

Answer 3

Neoplasia
Orchitis/Epididymitis
Torsion

Question 4

What are the complications of testicular neoplasia?

Answer 4

Infertility due to inappropriate hormone production and replacement of functional tissue

Question 5

How can orchitis/epididymitis occur?

Answer 5

From infections originating from the urinary tract, direct penetrations or haematogenous spread

Question 6

What is paraphimosis and outline treatment options.

Answer 6

Non-erect penis protrudes from the prepuce

Tx:

• Symptomatic
• Enlarge prepucial opening
• Phalloplexy
• Prepucial lengthening/reconstruction
• Partial penile amputation

Question 7

What is priapism and possible causes?

Answer 7

Erection of >4h not associated with sexual arousal

Trauma
Perineal abscess
Neurological disease

Question 8

What are the different categories of priapism?

Answer 8

non-ischaemic: entire penis rigid and non-painful

ischaemic- painful rigid shaft with soft glans EMERGENCY as occluded venules!

Question 9

How can priapism be further diagnosed?

Answer 9

Ultrasound

Blood gas analysis of aspirated blood

Question 10

What is the Tx for priapism?

Answer 10

• Buster collar, analgesia and topical treatment to prevent self trauma & exposure
• Therapeutic aspiration and flushing of corpus cavernosum, +/- intra cavernosal inj, of phenylephrine
• Penile or scrotal urethrostomy if other measures fail/inappropriate

Question 11

What are the causes of penile masses and how are they Dx?

Answer 11

Inflammation
Neoplasia
Urethral prolapse

Clinical appearance +/- biopsy

Question 12

What is extravasion of urine a clincal sign of and what needs to be done if this is seen?

Answer 12

Penile injury. Need to aspirate as trauma to the perineum can be a cause of this.

Question 13

When should the penis and prepuce be fully separated?

Answer 13

After puberty

Question 14

What is phimosis?

Answer 14

Inability to protrude the penis beyond the preputial orifice.

Question 15

When should preputial discharge be investigated?

Answer 15

When it is sever/blood tinged. A small amount of slight creamy discharge is normal.

Question 16

How is benign prostatic hyperplasia treated?

Answer 16

Castration - as the hyperplasia is testosterone dependant, involution should occur within 3-12 weeks.

Medical: Anti androgens, synthetic progestagens, GnRH analogue (not licenced), oestragens, faecal softeners

Question 17

How can prostatic abscessation/prostatitis be distinguished from BPH?

Answer 17

BPH would normally be a uniform enlargement whereas abscessation/prostatitis is more likely to be asymmetrical

Question 18

Is prostatic drainage an appropriate tx option for prostatic abscesses?

Answer 18

Yes as long as it is drained completely! Otherwise pus may leak into the peritoneum –> septic peritonitis.

Question 19

How are prostatic cysts and paraprostatic cysts usually treated?

Answer 19

Surgically with castration, omentalisation/drainage. Make sure to biopsy the cyst wall!!

Question 20

What is the Dx approach for prostati neoplasia and what is the prognosis?

Answer 20

Trucut under US or incisional biopsy. Prognosis is hopeless.