Common Genitourinary Conditions in Males

Question 1

Cryptochidism

Answer 1

• undescended testes: does not reside in/cannot be manipulated into scrotum
• retractile testis: can be brought into scrotum and remains there
• gliding testis: brought into scrotum; returns to high position
• ectopic testis: outside normal path of descent
• trapped testis: dislocated after herniorrhaphy
• progressive deterioration of any testis not in scrotum

Question 2

Hydrocele

Answer 2

-painless scrotal swelling (serous fluid in scrotum)

Question 3

Hydrocele: Non-communicating vs. Communicating

Answer 3

Non-communicating: only in scrotum

Communicating: processus vaginalis patent > fluid moves from abdomen to scrotum

Question 4

Hydrocele: Clinical Findings

Answer 4

• intermittent/constant bulge in scrotum that increases w/ activity, decreases w/ rest
• tense overlying skin
• no distress or vomiting

Question 5

Inguinal Hernia

Answer 5

• scrotal/inguinal swelling including abdominal contents
• can cause labial swelling in females
• incomplete closure of processus vaginalis
• obese males/weight lifters w/ hx of undescended testicles have increased risk

Question 6

Inguinal Hernia: Clinical Findings (History)

Answer 6

• family/personal history of undescended testicles
• swelling in inguinal area, scrotum
• prematurity
• weight lifting
• obesity

Question 7

Inguinal Hernia: Clinical Findings (Physical Exam)

Answer 7

• swelling in inguinal, scrotal, labial area
• reducible hernia
• transillumination does not occur
• direct: push outward at weakest point
• indirect: push downward into inguinal canal
• incarcerated: child fussy; abdomen distended
• silk glove sign

Question 8

Inguinal Hernia: Dx

Answer 8

• radiograph

- u/s

Question 9

Scrotal Trauma: Clinical Findings

Answer 9

• pain and injury
• swelling, discoloration, ecchymosis
• if hematoma, cannot trans-illuminate

*usually d/t sports/play

Question 10

Scrotal Trauma: Dx

Answer 10

u/s to r/o other diagnoses and to differentiate degree/type of injury

Question 11

Phimosis

Answer 11

• foreskin too tight to be retracted

- occurs in first 6 years

Question 12

Paraphimosis

Answer 12

• retracted foreskin cannot be reduced to normal position

- can occur w/ masturbation, sex

Question 13

Phimosis and Paraphimosis: Clinical Findings (History)

Answer 13

• infection
• inflammation of penis
• pain
• dysuria
• signs of urinary obstruction

Question 14

Phimosis and Paraphimosis: Clinical Findings (Physical Examination)

Answer 14

phimosis: tight, pinpoint opening of foreskin

pathologic phimosis: thickened, rolled foreskin

paraphimosis: edema, bluish glans/foreskin

Question 15

Phimosis and Paraphimosis: Management

Answer 15

phimosis:

• normal cleansing
• gentle stretching
• circumcision if urinary obstruction or infection
• corticosteroid cream if persistent

paraphimosis:

• lubricate foreskin to reduce
• surgical emergency if not successful