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RGU 3 > Diseases of Penis, Male Urethra, and Scrotal Contents > Flashcards

Diseases of Penis, Male Urethra, and Scrotal Contents Flashcards

1
Q

What are the most important modalities needed to make a diagnosis of the male genitalia?

A
  • thorough inspection of the penis, palpation, and ultrasound of the scrotal contents
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2
Q

What is the most common mass lesions within the scrotum?

A
  • hydrocele
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3
Q

*** What is a hydrocele?

A
  • an accumulation of fluid between the visceral and parietal layers of the tunica vaginalis that can surround the testicle, cord, or both.
  • results when there is a reduction in the reabsorption of or increase in the production due to injury or infection, cancer, or we just don’t know.
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4
Q

*** What is a congenital hydrocele?

A
  • a persistence of peritoneal fluid within 1 or more unobliterated segments of the process vaginalis as it descends from the abdomen and through the inguinal canal.
  • almost always accompanied by indirect inguinal hernia, which requires surgical repair.
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5
Q

What are the physical findings of a hydrocele?

A
  • involved side larger than the other.
  • involved side has sense of fluctuation and feels like a balloon filled with water.
  • will usually transilluminate
  • will not reduce unless it communicates.
  • testicle may not be palpable.
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6
Q

What is the treatment for a hydrocele?

A
  • observation (may resolve spontaneously, particularly in children).
  • large or uncomfortable, then surgical resection.
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7
Q

What is an inguinoscrotal hernia?

A
  • indirect hernia sac extending through the inguinal canal down into the scrotum.
  • usually contains bowel but can contain omentum, bladder, etc…
  • does not transilluminate well.
  • testicle and epididymus usually palpable.
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8
Q

Is an inguinoscrotal hernia usually reducible?

A
  • YES, but occasionally incarcerated or strangulated, which would require urgent surgery.
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9
Q

What is a spermatocele (epididymal cyst)?

A
  • a benign retention cyst of the head of the epididymus or aberrant tubules of the rete teste.
  • usually transilluminates.
  • contain spermatozoa
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10
Q

What will a spermatocele (epididymal cyst) feel like on palpation?

A
  • separate from the testicle on palpation.

- is firm to palpation, usually non-tender and about the size and shape of a marble.

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11
Q

How do you treat a spermatocele?

A
  • remove surgically only if painful (rare).
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12
Q

*** What is the most common cause of male infertility?

A
  • varicocele
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13
Q

How should you always check for a hernia?

A
  • with the man STANDING.
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14
Q

*** What is a varicocele?

A
  • a dilation of the internal and external spermatic and vasal veins within the scrotum.
  • caused by incompetency or absence of valves in the internal spermatic vein allowing retrograde flow of blood.
  • if acutely could be due to retroperitoneal mass.
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15
Q

Does varicocele happen more often on the left or right?

A
  • left side due to anatomy of the left spermatic vein draining into the left renal artery at a 90 degree angle.
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16
Q

With what are varicoceles associated?

A
  • rise in scrotal temperature leading to reduction in sperm motility and maturation and thus infertility
  • palpated as “bag of worms” in the upright position. NOT palpable in supine position.
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17
Q

Should you treat varicoceles?

A
  • only if discomfort or fertility is a problem.
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18
Q

What is a hematocele?

A
  • blood between the parietal and visceral layers of the tunica vaginalis resulting from trauma to the testicle.
  • cannot palpate testicle
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19
Q

With what is a hematocele usually associated?

A
  • ecchymosis (discoloration) of the scrotum
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20
Q

How do we treat a hematocele?

A
  • surgery
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21
Q

What must you remember about torsion of the spermatic cord?

A
  • extreme urgency that requires prompt diagnosis and treatment.
  • most occur in the 1st year of life.
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22
Q

What is the most common form of a spermatic cord torsion?

A
  • intravaginal torsion occurring in boys during puberty.

- testicle and cord twist within the tunica vaginalis.

23
Q

What are the clinical findings of torsion of the spermatic cord?

A
  • sudden onset severe pain that may be referred along the cord to groin.
  • exquisite tenderness to palpation
  • nausea and vomiting common.
  • testicle engorged and high in scrotum with thickened cord.
  • pain may subside spontaneously and be recurrent.
24
Q

Will you see urinary tract symptoms with torsion?

A

NO

25
Q

How long do you have to save a boy’s testicle after a torsion?

A
  • 5-12 hours and FIX both sides bc this is a congenital anomaly.
26
Q

What should be on your DDx for torsion?

A
  • epididymitis and epididymo orchitis.
27
Q

What are the testicular appendages and can torsion occur in these?

A
  • appendix testes and appendix epididymis, which can both succumb to torsion.
28
Q

What is epididymitis, epididymo orchitis, and orchitis?

A
  • inflammation of the epididymis followed by the testicles due to infection causing mild discomfort in lower abdomen and within scrotum progressing to severe pain, mostly in scrotrum.
  • commonly associated with fever.
  • pyuria (pus in the urine) is often present if bacterial.
  • always rule out torsion first.
29
Q

What causes orchitis often?

A
  • secondary to systemic viral infection with MUMPS
30
Q

How do we treat epididymitis/orchitis?

A
  • ice, elevation, scrotal support, analgesics
  • cord block if pain is severe
  • broad spectrum antibiotics if bacterial.
31
Q

Does pain or size resolve first in epididymitis/orchitis?

A
  • pain resolves first
32
Q

What is the most common cancer in men age 18-40?

A
  • testicular cancer

* most are germ cell tumors (seminoma, embryonal, teratoma, choriocarcinoma, or yolk sac tumors).

33
Q

How does testicular cancer present?

A
  • painless swelling
  • can produce hydrocele or hematocele.
  • any area of the testicle that is firmer or harder than other areas must be suspicious.
34
Q

How should a primary testicular tumor be removed?

A
  • surgically through inguinal approach.
35
Q

Is chemo effective in treating metastatic testicular cancer?

A
  • YES very :)

* not chemo will not be effective on the primary tumor, so this is why it must be removed surgically.

36
Q

What is the most common cause for testicular avulsion?

A
  • trauma due motorcycle accidents or getting caught in machinery.
37
Q

What is Fournier’s gangrene?

A
  • infection of the genitalia that causes severe pain in the penis and scrotum or perineum, and progresses from erythema to necrosis of tissue.
38
Q

What is urinary extravasation?

A
  • collection of urine in other cavities due to blunt or penetrating trauma to the anterior or posterior urethra.
  • can be iatrogenic from catheterization.
39
Q

How do you diagnose urinary extravasation?

A
  • retrograde urethrogram
40
Q

What are the common dermatoses of the inguinal area?

A
  • tinea crurus
  • eczema
  • monillia
  • lice (crabs)
  • folliculitis
  • hemangiomas
41
Q

What STDs and other cutaneous disorders can occur on the penis?

A
  • genital herpes (HSV-2)
  • primary chancre (syphilis)
  • kaposi’s sarcoma (HIV)
  • condyloma accuminatum (HPV)
  • chancroid (haemophilus ducreyi)
  • lymphogranuloma venereum
  • granuloma inguinale
42
Q

If patient is uncircumcised, what should you always do to the foreskin of the penis?

A
  • retract the skin to inspect the glans penis.
43
Q

What are almost all cancers of the penis?

A
  • squamous cell carcinomas

* almost exclusively found in uncircumcised males.

44
Q

How does penile cancer metastasize?

A
  • through lymphatics
45
Q

What is Peyronie’s Disease?

A
  • growth of fibrous plaques on the dorsal or ventral tunica albuginia causing an abnormal dorsal or ventral curve of the erect penis.
  • can present with pain, difficulty with penetration or poor erection.
  • requires surgery to correct.
46
Q

What is priapism?

A
  • prolonged painful erection not related to sexual stimulation.
  • glans and corpora spongiosum will be soft, but corpora cavernosa will be firm.
  • urologic emergency
47
Q

What can cause of priapism?

A
  • intracavernous injection of vasoactive agents for impotence
  • PDE-5 inhibitors
  • leukemia
  • sickle cell disease
  • pelvic tumors
  • trauma
  • prolonged stimulation
48
Q

How do you reverse priapism?

A
  • intracorporeal adrenergic injection of epinephrine

- irrigate the blood.

49
Q

What is phimosis?

A
  • a condition in which the foreskin cannot be retracted due to stenosis or underlying adhesions.
50
Q

What is paraphimosis?

A
  • the retracted foreskin cannot be reduced. Progressive swelling occurs resulting in a urologic emergency.
51
Q

What has reduced the amount of urethral strictures?

A
  • the advent of penicillin
52
Q

What is fracture of the penis?

A
  • rupture of one or more of the tunica albuginea of the penis during aggressive intercourse.
  • easily treated surgically.
53
Q

When are posterior urethral valves most often diagnosed?

A
  • in utero

RGU 3 (19 decks)

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