Disorders of Testes and Penis

Question 1

Cryptorchidism:

• what is this?
• incidence is directly related to ___ and ___.
• when do testes normally descend into the scrotum?
• course of dz
• pathologic changes such as ___, ___, and ___ occur at 6-12mo.

Answer 1

What: undescended testes or absent testes

Incidence is directly related to birth weight and gestational age.
*premature males

Testes normally descend into the scrotum during 7-9mo gestation

Course:
-spontaneously decent during the first 3months of life, but by 6months of age spontaneously rarely occurs.

pathologic changes to the undescended testicle such as:

• delay in germ cell development
• changes in spermatic tubules
• reduced number of leydig cells occur at 6-12mo.

Question 2

Cryptorchidism:

• consequences if untreated after 6mo age
• dx
• tx

Answer 2

consequences:
- infertility: decreased sperm counts and quality
- malignancy risk is increased
- indirect inguinal hernias
- increased incidence of testicular torsion

Dx:

• examine genitalia
• differentiate between undescended and retractable testes.
• US
• laparoscopy

Tx:

• orchiopexy after 6 mo of life (surgical placement and fixation of testes in the scrotum)
• lifelong follow up

Question 3

Hydrocele:

• what is this?
• cause
• dx
• tx

Answer 3

What: excess fluid collection between the layers of the tunica vaginalis, can be unilateral or bilateral

Cause:

• primary congenital:
• -associated with indirect inguinal hernia
• secondary:
• -trauma, epididymitis, testicular torsion, orchitis, infection, testicular cancer, appendiceal torsion

Dx:

• transillumination
• US

Tx:
-Primary causes: surgical correction

-secondary: treat the underlying condition

Question 4

T/F, if hydrocele develops in a young man without apparent cause it should be considered CA until proven otherwise.

T/F, in an adult male hydrocele without apparent cause should be considered CA until proven otherwise.

Answer 4

True.

False, hydrocele in adult male is relatively benign.

Question 5

Hematocele:

• what is this?
• causes

Answer 5

What: accumulation of blood in the tunica vaginalis, causes scrotal skin to become dark red or purple.

Causes:

• abd surgical procedure
• scrotal trauma
• bleeding disorder
• testicular tumor

Question 6

Spermatocele:

• what is this?
• characteristics

Answer 6

What: panless, sperm containing cyst that forms on the epididymis located above the posterior to the testes.

Characteristics:

• solitary or multiple
• usually greater than 2cm
• freely moveable and should transilluminate
• if large may become painful and require excision

Question 7

Varicocele:

• what is this?
• MC at what ages?
• MC side, why?
• sx
• what does this look like?
• Tx

Answer 7

What; varicosities of the pampiniform plexus

MC between 15-35YO in men

MC in left side; incompetent valves are more common in the left.

Sx:

• asymptomatic
• dull aching
• atrophy
• infertility
• pain goes away when lying down

Looks like a “bag of worms”

Tx:

• surgical ligation of the gonadal vein
• interventional radiology (embolization of veins)
• necessary in young males who are showing testicular atrophy*
• for those not needing increased fertility = NSAIDS and scrotal support

Question 8

Testicular Torsion:

• what is this?
• MC what ages?
• what is the blue dot sign?
• presentation in neonates and adolescents?

Answer 8

What: urological emergency, twisting of the spermatic cord cutting off blood supply to the testis

MC in perinatal and prepubertal ages ( 10-25YO )

Blue dot sign = torsion of the appendix testis

Presentation neonates:
-firm smooth painless scrotal mass, scrotal skin red with some edema.

Presenatation adolescents:

• n/v
• tachycardia
• large, firm, tender, testes
• pain radiates to inguinal area
• twisted testicle will be higher
• absent cremaster reflex*
• swelling and redness

Question 9

Testicular Torsion:

-dx

Answer 9

Dx: color doppler US must be done right away!!

Tx:
-refer to urology for surgical detorsion and fixation (orchiopexy)
-may require orchiectomy
-can attempt manual detorsion. normal torsion twist inward so to untwist them it looks similar to the “opening of a book.”
(twist outward and laterally)

Question 10

Epididymitis:

• causes
• sx
• dx
• tx

Answer 10

Cause:

• STI
• UTI/Prostatitis(e.coli, pseudomonas, gram + cocci)
• post vasectomy
• trauma
• *most are caused by bacterial pathogens!!!

Sx:

• unilateral pain and swelling in the epididymis over a period of days
• redness and swelling of scrotal skin
• tender groin/lower abd
• fever
• dysuria
• urethral discharge if gonococcal

dx:
- CBC, UA/UC, urethral culture or urine NAAT, gram stain

Tx:

• scrotal elevation and support
• abx
• oral analgesics but heath says avoid these
• tighty whiteys or boxer briefs

Question 11

Hypogonadism:

• definition
• cause
• signs and sx

Answer 11

def: testosterone deficiency with associated signs or sx, deficiency of sperm production, or both. Can be primary or secondary.

Cause:

• primary hypogonadism: –failure of testes to respond to FSH and LH
• -testosterone is low to inhibits production of FSH and lH
• *MC is klinefelters
• secondary hypogonadisM:
• -failure of hypothalamus to produce GnRH or the pituitary to produce enough FSH or LH

Signs and Sx:
-congenital: 1st trimester = inadequate male sexual differentiation, 2nd or 3rd trimester = microphallus and undescended testes

• childhood-onset: impairs 2ndry sex characteristics. Have poor muscle development, high pitched voice, small scrotum, decreased penis and testicular growth, sparse pubic and axillary hair.
• adult onset: decreased libido, ED, depression, anger

Question 12

Hypogonadism:

• dx
• tx

Answer 12

Dx: FSH, LH, and testosterone levels

Tx:
-Testosterone replacement therapy

Question 13

Infertility:

• definition
• cause
• PE
• Dx
• Tx

Answer 13

Def: inabiliity to get prego after trying for at least 1 year for couples under 35 and 6mo for those older than 35YO.

Cause:

• blockage of reproductive system
• medicines
• undescended testicles
• infection

PE:
-Testicular size, vas deferens, spermatic cord, penis, rectum, body habitus

Dx:

• semen analysis
• -semen volume 2-5ml
• -pH 7.2-7.8
• -sperm density greater than 20million
• -motility 50% forward progressive
• -morphology greater 60% normal
• Antisperm aby test
• hormonal analysis
• transrectal US
• scrotal us

Tx:

• boxer shorts
• avoid hot tubs
• timing of intercourse
• avoid illegal drugs, chemicals, and spermicidals
• medications: clomid, impipramine, zoloft
• surgical:
• -varicocelectomy
• -vasovasostommy
• -testicular bx
• -transurethral resection of ejaculatory ducts