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Urology (Surgery) > Genital Tract > Flashcards

Genital Tract Flashcards

1
Q

role of Leydig vs Sertoli cells

A

Leydig Cells produce testosterone in the presence of LH

Sertoli cells secrete androgen binding protein under the action of FSH

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2
Q

where does lymphatic drainage of the testis go to

A

para-aortic nodes

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3
Q

what is the most common cancer in men aged between 20-40yrs

A

testicular cancer

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4
Q

primary testicular tumours are categorised into 2 categories - what are they and which is most common

A

germ cell tumours (GCT) - 95%

non-germ cell tumours (NGCT) - 5%

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5
Q

what are NGCTs

A

testicular tumour - 5%

usually benign - either leydig cell or sertoli cell tumours

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6
Q

GCTs can be further categorised into what

A

seminomas

non-seminomatous GCTs

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7
Q

GCTs are usually benign - true or false

A

false - they are usually malignant

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8
Q

difference between seminomas and non-seminomatous GCTs

A

seminomas usually localised and have good prognosis

NSGCTs usually metastasise early and have worse prognosis

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9
Q

examples of NSGCTs

A

choriocarcinoma

yolk sac tumour

teratomas

embryonal carcinomas

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10
Q

risk factors for testicular cancer

A

cryptorchordism - undescended testis

previous testicular malignancy

positive family history

Klinefelters syndrome

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11
Q

what is cryptorchordism

A

undescended testis

associated with a 4-10x higher risk of GCTs

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12
Q

clinical features of localised and malignant testicular tumours

A

unilateral painless lump

mass is irregular, firm, fixed and does not transilluminate

metastatic disease indicated by weight loss, lethargy, bone pain, back pain, dyspnoea

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13
Q

how would a lump on the testis feel on examination

A

irregular, firm, fixed and would not transilluminate

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14
Q

investigations into suspected testicular tumour

A

tumour markers can be diagnostic and prognostic - BhCG, AFP, LDH

scrotal USS alongside concurrent tumour markers

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15
Q

why is biopsy not done in testicular tumours

A

risk of seeding the cancer

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16
Q

what are the tumour markers for testicular tumours

A

AFP

LDH

B-hCG

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17
Q

management options in patients with testicular tumours

A

surgery, radiotherapy and chemotherapy

surgical management would indicate a radical orchidectomy (removal of testis, epididymis, spermatic cord and fascia)

metastatic cancers require chemo or radiotherapy

18
Q

what is testicular torsion

A

twisting of the spermatic cord and its contents within the tunica vaginalis, compromising the blood supply to the testis

19
Q

what is ‘bell-clapper deformity’ and what does it make you more prone to

A

where the testis lack the normal attachment to the tunica vaginalis and so therefore are more mobile - the testis often have a horizontal lie

more prone to testicular torsion

20
Q

what is the pathophysiology of testicular torsion

A

occurs when mobile testis rotates around the spermatic cord - compromising its blood supply

leads to reduced arterial blood flow, impaired venous return and venous congestion leading to resultant oedema and infarction of the testis

21
Q

risk factors for testicular torsion

A

cryptorchidism

‘bell clapper’ deformity

family history

previous torsion

22
Q

clinical features of testicular torsion

A

severe unilateral scrotal pain with associated nausea and vomiting

23
Q

on examination of a testis that has undergone torsion - what would you find

A

testis will often sit higher than the unaffected side and have a horizontal lie

testis will be swollen and very tender

cremasteric reflex will be absent

24
Q

what reflex is lost in testicular torsion

A

cremasteric reflex

25
Q

what is torsion of the Hydatid of Morgagni and how can you tell the difference between this and testicular torsion

A

torsion of the remnant of the mullerian duct

presents with similar sudden onset scrotal pain

scrotum appears less erythematous than torsion and the testis has a normal lie (not horizontal)

blue dot sign will be present in the upper half of the scrotum - this is the visible infarcted hydatid

26
Q

investigations into suspected testicular torsion

A

none - diagnosis is a clinical one and any suspected testicular torsion should be taken immediately to surgery for urgent scrotal exploration

27
Q

management of testicular torsion

A

urgent surgery required - 4-6hrs window before testis infarcts

strong analgesia and anti-emetics

orchidectomy or orchidopexy may be warranted

28
Q

what is orchidopexy

A

fixing of the testis to the scrotum to avoid further torsion in the future

29
Q

what are the 2 classifications of urethritis and the causative organism of each

A

gonococcal urethritis - N. gonorrhoea

non-gonococcal urethritis - C. trachomatis

30
Q

risk factors for urethritis

A

age <25yrs

recent new sexual partner

multiple sexual partners within the last year

men who have sex with men (MSM)

previous STI

31
Q

clinical features of urethritis

A

urethral discharge

dysuria

penile irritation

32
Q

what are some complications of urethritis

A

epididymitis

reactive arthritis

33
Q

investigations into suspected urethritis (what is gold standard)

A

urethral gram stain performed on urethral swabs

gold standard is first-void urine NAAT checking for N. gonorrhoea and C. trachomatis

mid stream urine dipstick

further STI investigations - and contact tracing

34
Q

management of urethritis

A

initial management is antibiotic therapy depending on the underlying causative organism

abstain from sexual intercourse for 7 days post antibiotics course

contact tracing

35
Q

pathophysiology of epididymitis and causative organism based on mechanism

A

local extension of infection from the lower urinary tract

in males <35 most likely mechanism is sexual transmission and so C. trachomatis and N. gonorrhoea are most common

in males >35 most likely mechanism is enteric organism from a UTI and so E. coli is most common

36
Q

mechanism of infection in epididymitis in men aged under and over 35yrs

A

in males <35 most likely mechanism is sexual transmission and so C. trachomatis and N. gonorrhoea are most common

in males >35 most likely mechanism is enteric organism from a UTI and so E. coli is most common

37
Q

risk factors for epididymitis

A

MSM

multiple sexual partners

indwelling catheter

bladder outlet obstruction

immunocompromised

38
Q

clinical features of epididymitis

A

unilateral scrotal pain and associated swelling

fever and rigors may be present

associated LUTS

39
Q

difference between testicular torsion and epididymitis

A

cremasteric reflex intact in epididymitis

gradual onset pain in epididymitis compared to acute severe in torsion

40
Q

investigations into epididymitis

A

urine dip

first void urine sent for NAAT

routine bloods

diagnosis is usually clinical however scrotal USS can confirm diagnosis

41
Q

management of epididymitis

A

antibiotics and analgesia

Urology (Surgery) (5 decks)

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