Genital Tract Flashcards by Will Orton

role of Leydig vs Sertoli cells

Leydig Cells produce testosterone in the presence of LH

Sertoli cells secrete androgen binding protein under the action of FSH

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where does lymphatic drainage of the testis go to

para-aortic nodes

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

testicular cancer

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

germ cell tumours (GCT) - 95%

non-germ cell tumours (NGCT) - 5%

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what are NGCTs

testicular tumour - 5%

usually benign - either leydig cell or sertoli cell tumours

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GCTs can be further categorised into what

seminomas

non-seminomatous GCTs

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GCTs are usually benign - true or false

false - they are usually malignant

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difference between seminomas and non-seminomatous GCTs

seminomas usually localised and have good prognosis

NSGCTs usually metastasise early and have worse prognosis

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examples of NSGCTs

choriocarcinoma

yolk sac tumour

teratomas

embryonal carcinomas

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risk factors for testicular cancer

cryptorchordism - undescended testis

previous testicular malignancy

positive family history

Klinefelters syndrome

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what is cryptorchordism

undescended testis

associated with a 4-10x higher risk of GCTs

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clinical features of localised and malignant testicular tumours

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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how would a lump on the testis feel on examination

irregular, firm, fixed and would not transilluminate

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investigations into suspected testicular tumour

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

scrotal USS alongside concurrent tumour markers

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why is biopsy not done in testicular tumours

risk of seeding the cancer

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what are the tumour markers for testicular tumours

AFP

LDH

B-hCG

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management options in patients with testicular tumours

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

what is testicular torsion

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

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

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

what is the pathophysiology of testicular torsion

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

risk factors for testicular torsion

cryptorchidism

‘bell clapper’ deformity

family history

previous torsion

clinical features of testicular torsion

severe unilateral scrotal pain with associated nausea and vomiting

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

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

what reflex is lost in testicular torsion

cremasteric reflex

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

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

investigations into suspected testicular torsion

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

management of testicular torsion

urgent surgery required - 4-6hrs window before testis infarcts strong analgesia and anti-emetics orchidectomy or orchidopexy may be warranted

what is orchidopexy

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

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

gonococcal urethritis - N. gonorrhoea non-gonococcal urethritis - C. trachomatis

risk factors for urethritis

age <25yrs recent new sexual partner multiple sexual partners within the last year men who have sex with men (MSM) previous STI

clinical features of urethritis

urethral discharge dysuria penile irritation

what are some complications of urethritis

epididymitis reactive arthritis

investigations into suspected urethritis (what is gold standard)

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

management of urethritis

initial management is antibiotic therapy depending on the underlying causative organism abstain from sexual intercourse for 7 days post antibiotics course contact tracing

pathophysiology of epididymitis and causative organism based on mechanism

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

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

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

risk factors for epididymitis

MSM multiple sexual partners indwelling catheter bladder outlet obstruction immunocompromised

clinical features of epididymitis

unilateral scrotal pain and associated swelling fever and rigors may be present associated LUTS

difference between testicular torsion and epididymitis

cremasteric reflex intact in epididymitis gradual onset pain in epididymitis compared to acute severe in torsion

investigations into epididymitis

urine dip first void urine sent for NAAT routine bloods diagnosis is usually clinical however scrotal USS can confirm diagnosis

management of epididymitis

antibiotics and analgesia