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Finals > Genito-urinary > Flashcards

Genito-urinary Flashcards

1
Q

what is an epididymal cyst

A

usually develop in adulthood and contain clear on milky (spermatocele) fluid.

lie above and behind the testis

remove if symptomatic

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2
Q

what is a hydrocele

A

fluid within the tunica vaginalis

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3
Q

what is a congenital hydrocele

A

associated with a patent processus vaginalis, which typically resolves during the 1st year of life.

communicating:

    • occurs due to the failed closure of the processus vaginalis during development.
    • usually discovered in infancy
    • reducible. increases in size with the valsalva manoeuvre.

non-communicating hydrocele

  • no connection to the peritoneal cavity present.
    • NOT reducible. doesn’t increases in size with the valsalva manoeuvre.
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4
Q

what is an acquired hydrocele

A

secondary to underlying pathology: testis tumour/ trauma/ infection/ torsion

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5
Q

clinical features of hydrocele

A

fluctuant, painless swelling of affected scrotum.

  • may be present since infancy or childhood
  • may or may not be reducible

positive transillumination

palpation above the swelling is possible - a normal spermatic cord and inguinal ring are present

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6
Q

diagnosis of hydrocele

A

clinical usually

ULTRASOUND every hydrocele to rule out malignancy - hypoechoic fluid confirms the diagnosis.

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7
Q

treatment of hydrocele

A

congenital hydrocele usually resolves spontneously within 6 months of birth.

indications for surgery

  • if spontaneous resolution doesn’t occur by 1 year of age.
  • excessive discomfort
  • underlying pathology suspected
  • testicle not palpable
  • infertility is a concern

procedures

  • surgical excision of the hydrocele sac
  • percutaneous aspiration of the hydrocele fluid
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8
Q

what is a varicocele

A

abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum due to proximal obstruction of the spermatic vein.

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9
Q

causes of primary varicoele

A

not fully understood.
left testicle most commonly affected (85%)
- longer course of the left spermatic vein and its insertion at a 90° angle into the left renal vein predisposes to slower drainage and increased hydrostatic pressure.

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10
Q

causes of a secondary varicocele

A

mass in the retroperitoneal space (Ormond disease, lymphoma, RCC) obstructing venous drainage into the IVC (right-sided varicocele) or left renal vein (left-sided varicocele)

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11
Q

clinical features of a varicocele

A

painless enlargement may be present.
dull, aching pain of the hemiscrotum
HEAVINESS OF THE AFFECTED SCROTUM.
soft bands/strands are palpable in the upper pole of the affected scrotum (‘bag of worms’)

symptoms worsen when standing or performing the valsalva maneouver.

negative transillumination

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12
Q

diagnosis of varicocele

A

BILATERAL ULTRASOUND (dilated >2mm hypoechoic pam-uniform vessels)

doppler ultrasonography

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13
Q

treatment of varicocele

A

conservative management - scrotal support.

invasive treatment

  • laparoscopic varicocelectomy - occluded by ligation.
  • percutaneous embolisation
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14
Q

complications of varicocele

A

infertility

  • sperm is produced in the testicles at 2°C below the average body temp
  • in a varicocele, blood stasis within the scrotum increases local temp, resulting in sub-optimal environment for spermatogenesis.
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15
Q

what is cryptorchidism

A

failure of one or both testicles to descend to their natural position in the scrotum

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16
Q

risk factors for cryptorchidism

A

prematurity

low birth weight

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17
Q

clinical features of cryptorchidism

A

palpable (80%) - testicle cannot be manually manipulated into the scrotum.

non-palpable - may be intra-abdominal or absent.

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18
Q

variants of cryptorchidism

A

inguinal testis - testicle is located between the external and internal inguinal ring, preventing adequate mobilisation (90%).

intra-abdominal testis - testicle is located proximal to the internal inguinal ring.

ascending testes - testicular retraction into the scrotal pouch is possible.

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19
Q

diagnosis of cryptorchidism

A

clinical diagnosis
laboratory tests
- testosterone (bilateral - low, unilateral - normal (normal Leydig cell function))

  • low inhibin B
  • high FSH, high LH
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20
Q

treatment of cryptorchidism

A

typically resolves without treatment via spontaneous descent of testicles by 6 months of age.

persistent cases (6-18 months of age)
- ORCHIDOPEXY
- Orchidectomy
(if non-viable testicular remnants or late discovery of undescended testicle (>2y).

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21
Q

complications of cryptorchidism

A

testicular cancer (germ cell tumours)

infertility - higher temp of the abdo cavity is suboptimal for spermatogenesis –> oligospermia –> infertility

testicular torsion
inguinal hernia

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22
Q

what are the different types of testicular tumour

A

Seminoma (55%) 30-65yeard olds

Non-seminomatous germ cell tumours e.g. teratoma (33%) - 20-30 year olds

mixed germ cell tumour

lymphoma

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23
Q

signs of testicular tumour

A

PAINLESS TESTIS LUMP, found after trauma/infection ± haematospermia, secondary hydrocele.

dyspnoea (lung mets)

abdominal mass (enlarged nodes) or effects of secreted hormones.

25% of seminomas and 50% of NSGCT present with metastases

gynaecomastia - if HCG high

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24
Q

risk factors for testicular cancer

A

cryptorchidism (undescended testis)

infertility

contralateral testicular cancer

family history of testicular cancer

Klinefelter syndrome; trisomy 21 (increased risk for germ cell tumours).

germ cell neoplasia in situ

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25
Q

tumours markers used in testicular cancer

A

AFP

Beta-HCG

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26
Q

which tumour marker is raised in testicular choriocarcinoma (NSGCT)

A

beta-HCG - extremely high levels

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27
Q

which tumour marker is raised in yolk sac tumours (NSGCT)

A

AFP - high

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28
Q

what type of nonseminomatous GCT are there

A

embryonal carcinoma
teratoma
testicular choriocarcinoma
yolk sac tumour

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29
Q

what is a teratoma in testicular cancer

A

commoner in children

may contain elements of muscle, cartilage, bone, teeth.

30
Q

what is the most common testicular tumour in men >60 years of age

A

LYMPHOMA (large b-cell lymphoma) - extra-nodal non-hodgkins lymphoma

31
Q

how to testicular tumours metastasise

A

via the lymphatic system - drain to the para-aortic lymph nodes first.

32
Q

what are the paraneoplastic features of testicular cancer

A

hyperthyroidism

- HCG can mimic TSH, enabling weak stimulation of the TSH receptor in tumours with HCG overproduction.

33
Q

investigations for testicular cancer

A

lab tests - AFP, HCG + LDH

imaging - ULTRASOUND

CT TAP - for staging and checking for mets

biopsy - only done following removal of testis to prevent tumour seeding.

34
Q

treatment of testicular cancer

A

prior to surgery - sperm cryopreservation

radical inguinal orchidectomy

adjuvant chemoradiotherapy (based on histology findings and staging)

35
Q

symptoms of torsion of testis

A

SUDDEN ONSET PAIN IN ONE TESTIS - making walking uncomfortable. typically swollen and tender testicle and/or lower abdo tenderness.

pain in the abdomen

nausea and vomiting

36
Q

signs of torsion of testis

A

inflammation of one testis - tender, hot and swollen

lies high and transversely

ABSENT CREMASTERIC REFLEX

PREHN SIGN NEGATIVE

37
Q

what is torsion of testicular appendage (hydatid of Morgagni)

A

causes less pain
tiny BLUE nodule may be visible under scrotum.

Mx - NSAIDs or if in doubt, surgical exploration

38
Q

ddx of testicular pain

A

testicular torsion
epididymo-orchitis
tumour
trauma

39
Q

treatment of testicular torsion

A

SURGERY WITHIN 6 HOURS

consent for bilateral orchidopexy and possible orchidectomy.

only do a doppler ultrasound if diagnosis is uncertain but DO NOT DELAY SURGERY!

40
Q

ddx of undescended testes

A

cryptorchidism

retractile testis - excessive cremasteric reflex. found in external inguinal ring. mx - reassure.

maldescended testis - found anywhere from abdo to groin

ectopic testis - common in superior inguinal pouch but could be in the abdo, perineal, penile or femoral triangle.

41
Q

complications of maldescended and ectopic testis

A

infertility

testicular cancer

testicular trauma

testicular torsion

hernias (patent processus vaginalis)

42
Q

treatment for maldescended or ectopic testis

A

ORCHIDOPEXY

hormonal - HCG

43
Q

what is balanitis

A

acute inflammation of the foreskin and glans

associated with strep and staph infections

MOST COMMON IN DIABETICS

often seen in young children with tight foreskin

44
Q

management of balanitis

A

antibiotics
circumcision
hygiene advice

45
Q

causes of balanitis

A

poor genital hygiene

contact allergies and topical irritants

drug reaction

bacterial infection e.g. STI (gonorrhoea)

yeast infection - recent hx of ABx use

trauma

46
Q

clinical features of balanitis

A

pruritus, pain, and oedema of the glans penis

erythema and ulcerated lesions of the glans or foreskin

fever, arthralgia, malaise

thick penile discharge

47
Q

investigation for balanitis

A

clinical usually

gram stain and culture for bacterial infection

48
Q

treatment of balanitis

A

conservative

  • daily retraction of foreskin and bathing with warm saline solution.
  • avoid known irritants e.g. soap
  • topical anti fungal e.g. clotrimazole
  • Abx for bacterial infection
  • topical corticosteroid cream for irritant contact or drug reaction.
  • treat underlying chronic condition (psoriasis, reactive arthritis, diabetes)

surgery
- circumcision in recurrent cases

49
Q

complications of balanitis

A

post inflammatory phimosis

UTI

recurrent UTI

penile cancer

50
Q

what is phimosis

A

tight foreskin that cannot be completely retracted over the glans penis

51
Q

causes of phimosis

A

post-infection of balanitis

congenital

scarring after trauma or circumcision

52
Q

sx of phimosis

A

difficulty in retracting the foreskin posteriorly

painful erection and/or dyspareunia

53
Q

treatment of phimosis

A

conservative - topical corticosteroid cream

stretching exercises

surgical
- vertical incision or circumcision

54
Q

complication of phimosis

A

foreskin tear - haemorrhage

paraphimosis

55
Q

what is paraphimosis

A

urological emergency

tight foreskin is pulled back behind the head of the penis and then becomes stuck.

it cannot be placed forward again to its usual position covering the tips of the penis.

causing swelling, pain and loss of blood flow to the tip of the penis.

56
Q

causes of paraphimosis

A

complications of phimosis

iatrogenic - following bladder catheterisation

trauma

57
Q

features of paraphimosis

A

noticeable band of constricting tissue

foreskin cannot be returned to original position.

oedema and pain of the glans penis

features of penile ischaemia (blue skin)

58
Q

treatment of paraphimosis

A

conservative - manual reduction with adequate pain control (topical anaesthesia, local anaesthesia, regional block)

surgery

  • dorsal slit reduction surgery
  • circumcision (last resort)
59
Q

complication of paraphimosis

A

penile necrosis

60
Q

what is prostatitis

A

inflammation of the prostate gland which may be infectious (acute and chronic bacterial prostatitis) or non-infectious (chronic pelvic pain syndrome).

61
Q

common cause of acute bacterial prostatitis

A

E. COLI

gonorrhoea and chlamydia - consider in men <35y of age.

62
Q

common cause of chronic prostatitis

A

bacterial - e.coli

non-bacterial

  • immune response to a prior UTI
  • nerve damage in the pelvic region
  • chemical irritation
  • pelvic floor muscle dysfunction
  • parasitic or viral infection
63
Q

causes of both acute and chronic bacterial prostatitis

A

UTI - urethritis, cystitis, epididymitis

genitourinary tract interventions - catheter, prostate biopsy

voiding dysfunction and bladder outlet obstruction

64
Q

clinical features of acute bacterial prostatitis

A

spiking fevers, chills, malaise

acute dysuria, frequency, urgency

severe pain in lower back, perineal, pelvic and with defecation

prostate - tender, boggy, warm and swollen

65
Q

clinical features of chronic bacterial prostatitis

A

low-grade fever in some patients.

dysuria, frequency, urgency, ED, bloody semen

mild genitourinary pain

prostate - normal, may be enlarged or tender

66
Q

clinical features of chronic pelvic pain syndrome

A

possibly ED

painful ejaculation

bloody semen

moderate, diffuse pain in the lower abdo, lower back, perineum, scrotum and penis.

prostate - normal usually.

67
Q

laboratory tests for acute bacterial prostatitis

A

urinalysis - MSU - high WCC

urine culture - e.coli most common

urine gram statin

bloods - raised WCC, CRP.

blood cultures - if septic

68
Q

treatment of bacterial prostatitis

A

first line - Antibiotic therapy for 6 weeks (ciprofloxacin, co-trimoxazole)

if acute retention and persistent fever - suprapubic catheterisation

69
Q

treatment of chronic pelvic pain syndrome

A

alpha-blockers - tamsulosin

5-alpha reductase inhibitors - finasteride

NSAIDs

psychological support and treatment

physiotherapy

70
Q

complication of prostatitis

A

prostatic abscess (antibiotics + transrectal USS-guided drainage)

acute urinary retention

pyelonephritis and sepsis

epididymitis

Finals (4 decks)

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