Genitourinary Flashcards
1
Q
where do kidneys lie on the spine level?
A
t11-l3
2
Q
what is the blood supply for kidneys?
A
renal artery from aorta at L1
3
Q
at what junction is the reflux of urine prevented by?
A
vesicoureteric junction
4
Q
what nerves supply the bladder and sphincter?
A
- Parasympathetic Nerve (pelvic nerve)
- S2-S4, ACH
- Sympathetic Nerves (hypogastric plexus)
- T11 – L2, norad - Somatic Nerve (pudendal nerve)
S2-S4 - Afferent pelvic nerve
- Sensory nerve - signals from detrusor muscle
5
Q
what maintains the guarding reflex in bladder control?
A
onuf’s nucleus
6
Q
what is responsible for the Micturition reflex?
A
Sacral Micturition Centre
7
Q
what is responsible for the co-ordination of voiding?
A
pontine micturition centre
PAG
8
Q
what happen during filling stage in the bladder?
A
- detruser muscle relaxed - sympathetic/hypogastric stimulated
- urethra contracted - somatic/pudendal stimulated
9
Q
how is urine expelled from bladder?
A
- detruser contraction - Pelvic parasympathetic stimulated
- external sphincter relaxation - Pudendal nerve inhibited
10
Q
what are the causes of erectile dysfunction?
A
Multifactorial:
- vascular - hypertension, atherosclerosis, hyperlipidemia, smoking
- neurological - parkinsons, MS
- hormonal - hyperprolactin, thyroid, cushings
- drug-induced - beta-blockers, diuretics
- systemic disease - diabetes, renal failure
- structural - trauma
- psychological
impotence
inflammatory, mechanichal, psych, occlusive, trauma, extra, neuro, chem, endo
11
Q
what questionnaire asseses erectile dysfunction?
A
International Index of Erectile Function
- 5 questions
- over last 6 months
12
Q
when is Nocturnal penile tumescence testing (NPT) used?
A
complex/refractory ED
distinguises between organic/psychogenic
13
Q
what medication is given to help get an erection?
A
Phosphodiesterase-5 inhibitors - sildenafil, vardenafil, avanafil
(can cause priapism)
14
Q
what autonomic nerves control penis functions?
A
para - produces erection
sympathetic - ejaculation and detumescence
15
Q
what somatic nerves are in penis?
A
Dorsal Nerve of the Penis from pudendal nerve - sensory
Perineal Nerves - motor & sensory
16
Q
what part of brain is responsible for erections?
A
medial preoptic area
paraventricular nucleus in hypothalamus
17
Q
for are the treatment/management options for ED?
A
- modification of risk factors
- treat underlying cause
1ST LINE - PDE-5 inhibitors - sildenafil - short hl, tadalafil - long hl - contraindications are heart attack/arrhythmia - alprostadil (increases cAMP) - MUSE
- caverject - injections
- psychosexual counselling
- hormone therapy - testosterone if low
- surgery - inflatable implants, semirigid rods
18
Q
what is the definition of ED?
A
an inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners
19
Q
what are ED at risk of?
A
cardiovascular conditions
20
Q
what investigations are needed for penile cancer?
A
- biopsy
- ct scan/ultrasound assess tumour size
- MRI (not common) checks for fibrosis
- CVD risk factors - bloods eg lipids, glucose,BP, bloods for general health
21
Q
what cell carcinoma is penile cancer?
A
squamous cell carcinoma
kaposi sarcoma
22
Q
how is penile cancer graded?
A
G1, G2, G3
(cell are graded - normal/abnormal)
23
Q
what is the T staging of penile cancer?
A
Ta - epithelium
T1 - lamina propia
T2 - spongiosum
T3 - cavernosum
T4 - scrotum/prostate/bone
24
Q
what is the N staging in penile cancer
A
N0 - no nodes
N1 - up to 2 unilateral inguinal nodes
N2 - 3+ unilateral/bilateral nodes
N3 - pelvic nodes
m1 - metastatic disease
25
how does penile cancer present?
- hard painless lump
- can be red patch/ulcer
- most commonly on glans or prepuce(foreskin)
- discharge/bleeding
26
what is important to examine in penile cancer?
lymphs in groin
27
what is the treatment options for penile cancer
- GS: surgery- partial/total penectomy
- cream - 5-fluorouracil (5-FU) and imiquimod (IQ)
- chemo/radio (platinum based)
28
what are risk factors of penile cancer?
- HIV/HPV (multiple sexual partners)
- tobacco
- no circumsision
- Lichen Sclerosus - skin condition, inflammation etc.
- age - more in over 50
- geography - asian/african
29
what is the most common Bladder carcinoma?
Urothelial carcinoma - invasion of basement membrane or deeper
30
what are the risk factors for bladder cancer?
- smoking
- schistosomiasis infection - parasite
- chemical exposure - paint, rubber, dye
31
what is the pathway of development of Urothelial carcinoma?
- papillary lesions - high/low grade
- flat/in-situ lesions - always high grade
32
why is PD-L1 expression in urothelial carcinomas significant?
more likely to respond to immunotherapy
33
what are less common forms of bladder cancer?
squamous cell carcinoma
small-cell carcinoma
adenocarcinoma
34
what are the presentations of bladder cancer?
- over 60 years old
- micro/gross hematuria
- infection/obstruction
- less common: painful frequent urination, fatigue, weight loss, pelvic mass
35
what are the investigations for bladder cancer?
- cystoscopy (+biopsy) - camera - gold standard
- CT/MRI/ultrasound
- biopsy- urine cytology - detects cancer cells
36
what is the treatment for non-muscle-invasive bladder cancer?
- TURBT - removal of cancer + single dose chemo
- chemo
- BCG vaccine
- cystectomy
37
what is the treatment for muscle-invasive bladder cancer?
- cystectomy
- radiotherapy
- chemo
- immunotherapy if advanced
38
what is used to stage and diagnose CKD?
- eGFR - less than 60 (for over 3 months) (used with sex and age to calculate stage)
- ACR - albumin creatinine ratio - over 30 is abnormal
39
at what eGFR do people need dialysis?
5-7 (starts planning at 15)
40
what most commonly causes CKD?
hypertension
diabetes
glomerulonephritis
41
what are BP targets in CKD for ACR over and under 70?
under 70 - 140/90
over 70 - 130/80
42
how is anemia in CKD treated?
EPO
Iron
43
what is the management of CKD?
- control BP - ACE inhibitors
- **SGLT2 inhibitors** - blockglucose reabsorption, reduce proteinuria
- monitor
- diet changes - low salt and protein
- dialysis/transplant for end-stage
44
what are the stages of CKD?
Stage 1: GFR ≥90 mL/min/1.73 m² with evidence of kidney damage.
Stage 2: GFR 60-89 mL/min/1.73 m² with evidence of kidney damage.
Stage 3: GFR 30-59 mL/min/1.73 m².
Stage 4: GFR 15-29 mL/min/1.73 m².
Stage 5: GFR <15 mL/min/1.73 m² or on dialysis (also known as end-stage renal disease, ESRD).
45
how does CKD effect calcium/parathyroid?
- decreased calcium reabsorption by kidneys/ absorption due to no vit D conversion
- secondary hyperparathyroidism
- increased bone turnover
(increased phosphate levels in blood)
46
what are the types of dialysis?
- haemodialysis
- peritoneal dialysis
47
what is conservative care in CKD?
- no dialysis
- managing symptoms - fatigue, nausea, itching
48
what are risk factors for renal cancer?
- hypertension
- obesity
- smoking
(all cause hypoxia)
49
what is VHL?
- tumour suppressor on chromosme 3
associated with kidney cancer
50
how is kindey cancer diagnosed by symptoms ?
- mass (palpable/CT imaging)
- blood in urine
- pain
51
what is the T staging of renal cancer?
TNM
t1 - completely inside the kidney.
t2 - completely inside the kidney.
t3 - spread to surrounding tissue
t4 - spread to adrenal glands etc
52
what is the grading of kidney cancer?
Grade 1: Nuclei are small and round with little variation in size and shape.
Grade 2: Nuclei are slightly larger with more variation in size and shape.
Grade 3: Nuclei are even larger with noticeably irregular size and shape.
Grade 4: Nuclei are very large and bizarre-looking, with many irregularities.
53
what are the subtypes of kidney cancer?
- **clear cell** - most common
- papillary
- rare: Chromophobe, collecting duct
54
what are the treatment options for kidney cancer?
- surgery - nephrectomy (radical/aprital/simple)
- radiation therapy
- targeted therapy
- chemo
- ablation eg Cryoablation
55
what is Upper Tract Urothelial Carcinoma?
in upper urinary tract - renal pelvis and ureters
56
what is normal GFR?
over 90
57
what factors decrease GFR?
- Urinary tract obstruction
- Renal disease, Diabetes mellitus, Hypertension
- increased Afferent artery resistance - NSAIDs
- decreased efferent artery resistance - ACEi/ARB
- decreased renal blood flow - dehydration
- increased age
58
what drugs may cause AKI?
DAMN
diuretics, ACEi/ARB, metformin, NSAIDs
59
what is required to measure GFR?
plasma and urine creatinine values
(URINE Cr/ PLASMA Cr) * urine flow rate
60
what is GFR influenced by?
Net Filtration Pressure (NFP)
Renal Blood Flow (RBF) - autoregulation
Filtration coefficient (Kf; filter integrity/function)
61
what is net filtration pressure calculated by?
GHP - (BCP+piG) (piG=Glomerular colloid osmotic pressure)
62
how in BP/volume regulated by kidneys?
(Baroreceptor reflexes (medulla) and Osmoreceptor Reflexes (hypothalamus))
- Juxtaglomerular Apparatus & Macula densa (Renin/Angiotensin)
- Tubuloglomerular feedback - GFR
- Negative feedback loops
63
what is ANP degraded by?
Neprilysin
64
what is the function of anp?
- increases GFR - dilates afferent arterioles and constricts the efferent arterioles
- inhibits sodium and water reabsorption
65
what is the most common type of testes cancer?
- germ cell tumor - seminoma and nonseminomatous germ cell tumors
66
what are risk factors of testicular cancer?
- family history
- excessive oestrogen in mother
- scandinavian
- Undescended Testicle (Cryptorchidism)
- 15-35
- Klinefelter syndrome and Kallman syndrome
67
what is used to diagnose testicular cancer?
ultrasound
tumour markers - LDH, AFP, beta HCG
68
where does testicualr cancer commonly spread to?
lymphs in retroperitoneum
69
how does testicular cancer present?
unilateral painless testicular lump
- back pain/weight loss if spread
70
what is the management of testicular cancer?
- CT of plevis/abdo for staging
- radical inguinal orchidectomy
- sperm bank/cryopreservation
- potetnial chemo/radio for late stage
71
What Is Glomerulonephritis?
group of parenchymal kidney disease – characteristic of inflammation and damage to glomeruli
72
what can Glomerulonephritis lead to?
end stage kidney failure
73
what is the Glomerulonephritis Pathophysiology?
- inflammation of glomeruli
- immunoglobin deposits
- can damage basement membrane
74
what are examples of Glomerulonephritis?
- Nephritic syndrome
- Nephrotic syndrome
- lupus
- C3 Glomerulopathy
75
how does Acute Nephritic syndrome present?
- rapid deterioration - AKI
- haematuria (high) and proteinuria (low-mid)
- Oliguria
- hypertension
- fluid retention - oedema etc
76
what can cause Acute Nephritic syndrome (including pathology)?
- Immune Complex Formation and Deposition - eg **post streptococcal infection** & Systemic Lupus Erythematosus
- **anti-glomerular basement membrane** antibodies - eg Goodpasture’s disease
- **ANCA associated vasculitis**
- Crescentic **IgA** nephropathy/ Henoch Schonlein purpura (HSP) (kidney diseases)
77
how is ANCA-Associated Vasculitis treated?
- steroids
- cyclophosphamide
- rituximab
(control immune respone and inflammation)
78
how is ANCA-Associated Vasculitis diagnosed?
- serum ANCA - changes in titre correlate with activity
- biopsy - lesions/fibrosis/tubular atrophy
79
what are clinical features of ANCA-Associated Vasculitis?
inflammatory features eg
- rash, ulcers, Sinusitis, nasal discharge
- kidney and other organ involvement
80
what is considered when ANCA-Associated Vasculitis is life threatening?
plasmapheresis - blood plasma exchange
81
what is the most common cause of glomerulonephritis?
IgA Nephropathy
82
how is IgA Nephropathy diagnosed?
biopsy - mesangial IgA deposits in glomeruli
83
how is IgA Nephropathy managed?
- BP management
- max tolerated ACE/ARB
- lifestyle modification
- asses CVD risk
- glucocosteroids - limited evidence
- **Budesonide** recommended by NICE
84
what is IgA Nephropathy?
- Berger's disease
- deposits of IgA in glomeruli causes inflammation and damage
85
how does Systemic Lupus Erythematosus (SLE) present?
Rash
arthralgia,
kidney failure
neurological symptoms
pericarditis
pneomonitis
86
how is Systemic Lupus Erythematosus (SLE) treated?
steroids
cyclophosphamide
mycophenolate mofetil,
rituximab,
87
how does Henoch Schonlein purpura present?
- purple rash
- abdominal pain
- AKI (igA deposits)
88
what is Henoch Schonlein purpura?
Systemic form of IgA Nephropathy
- more common in children
- can progress to CHD but often self limiting
89
how is Anti- glomerular Basement Membrane disease (Goodpasture syndrome) treated?
plasma exchnage - remove antibodies
steroids/cyclophosphamide - immunosuppression
90
how is Henoch Schonlein purpura treated?
supportive measures
steroids
91
how do Nephrotic syndrome present?
- Heavy proteinuria
- **Hypoalbuminaemia**
- oedema
(- Hypercholesterolaemia
- Haematuria usually absent or mild)
92
what are primary causes of nephrotic syndromes?
- minimal change syndrome - more in children
- Focal Segmental Glomerulosclerosis (FSGS)- scaring due to multiple reasons eg HIV/drugs/diabetes
- membranous - BM thickening
- Membranoproliferative Glomerulonephritis (MPGN) - (can also be nephritic)
93
what are secondary causes of nephrotic disease?
- Systemic Lupus Erythematosus (SLE)
- diabetes - 1 earlier, 2 later in life
- amyloids - proteins
- infections - HIV/Hep
- drugs - gold, penicillamine
- malignancy
94
what investigations are required for Nephrotic Syndrome?
- renal biopsy
- Serum albumin, creatinine (+eGFR), lipids and glucose, urinalysis
- protein/creatinine ratio - proteinuria
- antibodies eg ANA, dsDNA, C3, C4 (lupus), PLA2Rab (membranous, HepdsAg & HepCAb
95
how is nephrotic syndrome treated?
- control fluids - diuretics, ACE/ARBs, spironolactone
- statins
- anticoagulation (membranous/amloid - low albumin)
- prophylactic antibodies in children
96
what is primary vs secondary Membranous Nephropathy?
primary - PLA2R antigen - immune system attacks BM
secondary - systemic causes eg viruses, drugs, tumours, other auntominnume conditions
97
how is minimal change disease diagnosed and treated?
- biopsy - podocytes fused
- steroids
(2nd= tacrolimus, cyclosporin, cyclophosphamide or rituximab)
98
what is Asymptomatic Urinary abnormalities?
- Incidental finding of dipstick haematuria +/- proteinuria
- normal kidney function & BP
- Causes: IgA, Thin membrane disease
99
what is alports syndrome?
- genetic condition - affects type 4 collagen
- causes kidney disease
100
where does prostate cancer occur?
peripheral zone of prostate
101
what is the most common class of prostate cancer?
- Adenocarcinoma - glandular cells
- Small Cell Carcinoma - less common more aggressive
102
what are risk factors for prostate cancer?
- age - over 50
- family history
- african-american men
- genetics
- high fat diet
103
what are signs/symptoms of prostate cancer?
only present in later stages
- urine changes - frequency, starting/stopping, weak stream
- blood in urine/semen
- pelvic discomfort
104
how is prostate cancer diagnosed?
- lower urinary tract symptoms
- PSA blood levels
- PCA3 in urine
- transrectal ultrasound (TRUS), MRI, bone scan
- prostate biopsy - gleason grading
- DRE (posterior and lateral aspects of the prostate gland)
105
when can PSA be elevated?
- prostate cancer
- UTI
- prostatitis
106
how is prostate cancer staged using T stage?
T1 - no palpable tumour on DRE
T2 - palpable tumour, confined to prostate
T3 - palpable tumour extending beyond prostate
107
how is localised/locally advanced prostate cancer treated?
- surgery
- radiotherapy
- adjuvant/neoadjuvant hormones
108
what are risk factors for AKI?
- high BP
- CKD
- Diabetes
- heart/liver problems
- increased age
- Nephrotoxic Drugs
109
what is diagnostic criteria for AKI?
- increase in serum creatinine by 0.3 mg/dL or 1.5-1.9 times baseline
- urine output less than 0.5 mL/kg/h for 6-12 hours
Stage 1/2/3 based on severity
110
what are pre renal causes of aki?
-Decrease in blood volume and blood flow
eg hypovolemia, heart/kidney failure, sepsis, drugs, hyper Ca
111
what are inta renal causes of aki?
- damage to kidneys
eg ATN Acute tubular necrosis, AIN Acute interstitial nephritis, GN
112
what are causes of post renal AKI?
- obstruction of urine flow causing high pressure
eg calcus, compression, prostate, medication, tumours
113
what are signs of AKI?
- azotemia - high nitrogen (urea and creatinine)
- high K, low Ca
- decreased urine output
- fluid overload/retention
- accumulation of drugs
114
what investigations are required for AKI?
- Serum Creatinine
- FeUrea - pre=low, intra=high
- urine sodium - pre=low, inta=high
- Urinalysis - protein/blood - intra
- urine osmolarity - higher=pre
- Fractional Excretion of Sodium FeNa - <1% = prerenal, >2% = intra
- ultrasound - shows kidney stones
115
how is AKI managed?
- treat underlying cause
- dialysis if severe
- fluids - when no fluid overload, rarely with dialysis
- collids - fluids type, anaphylaxis risk
- blood products eg RBCs
116
how does androgen deprivation/ hormone therapy treat prostate cancer?
- cancer is driven by androgens like testosterone
- can be surgical - castration
- **LH antagonists or GNrH analogues**
117
how is Castration-resistant prostate cancer treated?
- Abiraterone & Enzalutamide - hormone therapy
- chemo - Docetaxel, Carbazitaxel
- bisphosphonates - prevent bone comlications
118
what is the classification of UTI?
Asymptomatic bacteriuria
Uncomplicated
Complicated
119
what pathogen most commonly causes UTI?
E.coli
proteus - associated with renal stones
klebsiella (gut) - catheter associated
Staphylococcus saprophyticus (skin) - younger women - gram +ve cocci
120
what factors contribute to pathogenesis of UTIs?
- obstruction eg stones/tumours
- low fluid intake
- increased pH - due to bacteria
- catheters
121
what are symptoms of an lower UTI?
- dysuria
- increased frequency and urgency
- Suprapubic pain
- Cloudy or strong-smelling urine
122
what are symptoms of an upper UTI?
- Fever and chills
- Nausea and vomiting
- Malaise and fatigue
- Dysuria, urgency, and frequency
- Flank pain
123
what is found on a urinalysis in a UTI?
- nitrates
- leukocytes
- blood
124
when is an early morning urine required? (bacteria)
TB UTI
125
what level of bacteria signifies UTI in microscopy?
Counts >10^5 cfu/ml
126
what is the first line treatment for UTIs?
nitrofurantoin
- Not given in thrid trimester
127
when should UTI not be treated?
over 65 asymptomatic
128
what is Pyelonephritis?
Infection of the renal parenchyma and soft tissues of renal pelvis /upper ureter
(upper UTI)
- associated with sepsis, fluid depletion
129
what are Pyelonephritis symptoms?
Loin pain
Fever
Pyuria - leukocytes
130
what are Pyelonephritis routes of infection?
- Urethra colonised with bacteria - especially female
- blood - S.aureus/Candida
131
what investigations are done for Pyelonephritis?
- physical examination - tender lion/Renal angle tenderness
- Bloods including cultures
- ultrasound scan - rule out obstruction
- MSU
132
how is Pyelonephritis treated?
- IV antibiotics – eg. Co-amoxiclav +/- Gentamicin
- fluid replacement
- catheter
- analgesia
- draining obstructed kidney
133
what are complications of Pyelonephritis?
- Renal abscess (common in diabetics)
- Emphysematous pyelonephritis (gas accumulation - Rare)
134
what are lower urinary tract (LUTS) symptoms?
- Frequency
- Nocturia
- Urgency
- Hesitancy/Straining
- Poor/intermittent stream
- Incomplete emptying
- Post micturition dribbling
135
what cell is increased in benign prostatic hyperplasia?
epithelial and stromal cell numbers in the periurethral area of the prostate
136
what is International Prostate Symptom Score (IPSS) ?
8 questions to asses LUTS
8-19 = mild
20-35 = severe
137
what is physically examined in LUTS?
- Abdominal - bladder distension
- External genitalia - urethra narrowing/ cancer
- Digital rectal examination (DRE) - prostate cancer
- neurological examination - dementia/MS
- lower limbs/peritoneum - sensory/motor
138
what investigations are done for LUTS?
- urinanalysis
- imagings
- TRUS - prostate
- cystoscopy - if haematuria
- urine frequency charts - flow rate/urine output
- PSA
139
what medication is used in prostate enlargement?
- Alpha-Blockers - relax the muscles in the prostate and bladder neck
- 5-Alpha Reductase Inhibitors - shrink the prostate over time, inhibits conversion of testosterone
140
what surgical intervention is used in benign prostate enlargement?
TURP
141
how is long term Interactive obstructive uropathy treated?
(urine isnt drained/blockage)
TURP
Long term catheter
142
where are upper urinary tract vs lower urinary tract stones found?
upper - renal and Ureteric
lower - bladder, prostatic, urethral
143
what may cause stones in urinary tract?
- anatomical - eg horseshoe
- obstruction
- trauma
- calcium, oxalate, urate, cystine
- infection
- dehyrdration
144
what is the Nucleation theory for stone formation?
stones form from crystals in supersaturated urine
145
how are stones prevented?
- overhydration
- low sodium diet
- reducing BMI
- active lifestyle
- healthy protein intake
146
what are symptoms of stones in urinary tract?
- Asymptomatic
- Loin pain
- “Renal” colic
- UTI symptoms- dysuria, strangury, urgency, frequency
- Recurrent UTIs
- Haematuria
147
what is gold standard for diagnosing stones?
- non-contrast CT of kidneys, ureters and bladder (KUB)
148
what is a compliaction from stones in the urinary tract?
urosepsis
149
what are the treatment options for stones?
- conservative
- mediaction to dissolve stone eg potassium citrate
- Percutaneous Nephrolithotomy (PCNL) - incison in back - larger stones/ renal
- Ureteroscopy - laser
- drainage - Ureteric stones
- endoscopy - bladder stones
- ESWL
150
what is Hydronephrosis?
Dilation of the renal pelvis or calyces
151
what is Supravesical obstruction vs Infravesical obstruction
supra - above bladder
infra - below bladder
152
what is cystitis?
bladder infection
upper uti
153
what bacteria most commonly causes Urethritis
Neisseria gonorrhoeae
Chlamydia trachomatis.
- sti
154
what investigations are needed for urethritis?
- Gram stain culture of urethral discharge and/or urine sediment
- nucleic acid amplification tests (NAAT) - for bacteria
155
what are symptoms/signs of urethritis?
- presence of risk factors
- urethral discharge
- urethral irritation or itching
- dysuria
156
what are symptoms of Epidydmo-Orchitis/Epididymitis?
Pain and swelling in one or both testicles
Fever and chills
Nausea and vomiting
Discharge from the penis
A feeling of heaviness in the affected testicle
Dysuria (painful urination)
Urgency and frequency of urination
Erythema and edema of the scrotum
157
what causes Epidydmo-Orchitis?
chlamydia
gonorrhea
mumps
UTIs
158
what investigations are needed for Epidydmo-Orchitis?
- physical examination - swelling, pain, thickening, UTI symptoms.
- Positive Prehn’s sign, Cremasteric reflex present
- Urinalysis and Urine Culture: To identify bacterial infections
- ultrasound - rule out testicular torsion
- sti test
159
how does Varicocele present?
- pain uncommon
- scrotal swelling usually left side
- 'bag of worms'
- infertility
- small testes if growth arrest
160
what investigations are required for varicocele?
- clinical examination - basis of diagnosis
- ultrasound with doppler imaging - to confirm
- semen analysis, FSH and testosterone levels to assess testes function
161
what are treatment options for varicocele?
- observe if asymptomatic
- surgery if high grade - Varicocelectomy
162
what is Testicular torsion?
- twisting of the spermatic cord within the scrotum
- occulusion of venous return and compramise of arterial suuply
- leads to ischaemia of the testis
163
when is peak age for Testicular torsion?
10-14
164
what are risk factors of Testicular torsion?
Cryptorchidism (undescended testes)
Pubertal changes (increase in testicular volume)
Testis with a horizontal lie
Previous testicular tumour
Bell-clapper deformity
Recent strenuous exercise
Previous testicular torsion
Family history of testicular torsion
165
what are symptoms of Testicular torsion?
- Sudden onset, severe unilateral testicular pain
- Lower abdominal pain
- Nausea and vomiting
166
what are examination finding of Testicular torsion?
- swollen/tender
- bell-clapper position - horizontal testes
- Absent cremasteric reflex: stroke thigh = scrotal contents move up
- negative Prehn’s sign - pain relief on elevation - not specific
- permatic cord may be palpated in early not severe
167
what are investigations for Testicular torsion?
- mainly clinical - treatment should not be delayed
- doppler ultrasound
- urinalysis - UTI
168
what is the management of Testicular torsion?
- Manual Detorsion - while waiting, temporary
- orchidopexy (fixation) and orchidectomy (removal)
169
what is hydrocele?
a fluid-filled sac surrounding a testicle that results in swelling of the scrotum
- more common in infants or over 40
- uncomfortable but not usually painful
170
what investigations are required for hydrocele?
- Transillumination of the testis
- ultrasound
- urine culture and dipstick - excludes uti
- presence of the cremasteric reflex
171
what is the management for hydrocele?
- observation - infants usually resolve
- treat underlying causes
- scrotal support eg supportive underwear
- draining - may refill
- surgery if symptomatic and severe
172
what causes hydrocele?
- uknown causes mainly
- may be infection, inflammation, trauma, tumours
- fluid retention
