Genitourinary #3 Flashcards
Prostatitis is prostate gland inflammation secondary to an ascending infection. What are the MC causes if the patient is > 35 years and < 35 years old?
> 35: E. Coli
< 35: Chlamydia and Gonorrhea
However, in children, the MCC of prostatitis is
Viral (Mumps)
Symptoms of prostatitis
Irritative voiding: dysuria, frequency, urgency
Obstructive voiding: hesitancy, dribbling, incomplete emptying, malaise, arthralgia
Acute: fever, chills, perineal pain. Lower back pain.
What symptoms does the patient usually have if the prostatitis is chronic in nature?
Recurrent UTIs or intermittent dysfunction
Fever NOT common in chronic
On physical exam for prostatitis, the prostate is usually boggy. What is the difference in prostate exam if the case is acute vs chronic
Acute: VERY tender, boggy
Chronic: contender, boggy
Explain the unique diagnostics of prostatitis
UA and urine culture: pyuria and bacteriuria in acute. Often negative in chronic so prostatic massage to increase bacterial yield. However, do NOT do massage in acute, can lead to bacteremia.
Treatment for prostatitis if the patient is > 35 years old
Fluoroquinolones or Trimethoprim-Sulfamethoxazole x 4-6 weeks
If inpatient, IV Fluoroquinolones with Aminoglycoside
If the patient is < 35 years old, then an STI is likely cause of prostatitis. Therefore the treatment is
Ceftriaxone + Doxycycline (or Azithromycin instead of Doxy)
If the prostatitis is refractory to other medications, you should do
Transurethral resection of the prostate (TURP)
MCC of epididymitis in males 14-35 years old
Chlamydia Trachomatis and Gonorrhea
In men > 35, the MCC of epididymitis is
E. Coli
Symptoms of epididymitis
Gradual onset of localized testicular pain and swelling (unilateral)
Groin, flank, or abdominal pain
May be associated with fever, chills, or irritative symptoms (dysuria, urgency, frequency)
What is seen on physical exam of a patient with epididymitis?
-Scrotal swelling and tenderness
-Positive Prehn Sign (relief of pain with scrotal elevation)
-Positive cremasteric reflex: elevation of testicle after stroking inner thigh
What is the best initial test for epididymitis and what is seen on it?
Scrotal US: enlarged epididymis and increased testicular blood flow
However, what other test for epididymis should also be done and why?
NAAT to rule out Gonorrhea and Chlamydia
Conservative Management of epididymitis
Scrotal elevation, NSAIDs, cool compresses
Medical management of epididymitis
< 35 years: Doxycycline + Ceftriaxone (or Azithromycin instead of Doxycycline)
> 35 years: Fluoroquinolones (Ciprofloxacin, Ofloxacin, Levofloxacin) (Bactrim is an alternative)
MCC of orchitis
Viral (Mumps MC, Echovirus, Rubella, Coxsackie)
Symptoms of orchitis
-Scrotal pain, swelling, and tenderness
-Scrotal erythema and tenderness
Treatment for orchitis
-Symptomatic management: NSAIDs, bed rest, scrotal support, and cool packs.
Who is at highest risk for testicular torsion (2 groups)?
Males 10-20 years of age & Neonates
Symptoms of testicular torsion
Abrupt onset of scrotal, inguinal, or lower abdominal pain (usually < 6 hours)
Nausea, vomiting
If ____ and ___ are present, suspect torsion over epididymitis
Nausea and vomiting
Physical exam findings of a patient with testicular torsion
-Swollen, tender, high-riding testicle that may have horizontal lie
-Negative Prehn Sign: no pain relief with elevation
-Negative cremasteric reflex
Although testicular torsion is a clinical diagnosis, what study is most commonly done, but what other study gives a definitive diagnosis?
Common: testicular doppler US
Definitive: Surgical exploration
Treatment for testicular torsion
Urgent detorsion and orchiopexy within 6 hours of pain onset
(Irreversible damage of ischemia after 12 hours)
What is cryptorchidism?
Testicle that has not descended into the scrotum by 4 months of age
Name 3 facts about cryptorchidism
-Most resolve spontaneously
-Most are right-sided
-Most commonly found just outside the external ring, inguinal canal, or abdomen
Risk factors for cryptorchidism
Prematurity
Low birth weight
Maternal obesity
Maternal Diabetes
Treatment for cryptorchidism
Orchiopexy as early as 4-6 months old, before 2 years old
What are four major complications of cryptorchidism
Increased risk of testicular cancer
Decreased fertility
Testicular torsion
Inguinal hernia
True or False: Testicular cancer is the MC solid tumor in young men 15-35 years old
True
Most significant risk factor for testicular cancer
Cryptorchidism
Other risk factors for testicular cancer
Caucasians
Klinefelter’s Syndrome
Hypospadias
What type of testicular cancer type is the MC?
Germinal cell tumors (Nonseminomas and Seminomas)
Nonseminomas, the MC type of testicular cancer, is associated with what 2 labs and….
-Increased serum alpha-fetoprotein and beta-HcG
Resistance to radiation
What are the 4 S’s of Seminomas?
-Simple (lacks tumor marker alpha-fetoprotein)
-Sensitive (sensitive to radiation)
-Slower growing
-Stepwise spread
Symptoms of testicular cancer
-Painless testicular mass (MC)
-May have dull pain or testicular fullness
-Firm, hard, fixed mass that does not transilluminate
Initial test of choice for testicular cancer
Scrotal US
On scrotal US, what is seen with a nonseminoma?
Cystic, non homogenous mass
On scrotal US, what is seen with a seminoma?
Hypoechoic mass
What tumor markers are present in nonseminomas?
Increased alpha-fetoprotein and beta-hCG
For staging of testicular cancer, what diagnostic is done
CT of the abdomen, pelvis, and chest
What is the prognosis usually like with testicular cancer?
Excellent (5 year survival rate > 95%)
If the testicular cancer is low-grade seminoma vs high-grade seminoma, what’s the treatment?
Low grade: radical orchiectomy. May need radiation
High grade: chemotherapy followed by orchiectomy and radiation
What is a hydrocele?
Serous fluid collection within the layers of the tunica vaginalis of the scrotum
A hydrocele is the MCC of
painless scrotal swelling
MCC of a hydrocele
Idiopathic
Symptoms of a hydrocele
Painless scrotal swelling (may increase throughout the day)
Dull ache or heavy sensation with increasing size
Initial test of choice for a hydrocele
Testicular US
What is unique about a hydrocele on physical exam?
It transilluminates
Treatment for a hydrocele
watchful waiting (often resolves within first 12 months of life)
Surgical if persists beyond 1 year in age or communicating (link to peritoneum) to reduce risk of hernia
What is a spermatocele?
Epididymal cyst that contains sperm
Physical exam findings of a patient with a spermatocele
Round, soft mass at the head of the epididymis that is superior, posterior, and separate from the testes
Freely movable and transilluminates
Even though scrotal US is done for a spermatocele, what is the treatment?
No treatment usually necessary, but surgical excision if chronic pain (rare)
