GU

Question 1

Epispadias

Answer 1

Embryonic malformation due to malposition of the genital tubercle that causes incomplete urethral tubularization on the DORSAL penis when associated with bladder exstrophy, although in attenuated form

Question 2

Epispadias Treatment

Answer 2

Young patients: Operative closure
With urethroplasty and reconstruction of genitalia if indicated
In patients with long-term indwelling catheters: Insertion of a suprapubic indwelling catheter (reconstructive treatment is usually not necessary)

Question 3

Complication of Epispadias

Answer 3

Males: ED and infertility
Females: Frequent and painful urination, recurrent UTIs

Question 4

Hypospadias

Answer 4

Common congenital malformation with incorrect position of the external urethral meatus due to failure of urethral folds and foreskin to fuse on VENTRAL penis

Question 5

Signs and symptoms of Hypospadias

Answer 5

Abnormal foreskins (dorsal hood)
Ventral penile curvature
Two meatal openings
Proximal hypospadias are assoc. With bifid scrotum and penoscrotal transposition
Assoc. With:
-Inguinal hernias
-Cryptorchidism
-Chordee (abnormal ventral curvature)

Question 6

Hypospadias Treatment

Answer 6

Mild cases do NOT necessarily require surgery
Significant displacement or symptomatic micturition warrants surgical repair
Reconstruction of urethra, penis, scrotum at 6 months of age: urethroplasty and arthroplasty
Severe Cases: Require two-stage repair with correction of penile curvature first followed by urethroplasty at least 6 months later

Question 7

Complications of Hypospadias

Answer 7

Urethral Fistula, Meatal stenosis( Narrowing of ventral meatus causes thin urinary stream and straining with urination ), Urethral diverticulum( Distinct outpouching of the urethral mucosa that most frequently leads to dribbling, dysuria, and dyspareunia), UTIs

CIRCUMCISION CONTRAINDICATED

Question 8

Phimosis

Answer 8

Tight foreskin that cannot be completely retracted over the glans penis mostly congenital but can be caused by trauma (circumsicion), or post-infectious complication following balanoposthitis

Question 9

Signs and Symptoms of Phimosis

Answer 9

Relative: Difficulty in retracting the foreskin
Full: Inability to retract the foreskin
Painful erection and/or dyspareunia

Question 10

Phimosis Treatment

Answer 10

Conservative: Reassurance, topical corticosteroid, stretching exercise
Surgical: Vertical incision (of constricting bands), or circumcision if conservative management fails

Question 11

Phimosis Complication

Answer 11

Foreskin tear with possible hemorrhage, paraphimosis

Question 12

Paraphimosis

Answer 12

Retracted foreskin in an uncircumcised male that cannot be returned to its original position
UROLOGICAL EMERGENCY

Question 13

Paraphimosis Treatment

Answer 13

Conservative: Manual reduction with adequate pain control (topical anesthesia)
Surgical: Dorsal slit reduction surgery (incision of the constricting band) if manual reduction fails or penile ischemia occurs
Circumcision is LAST RESORT

Question 14

Paraphimosis Complications

Answer 14

Penile Necorsis

Question 15

Peyronie’s Disease

Answer 15

Fibroproliferative disorder that affects the tunica albuginea of the penis, causing abnormal curvature

Question 16

Pathophysiology of Peyronie’s Disease

Answer 16

Repeated penile microtrauma during sexual course or athletic activity followed by abnormal wound healing: Fibrous plaque formation

Question 17

Peyronie’s Disease Classification

Answer 17

Active phase: Acute or inflammatory phase; Characterized by progressive penile deformity and painful erection
Stable phase: Chronic phase, Characterized by lack of progression of penile deformity and pain

Question 18

Signs and Symptoms of Peyronie’s Disease Classification

Answer 18

Penile pain, penile nodules/indurations on affected area, ED and can be associated with psychological conditions (anxiety, depression)

Question 19

Peyronie’s Disease Treatment

Answer 19

Active phase: oral NSAIDs or oral pentoxifylline for 3 months
-No symptomatic improvement:
Intralesional collagenase injections
-Symptomatic improvement: Observative
or continuation of oral pentoxifylline for
another 6 months
Stable phase: Depends
-Observation: For patients with mild penile
curvature (<30 angle) and no ED
- Intralesional Collagenase injections:
Patients with penile curvature (>30
angle) and/or ED
- Surgical repair: patients unresponsive to
treatment, with severe penile deformity,
and/or with extensive calcifications

Question 20

Erectile Dysfunction

Answer 20

Condition characterized by a persistent or recurrent inability to acquire or maintain an erection of sufficient rigidity or duration for sexual intercourse due to substances/medications, organic, and/or psychogenic causes

Question 21

ED Acronym for Etiology

Answer 21

P.sycological E.ndocrine N.eurogenic I.nsuffecient blood flow, S.ubstance use

Question 22

ED Dx

Answer 22

International Index of ED (IIEF), PMHx, Psychosocial Hx, Hypogonadism, abnormal pulses, CREMASTERIC REFLEX, anal tone, lower extremity sensation
Endocrine lab analysis: Testosterone (L), SHBG (H), Prolactin (H), LH (L), FSH (L)
Nocturnal penile tumescence measurement
Phallograohy: night time measurement
-Absence or nocturnal erections suggests and organic etiology (neurogenic, vascular)
-Normal test suggests a psychogenic cause

Question 23

ED Treatment

Answer 23

(first-line therapy)
Oral tadalafil, sildenafil, vardenafil
MOA: Inhibition of the phosphodiesterase type 5 enzyme and increase in cGMP results in prolonged smooth muscle relaxation -> increased intracaernosal NO-induced vasodilation and blood flow in the corpora cavernosa -> increase in penis size during erection
Most effective in ED d.t cardiovascular
Contraindicated in pt’s taking nitrates d/t high risk of profound hypotension
Tx: second line cont.
Penile Posthesis: Surgical implantationof an inflatable implant (two hollow cylinders) into the corpora cavernosa, and a saline reservoir and pump into scrotum
Indications:
LAST RESORT
Peyronie disease
Testosterone replacement if low serum levels (hypogonadism)
Psychotherapy, education, exercise, and couples counseling for patients with psychogenic factors contributing to ED

Question 24

Hydrocele

Answer 24

Painless accumulation of fluid in a sac around one or both testicles which derives from the tunica vaginalis, a tissue covering the testes

Question 25

Signs and Symptoms of Hydrocele

Answer 25

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
Normal spermatic cord and inguinal ring present

Question 26

Hydrocele diagnostic

Answer 26

U/S: hypoechoic fluid
MUST be differentiated from an inguinal hernia

Question 27

Treatment for Hydrocele

Answer 27

Congenital hydrocele usually resolves spontaneously in 6 months of birth
Surgery if it does not resolves by age 1, excessive discomfort, underlying pathology, testicle is not palpable or concern for infertility

Question 28

Hydrolectomy

Answer 28

Performed to correct a hydrocele and prevent its recurrence. Indicated for the reduction of large/thick walled hydroceles. Involves incision and complete/partial resection of the hydrocele sac (tunica vaginalis)

Question 29

Percutaneous aspiration

Answer 29

Aspirate fluid from hydrocele combined with instillation of sclerosing promoter into sac

Question 30

Spermatocele

Answer 30

Painless and freely moveable cystic mass containing sperm, most are <1cm in size; occur superior, posterior and SEPARATE from the testicle

Question 31

Spermatocele Dx

Answer 31

Scrotal U/S

Question 32

Treatment of spermatocele

Answer 32

IF painful can surgically remove