GU Flashcards
Clinical presentation of epididymitis
Gradual onset pain in flank and suprapubic area progressing to scrotum
Fevers
LUTS
Swollen tender epididymis that may progress to whole testicle if also orchitis
Prehn sign is relief w elevation of scrotum
Cremasteric reflex preserved
Treatment of epididymitis
<35 treat gonorrhea chlamydia
>35 treat w fluoroquinolone
Prepubertal give septra
What is the deformity that increases your risk of testicular torsion
Tunica vaginalis attaches higher up on spermatic cord leaving some redundant cord and mobile testicle
Clinical presentation of testicular torsion
Severe abrupt onset unilateral testicular pain
Loss of cremasteric reflex
Tender firm swollen testicle
Horizontal lie of contralateral testicle
Management of testicular torsion
Stat urology
Analgesia
Don’t delay consult for imaging
Attempt manual detorsion open book (medial to lateral) if that doesn’t work then do other way
Risk factors for Fournier’s gangrene
Diabetes, immunesuppression, obesity, malignancy, chronic steroid use, chronic alcoholism
Bugs most commonly involved in fourniers
E. coli, bacteroides fragilis
Treatment of Fournier
Aggressive supportive care
Broad spectrum antibiotics: mero vanco clinda
Emergent surgical debridement
Most common cause of Balanitis and balanoposthitis
Candida
Clinical presentation of balanitis
Pain, tenderness, itching of glans +- foreskin
Glans is erythematous, can be ulcerated with scaly lesion
Foreskin can be adherent or have purulent discharge when retracted
Treatment of balanitis
Topical antifungal x 1-3 weeks
Fluconazole 150 mg po x 1
Abx is cellulitis
When is phimosis considered pathological
With difficulty urinating or with sexual dysfunction
Treatment of phimosis
Daily cleaning of foreskin
Gentle retraction
Topical steroids
Immediate intervention if outlet obstruction or vascular compromise (dilation of the meatus with forceps)
Treatment of paraphimosis
Analgesia, consider dorsal penile block or procedural sedation
Reduce with firm circumferential pressure x 5-10 mins
Can use traction with forceps at 3 and 9 o’clock if no luck
Two types of priapism
Ischemic and non ischemic
Risk factors for ischemic priapism
Sickle cell disease
Malignancy (leukaemia, multiple myeloma)
Substance abuse (cocaine)
Sildenafil, tadalafil, CCBs, prazosin, trazodone, risperidone
Penile injections for erectile dysfunction (vasodilation agent eg phentolamine, prostaglandin)
Blood test to consider if cause of priapism unclear
CBC to screen for heme malignancy
Management of ischemic priapism
Analgesia
Trial SQ terbutaline and PO pseudoephedrine
Aspiration of blood from corpus cavernosum w butterfly needle
Injection of vasoconstrictor: phenylephrine bilateral corpus cavernosum
Clinical presentation of high flow or non ischemic priapism
Semierect and painless penis
Perineal compression with thumb causes detumescence
What is ruptured in penile fracture
Tunica albuginea surrounding corpus cavernosum
What should you consider in new r sided varicocele? And left?
Consider vascular compression – IVC if right sided of RCC causing L renal vein compression if left side
Consider CT is suspect vascular compromise
What is the blue dot sign in transillumination pathognomonic for
Appendageal torsion of the testicle.
Painful but no effect on fertility or viability
Management of appendageal torsion
Rest, analgesia, scrotal elevation
Usually resolves
Surgical in severe cases of pain
When should you consult surgery for an inguinal Hernia in the ER
Strangulated, incarcerated, causing obstruction
How to reduce an incarcerated Hernia in the ER
Trendelenberg, sedation, gentle pressure
Causes of acute urinary retention
Obstruction (penile, urethral, prostate) Neurogenic causes(diabetes, MS, Cauda equina) Meds (TCA, anticholinergic, antihistamine, alpha adrenergic)
