Lecture 36 - Clinical Urology: Abnormalities of the Male Parts

Question 1

_______ urinary symptoms are more due to stones, tumors, and/or infections. These symptoms include changes in Frequency, feelings of Urgency, Nocturia, Incontinence, and Dysuria.

_______ symptoms are more due to enlarged prostate.

Gross _______ is typically caused by stones or bladder/kidney tumors, but it can also be caused by UTIs. Microscopic, on the other hand, may simply be a result of _______.

Answer 1

Irritative

Obstructive

Hematuria

HTN

Question 2

During a male scrotal exam, a poorly developed scrotal sac may be indicative of ________.

Answer 2

Cryptorchidism

Question 3

The spermatic cord is susceptible to Varicocele, which is a dilated vein. Which side is it more common on? Other than causing some pain, what issues can arise?

Answer 3

It is more common on the Left.

Issues with blood flow through the vein can cause problems with temperature regulation. This can affect fertility (remember sperm require close temp regulation, needing to be a couple degrees BELOW body temp for viability).

Question 4

_______ is the term that describes foreskin that is tight and cannot be retracted to expose the glans of the penis.. _______ describes when the foreskin is pulled back, exposing the glans, but cannot be reduced (essentially acting as a tourniquet around the subcoronal aspect of the penis).

Which is a surgical emergency?

Answer 4

Phimosis

Paraphimosis

Paraphimosis, obviously.

Question 5

Genital warts are caused by HPV, most commonly strains ____ and ____. There is no cure, and the patient will always be a carrier, even without active lesions. Treatment can be surgical removal, cryotherapy, or topical including imiquimod, ______, podofilox, or _______ acid.

Answer 5

6 and 11

Podophyllin

Trichloroacetic acid

Question 6

Chlamydia in males is usually associated with dysuria, and it can be hard to culture. Treatment is typically a ____days course of _______ or 1gm of ________.

Answer 6

7 day

Doxycycline 1mg

Azithromycin

Question 7

Gonorrhea in males is associated with a _____ (color) discharge and is treated with an IM injection of _____mg of _______.

Answer 7

White

250mg

Ceftriaxone

Question 8

Trichomonas in males is treated with ______ 2gm PO.

Answer 8

Metronidazole

Question 9

Syphillis presents with painless _______ with heaped up edges and nontender ________. It is treated with either ______ or ______ for 14 days.

Answer 9

Chancres

Lymphadenopathy

Penicillin or Doxycycline

Question 10

Lymphogranulum Venereum presents with painless _____ followed by tender inguinal ________. It is caused by ______ ______ serotypes ___, ___, and ___. It is treated with ______ for ____days.

Answer 10

Papules

Inguinal Lymphadenopathy

Chlamydia trachomatis serotypes L1, L2, and L3.

Doxycycline

21 days

Question 11

H. ducreyi is the causative agent for _______, which are painful ulcers that do NOT have heaped up edges. It is treated with either 250mg IM injection of _______ or 1gm ______.

Answer 11

Chancroid

Ceftriaxone

Azithromycin

Question 12

Penile cancers typically arise around the _____ of the penis and are most often caused by HPV _____ and _____.

Answer 12

Glans

HPV 16 and 18

Question 13

Peyronie’s disease is caused by microtrauma to the _____ _____ (sheath around the erectile tissue), and it results in a fibrous plaque that causes a bending of the erect penis.

Answer 13

Tunica albuginea

Question 14

Priapism is more common in individuals with _____ _____ disease, which should make sense bc the blood in these patients, especially in low O2 states, has issues flowing.

It needs to be determined if the Priapism is caused by Low flow or High flow. Which is more of an emergency?

Answer 14

Sickle Cell disease

Low flow is more of an emergency, bc it suggests there’s been trauma or something disrupting blood flow to the penis. High flow suggests there’s blood flowing freely to the penis; it’s just having a problem coming back out.

Question 15

Penile fracture refers to a tear in the _____ ______.

Answer 15

Tunica albuginea

Question 16

Prehn’s sign is positive if ______ the testicle relieves pain.

Which disease states does it help to differentiate between?

Answer 16

Lifting

It helps distinguish between Epidydimitis and Testicular Torsion –> positive Prehn’s sign indicates Epidydimitis, as lifting the testicle will elicit GREATER pain in Torsion.

Question 17

Testicular torsion can be either Intravaginal or Extravaginal. Extravaginal means torsion of the entire spermatic cord, including the tunica vaginalis.

Which is more common in newborns and which is more common in teenagers?

Answer 17

Intravaginal –> teenagers

Extravaginal –> Newborns

Question 18

_______ refers to application of sutures to a testicle after torsion is corrected to prevent subsequent torsion.

Answer 18

Orchipexy

Question 19

Fournier’s Gangrene is a _____ faciitis of the genetalia and perineum that involves mainly ________ tissue. The _____ are usually NOT involved.

Most often the bacteria that causes this is ___ _____, but the flora are typically mixed, not just one type.

Answer 19

Necrotizing faciitis

Subcutaneous tissue

Testes

E. coli

Question 20

Treatment for Fournier’s Gangrene involves extensive debridement of the wound and reassessment after _____-_____hrs. Wound care and _______ _______ therapy are used as well.

Answer 20

24-48hrs

Hyperbaric oxygen therapy

Question 21

For male to female transgender patients, the _____ remains after bottom surgery, so screening needs to continue in adult life. It can be done vaginally instead of rectally.

For female to male trans patients, there’s a high rate of ______ strictures and fistulas after bottom surgery.

Answer 21

Prostate

Urethral