Male Genital Problems Flashcards
US findings in Scrotal Edema
- easily compressible thickened scrotal wall
- increased peritestitcular blood flow
- some cases, reactive hydrocele
Treatment of scrotal edema
- scrotal elevation
- rest
- NSAIDs
Remarks on Fournier’s gangrene
- a polymicrobial, synergistic, infective necrotizing fasciitis of the perineal, genital or perianal anatomy
- begins as a benign infection that quickly becomes virulent and results in microthrombosis of the small subcutaneous vessels, leading to the development of gangrene of the overlying skin
- Diabetes and alcohol abuse are disproportionately affected with Fournier’s gangrene
Bedside US findings of Fournier’s Gangrene
- scrotal wall thickening
- dirty shadowing (suggesting air in the tissues)
Treatment of Fournier’s
- aggressive fluid resuscitation
- antibiotic coverage for gram positive, gram negative and anaerobes
- urgent urologic consultation
Remarks on Balanoposthitis
- inflammation of the glans and the foreskin
- primarily caused by inadequate hygiene or external irritation with subsequent colonization with Candida, staph, and strep
- can be the sole presenting sign of diabetes
Treatment of Balanoposthitis
- cleansing the area with saline
- ensuring adequate dryness after cleaning
- application of antifungal creams
- treatment with an oral azole in severe cases
- circumcision for recurrent cases
for bacterial infection: clindamycin 300mg TID x 7 days or metronidazole 500mg BID x 7 days
Physical examination finding of penile fracture
- acutely swollen but flaccid, discolored and tender
This is a urologic emergency characterized by persistent, painful, pathologic erection in which both corpora cavernosa are engorged with stagnant blood
Priapism
Medications associated with priapism
- Intracavernosal injection of vasoactive substances for impotence (papaverine, prostaglandin E)
- oral agents for hypertension (hydralazine, prazosin, calcium channel blockers)
- neruoleptic medications ( chlorpromazine, trazodone, thioridazine)
Laboratory test recommended to differentiate nonischemic from ischemic priapism
Blood gas analysis of the first corporal aspirate
Two classifications of priapism
Ischemic (veno-oclussive, low flow)
Non-ischemic (arterial, high-flow)
Peak incidence of Testicular Tortion
Neonates and adolescents
Risk factors for Testicular tortion
Undescended testicle, rapid increase in testicular size, failure of prior orchiopexy
Remarks on Cremasteric Reflex and testicular tortion
- Testicular tortion less likely if cremasteric reflex is present
Diagnostic imaging of choice for tortion
Doppler US
Doppler US findings for “positive” for testicular tortion and “negative” for tortion
POSITIVE: ipsilateral intratesticular blood flow is absent or clearly reduced
NEGATIVE: flow is normal or increased
Treatment of Testicular Torsion
Detortion: typically done in a manner similar to opening a book – examiner at the patient’s feet and right testis will be rotated in a counterclockwise fashion while left testis in a clockwise fashion
Treatment for torsion of an appendage (appendix testis, appendix epididymis, paradidymis, vas aberrans)
Supportive, and is usually self-limiting
Treatment for epididymitis most likely caused by STI (Chlamydia or Gonorrhea)
Ceftriaxone 250mg IM single dose plus doxycycline 100mg PO BID x10 d
Treatment for epididymitis most likely caused by STI (Chlamydia or Gonorrhea) or enteric organisms (men who practice insertive anal sex)
Ceftriaxone 250mg IM single dose plus doxycycline 100mg PO BID x10 d PLUS
Levofloxacin 500mg PO x 10 days
Treatment of Acute Prostatitis
Uncomplicated: Floroquinolones ( Ciprofloxacin )
Sexually active: Ceftriaxone 250mg IM as a single dose plus doxycycline 100mg PO BID x 10d
