Male Genitalia

Question 1

Hypospadias (MC)

Epispadies (ventral surface)

Answer 1

Increased risk for urinary flow obstruction and UTIs

Surgical repair

Question 2

10X RISK FOR TESTICULAR MALIGNANCY

Usually unilateral (can be retractable)

Because they’re temp sensitive, might not develop properly

Answer 2

Cryptorchidism

tx = orchiopexy

Question 3

1. Inflammation of glans
2. Foreskin can’t retract back (stuck past glans)
3. Foreskin stuck behind glans -> creates strictures impairing supply

Answer 3

1. Balanitis
2. phimosis
3. paraphimosis

Question 4

Usually comp. of untreated urethritis/prostatitis

Testicular pain (not groin pain)

Answer 4

Epididymitis

young men = chlam (abx)

Old men = uropathogens (abx for gram neg rods)

Question 5

Progression from epididymitis

More serious -> sterility

Answer 5

orchitis

Question 6

Prostatitis…

1. Acute?
2. Chronic?
3. Pathogens?
4. SSx/tx?

Answer 6

1. Tender/enlarged (ATE)
2. Boggy/Soft (CBS)
3. E Coli/Proteus mirabilis
4. Ssx = pain/frequency/urgency/low grade fever

Abx = 4 wks

Question 7

Painless unilateral swelling (anterior/superior to testis)

Heavy-feeling scrotum

DOES NOT INVOLVE THE INGUINAL CANAL

Answer 7

Hydrocele - collection of serous fluid in tunica vaginalis

In adults, evaluate for cause! (infxn, tumor, trauma)

ALWAYS DO AN US!

(tx underlying cause)

Question 8

More common L side, what if on R side?

varicosity of testicular venous plexus

(painless to dull discomfort)

Answer 8

Varicocele

if on R side, must evaluate for venous occlusion (tumor)

Question 9

Infarction begins ~6 hours… after 12 hours, 25% of viability

Absent cremasteric reflex

Doppler US shows lack of blood supply

Answer 9

Testicular torsion

manual detorsion of testicle OR removal of nonviable testicle

Question 10

Nodules grow in CENTRAL prostate (vs prostate CA which begins in prostate periphery)

Gradually compresses the urethra

Answer 10

BPH

Question 11

Frequency and urgency increased (esp at night)

Decreased urinary flow strength

Answer 11

BPH

Question 12

Measures residual volume after voiding

Answer 12

Post Void Residual US

residual volume in BPH will be increased

Question 13

Post void residue US…

Have the pt urinate, then measure what remains in the bladder

PVR shoudl be less than?

Answer 13

50 mL

Question 14

Typical penile CA pt?

Answer 14

uncircumcised males > 40 (more common outside US)

(exposure to HPV is a risk; also poor hygiene/no circumcision)

Tx w / excision/radiation

Question 15

1. Testicular CA most common in whom?

2. Growth rate for testicular CA?

Answer 15

1. 25-45 y/o men
2. Rapid growth (doubles monthly)/rapid spread

ALL TESTICULAR MASSES ARE TREATED AS CANCER UNTIL PROVEN OTHERWISE

Question 16

Tests/Tx for testicular ca?

Answer 16

US scrotum and CXR for mets

Serum markers = HCG, AFP, LDH

Tx = pt education (self exams); for mass, immediate referall (w/in 72 hours); orchiectomy

Question 17

Testis lymph drainage?

Scrotal lymph drainage?

Answer 17

Testis -> para-aortic nodes (mid-abd)

Scrotum -> inguinal nodes

Question 18

Most common CA in males?

3rd CA-related deaths?

Answer 18

Prostate CA

Question 19

Asymptomatic to BPH-like symptoms

DRE MAY detect prostate nodule

Tranrectal US detects nodules

PSA > 4 ng/ml (not always a correlate)

Answer 19

Prostate CA

(ALP may be elevaed, indicating metz to SPINAL column)

PROSTAE CA BEGINS IN PERIPHERY