Male Genitourinary Disorders Flashcards
Cryptorchidism
undescended testis
Rectractile testis
testis out of scrotum but can be brought down into scrotum and they will stay
Gliding testis
testis is out of the scrotum, when moved into scrotum they return when released
Ectopic testis
lying outside the normal path of descent
Ascended testis
has fully descended but has reascended (outside scrotum)
Trapped testis
dislocated after herniorrhaphy
Development of testes
occurs during 7th month in upper growing of the abdomen
Reasons of failure to descend
mechanical
secondary to hormonal, chromosomal and anatomic disorders
Most common genitourinary disorder in boys
cryptorchidism
At risk for cryptorchidism
preterm infants low birth weight infants first born toxemia hypospadias subluxation of hip winter conception down's maternal age 35
Self correction of cryptochidism
majority will descend by 6 months
if >6 months the rate of spont. descend rare
Most often affected teste with cryptochidism
left (can be bilateral)
Most common location of undescended testes
- just outside external ring
- inguinal canal
- abdomen
Position for exam of testis
cross-legged
frog-legged
squat
standing
Appearance of scrotal rugae with cryptochidism
less full
Reason for early dx of cryptochidism
preserve fertility and detect malignancy
Risk of observation >1 year
delays tx
lowers rate of success
affects sperm
Possible complications of undescended testicles
poor development infertility malignancy (repair does not decrease risk) trauma torsion (50%) inguinal hernia
Testicular Torsion
pain and swelling
EMERGENCY
<6 years old with testicular pain
almost always torsion
7-12 years old with testicular pain
50% torsion
19-24 years old with testicular pain
80% epididymitis
most common cause of testicular loss
torsion
bell-clapper
used to describe torsion
testes swing and can twist at spermatic cords
Pain manifestation with torsion
acute onset
abnormal and should rule out abruption or torsion
testicular pain lasting >1 hr following trauma
General exam with torsion
swelling, red, warm, TENDER
transillumination of testes
reveals a solid mass
cremasteric reflex
pinch the skin of the upper thigh and watch for testicular reflex.
absent in torsion
Prehn Sign
elevate the scrotal contents, if pain relieved most likely epididymitis. If pain persists, torsion.
torsion of a testicular appendage
tenderness limed to upper pole
Blue dot sign
small bluish discoloration visible through the skin of the testes indicating torsion
Torsion signs
absence of cremaster reflex abnormal positioning of testes absent prehn's sign absent dysuria absent erythema neg UA
Epididymitis signs
positive cremaster reflex normal position of testes prehn's sign present can have dysuria erythema present pos UA
If torsion suspected
refer immediately
CBC with torsion
leukocytosis may be present with this and with epididymitis as well
doppler ultrasonography
perform if unsure of diagnosis
assesses blood flow of testicular artery
can see torsion and hydrocele
Nuclear Scintigraphy
takes 1-2 hours
can have false negative
Orchiopexy
surgical procedure for torsion
if surgery put up for >12 hours could require removal.
Testicular salvage rate with torsion
within 3 hours 100%
6 hours 92%
6-12 hours 62%
12-24 hours 38%
Trauma to testes
can lead to torsion, but more commonly scrotal hematoma and ecchymosis
pain caused by compression against pelvic bones
hydrocele
common cause of scrotal swelling
Cause of hydrocele in infants
caused by peritoneal fluids extending through a patent processus vaginalis
Cause of hydrocele in older kids
result from inflammatory processes, torsion, trauma or tumors
types of hydroceles
communicating
noncommunicating
communicating hydrocele
failure of the processus vaginalis to close during development and fluid is peritoneal (often hernia)
may increase in size during the day or with valsalva
noncommunicating hydrocele
fluid only in scrotum
fluid comes from the mesothelial lining of the tunica vaginalis
is not reducible and does not change size
To confirm hydrocele
transillumination
Tx of hydrocele
surgery for those persisting beyond one year
Scrotal masses in adult been best described
by anatomic origin
Mass in tunica vaginalis testis
hydrocele
hematocele
Mass in processus vaginalis testis
inguinal hernia
hydrocele
Mass in pampiniform plexus
varicocele
Mass in epididymis
epididymitis
spermatocele
Test of choice for evaluation of mass
color doppler untrasonography
Swelling of testis tender
torsion
orchitis
Swelling of testis nontender
hydrocele
carcinoma
Swelling of spermatic cord
hydrocele- smooth, transilluminates
varicocele- bag of worms
inguinal hernia- swelling into ingiunal ring
Irregular swelling of skin
rule out carcinoma
welling of skin that is smooth, cystic
sebaceous cyst
indirect inguinal hernia
follow the path of processus vaginalis thru the internal inguinal ring and into scrotum
can hernia’s be reduced
yes unless incarcerated
swelling in hernia vs hydrocele
will extend up spermatic cord into ring with hernia
will not extend up spermatic cord
a new hydrocele or one that hemorrhages may signal
cancer
varicocele
most common scrotal swelling in adult men
dilation of veins of pampiniform plexus
may ache or “drag”
more common on left side
Grade 1 varicocele
observed only with valsalva
Grade 2 varicocele
palpable but not visible
Grade 3 varicocele
visible
Refer varicocele if
if there is hypertrophy of testicle
if symptomatic
sudden left-sided in older adult (renal tumor)
sudden right-sided in older adult (vena cava obstruction)
Young men with varicocele and normal semen analyses
do analysis every 1-2 years
Causes of dysuria
infections malformations neoplasms inflammatory conditions psychogenic
Infections with dysuria
pyelo cystitis prostatitis urethritis orchitis
Malformations with dysuria
BPH
urethral strictures
Neoplams with dysuria
renal cell tumor
bladder or prostate cancers
Inflammatory with dysuria
spondyloarthropathies
drug S/E
pain after voiding
infection
Physical exam for dysuria
abdominal
costovertebral angle (pyelo)
penile (d/c)
DRE
Positive nitrate with UA
suggests UTI
Acute epididymitis
lasts <6 weeks
Causes of epididymitis
Chlamydia and gonorrhea in those <35
UTI in over 35
Evaluation of epididymitis
Gram stain of urethral secretions (perferred and highly sensitive)
Leukocye esterase
Tx of Epididymitis
Ceftriaxone 250 IM once
plus
Doxy 100 BID x 10 days
Adjunct therapy with epididymitis
bed rest
scrotal elevation
analgesics
Goal of tx with epididymitis
cure
improve symptoms
decrease transmission
decrease long term effects
Tx for acute epididymitis most likely caused by enteric organisms
Levofloxacin 500mg PO daily x 10 days
Type I prostatitis
acute bacterial prostatitis (UTI with systemic involvment)
Abx therapy for 2-4 weeks
Type II prostatitis
chronic bacteria prostatitis with or without symptoms
perineal, inguinal or suprapubic pain may be present with erectile dysfx
Fluroquinolones
TMP-Sulfa (Bactrum)
Type III prostatitis
chronic abacterial prostatitis
(Pelvic pain syndrome either inflammatory or noninflammatory)
pain with ejaculation
hesitancy
tx with muscle relaxants, NSAIDS, fluroquinolones
Type IV prostatitis
asymptomatic inflammatory prostatitis postvoid dribbling lumbar pain, penile and urethral pain must take biopsy Abx, NSAIDS
Chlamydia (c. trachomatis)
most common reportable STD among adolescents
Incubation period of chlamydia
7-21 days
Clinical manifestations of chlamydia
urethritis
epidymitis
Reiters syndrome
mucopurulent, mucoid or clear d/c
Reiters syndrome
post-inflammatory autoimmune disease
Dx chlamydia
culture
nucleic acid amplification
serology
Tx chlamydia
Azithromycin 1g once
plus
doxy 100mg BID x 7 days
No sex within 7 days
Evaluated partners for chlamydia
if sex with someone 60 days prior to onset of symptoms
Gonorrhea (Neisseria) risk factors
south black hispanic native americans ages 15-29 multiple sex partners lower socioeconomic status
transmission of gonorrhea
male-to-female at 50-70%/intercourse episode
female-to-male at 20%/episode but >4 60-80%
pharyngeal
increased risk for HIV
common indicator of gonorrhea in men
urethritis
incubation period for gonorrhea
7-14 days
inflammation of liver capsule with right upper quadrant pain from gonorrhea
perihepatitis (Fitx-Hugh)
Evaluation of gonorrhea
culture
oxidase pos gram-neg diplococcus
Tx for gonorrhea
Ceftriaxone 250 IM once plus azithromycin 1g once or doxy
Avoid in pregnancy for tx gonorrhea
quinolones
tetracyclines
Syphilis
Treponema Pallidum
incubation of syphilis
10-90 days
early manifestations of syphilis
involve skin and mucosal
late manifestations of syphilis
affect organ system and neurosphilis
syphilis most infective
during primary and secondary stages
syphilis spread
sexually and vertical (pregnancy)
view of syphilis under microscope
cork-screw shaped motile
lesions with syphilis
chancre
secondary and primary syphilis can overlap
clinical finding with secondary syphilis
rash on palmes and soles macular papular squamous pustular
other clinical manifestations in syphilis
lymphadenopathy malaise mucous patches condylomata lata liver and kidney involvment alopecia
Tertiary (late) syphilis
within 1-20 years but very rare and typically involves cardiovascular
early dx of syphilis
darkfield microscopy
other dx of syphilis
nontreponemal (VDRL, RPR, TRUST)
treponemal (TP-PA) can be pos for life
Tx of latent syphilis
PCN G 2.4 IM
if PCN allergic to doxy or tetracycline 500 QID x14 days
Tx of teriary syphilis
PCN G 2.4 IM x 3 doses
normal reaction to tx with PCN G
Jarisch-herxheimer reaction
F/U syphilis
6 months and 1 year for primary and secondary
12 and 24 montsh for latent
