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Clin Med- Renal/GU > Male GU Disorders > Flashcards

Male GU Disorders Flashcards

1
Q

What is a hydrocele?

A

Abnormal, painless collection of fluid in tunica vaginalis that leads to swelling of scrotum

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2
Q

What are 2 types of hydrocele

A

communicating

noncommunicating

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3
Q

What is communicating hydrocele

A

Congenital, most common in children <12 yo

Secondary to a patent process vaginalis

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4
Q

What is the noncommunicating hydrocele?

A

Acquired
No defects
Imbalance in rates of fluid secretion and reabsorption w/in a closed tunical vaginalis

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5
Q

Epidemiology of hydrocele

A

Incidence: unknown
Prevalence: 3.3% of infertile men aged 20-58 yo

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6
Q

Epidemiology of communicating hydrocele

A

Congenital patent processus vaginalis which allows peritoneal fluid to travel into the tunica vaginalis (most common cause in children)

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7
Q

Epidemiology of noncommunicating hydrocele

A 
Imbalance of fluid secretion/absorption of tunica vaginalis (most common cause in adults)
Iatrogenic (prior surgery)
Acute epididymitis
Systemic viral disease (ex. Mumps)
Malignancy
Torsion
Trauma
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8
Q

Signs and symptoms of hydrocele

A

Painless swelling in groin or scrotum
May describe heaviness in scrotum
May increase in size throughout the day

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9
Q

What would you find on physical exam for hydrocele

A

Swelling of the scrotum
Communicating: fluctuant that can be manually reduced
Noncommunicating: fluctuant that cannot be manually reduced
Transillumination (not diagnostic)
Fluid filled hydrocele will glow a soft red color

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10
Q

How would you make a diagnosis of hydrocele?

A

Clinical based on examination

Ultrasound may be needed to confirm if palpation and transillumination are inconclusive

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11
Q

What are 2 complications of hydrocele

A

Large and tense hydroceles may result in testicular damage affecting spermatogenesis
Large abdominoscrotal hydrocele swelling may impact surrounding structures

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12
Q

Treatment of hydrocele in children

A

Watchful waiting
in new non-communicating hydroceles in children >1yo
In communicating hydroceles, spontaneous resolution can occur (patent processus vaginalis typically close w/in first 12-24 mo)
Surgery

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13
Q

Treatment of hydrocele in adults

A

Surgery
Open hydrocelectomy, endoscopic approach- low recurrence rate
Aspiration and sclerotherapy- high recurrence rate

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14
Q

what is Varicocele

A

Dilated vein of spermatic cord

Most common correctable cause of infertility in men

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15
Q

Epidemiology of varicocele

A

6% at age 10y
13% at age 13y
15% adolescents
20% adults

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16
Q

Etiology and patho for varicocele

A

Etiology:
Valve insufficiency
Pathogenesis:
Increased pressure in veins d/t valve insufficiency or from a mass

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17
Q

2 complications for varicocele

A

Infertility (changes in sperm quantity and quality)

Testicular atrophy or hypotrophy

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18
Q

Signs and symptoms for varicocele

A

Often asymptomatic in children
Occasionally painful or heavy sensation that is worse w/ prolonged standing and improved when supine
Infertility

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19
Q

What could you find on physical exam for varicocele? (3)

A

“Bag of worms” appearance (dilated and tortuous veins)
Exam in supine and standing positions
Increases w/ Valsalva, decreases when supine

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20
Q

Labs/ Imaging for varicocele

A

Scrotal ultrasound w/ Doppler (used to assess for venous reflux and to assess testicular volume for hypoplasia)
Semen analysis
Consider abdominal ultrasound if varicocele does not decrease when in supine position

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21
Q

How do you classify varicocele

A

Grade I: palpable during Valsalva only
Grade II: palpable w/o Valsalva
Grade III: visible from a distance

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22
Q

Treatment for varicocele

A 
Symptomatic:  
scrotal support, analgesics
Surgery:
Venous ligation or embolization
Open surgery
Laparoscopic surgery
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23
Q

What is a spermatocele

A

Benign cystic accumulation of sperm that arises from the head of the epididymis
Can develop on the testicle itself or anywhere along the vas deferens

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24
Q

What is the epidemiology for spermatocele

A

Prevalence unknown
30% of cases are identified on US that is being performed for other reasons
patho= unclear

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25
Q

Symptoms found for spermatocele

A

Typically asymptomatic

Often found incidentally on exam

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26
Q

How to diagnose spermatocele

A

Clinical diagnosis based on hx and exam

Confirmed by US

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27
Q

What is epididymitis

A

Inflammation/infection of the epididymis

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28
Q

Incidence of epididymitis

A

600,000 cases annually in US (CDC)
Most common in men aged 18-35y
Bimodal distribution, age 16-30yo and age 51-70yo

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29
Q

Etiology of Epididymitis

A

Infectious

Men 35yo: urinary tract pathogens (most common is E. coli)

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30
Q

Risk Factors for epididymitis

A

All sexually active men

In prepubertal boys and men >35yo: recent urinary tract surgery/instrumentation, anatomic abnormalities

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31
Q

Complications of epididymitis

A 
Sepsis
Spreading infection
Testicular infarction
Testicular atrophy
Abscess
oligospermia
32
Q

Signs and symptoms of epididymitis

A 
Fever/chills
Testicular pain and swelling
Gradual onset
Often unilateral
Pain is typically localized posterior to testicle
Urinary tract symptoms may be present
Dysuria
Urgency
Frequency
hematuria
33
Q

physical exam findings for epididymitis

A

Signs of systemic infection may be present
Epididymis swollen and tender
Scrotal erythema may be present
Testes is typically in normal anatomic position
Pain may be relieved w/ testicular elevation
Cremaster reflex intact
May have suprapubic tenderness or CVAT if lower/upper urinary tract infx present
Recommend rectal exam to assess prostate for BPH, cancer, prostatitis
In setting of STD, may have urethral d/c

34
Q

how do you make a diagnosis of epididymitis

A

Made based on PE findings and confirmed by lab testing
(gradual onset, pain localized posterior to testes, concurrent symptoms of urethritis or UTI)
Labs: PCR for GC/Chl, urinalysis w/ culture, gram stain w/ culture of urethral swab
Imaging: U/S is not warranted unless you suspect torsion

35
Q

Treatment for epididymitis

A

Treat empirically, then adjust based on cx results
Do not delay treatment while waiting for cx
Symptomatic tx: scrotal elevation/support, ice and rest

36
Q

Abx treatment choice for epididymitis

A 
Abx choice is guided by sexual and urologic hx:
If suspect STD (GC/Chl):
Ceftriaxone 250mg IM once AND
Doxycycline 100mg bid x 7d
If enteric organism suspected:
Levofloxacin 500mg QD x 10d or
Ofloxacin 300mg bid x 10d
37
Q

follow up for epididymitis

A

Recommend f/u in 2-7 days after starting treatment to evaluate clinical response
If no response, consider alternative response

38
Q

Prognosis for epididymitis

A

Typically responds w/in 1-3 days of tx

Induration if present, may take up to 4 weeks to resolve

39
Q

What is Orchitis

A

Acute inflammatory reaction of the testis secondary to infection
Most cases are associated w/ a viral Mumps infection, but other viruses and bacteria can cause this as well

40
Q

Epidemiology for orchitis

A

20% of prepubertal boys w/ mumps will develop orchitis
In Mumps orchitis, occurs primarily in boys under 10y
In bacterial causes, most are associated w/ epididymitis and occurs in sexually active males or in men >50 due to obstruction

41
Q

Etiology for orchitis

A

Mumps is most common cause of isolated orchitis

Coxsackie virus, infectious mononucleosis, varicella, echovirus

42
Q

Signs and symptoms for orchitis

A

Acute onset
Testicular pain and swelling (mild to severe)
+/- fever, chills, nausea, malaise, myalgias
In mumps, orchitis develops 4-7 days after parotitis

43
Q

what can be found on physical exam for orchitis

A

Enlargement of testicle w/ induration
Testicular tenderness
Skin of scrotum erythematous and edematous

44
Q

Labs and imaging for orchitis

A

Labs:
Mumps- based on hx and PE alone, but can be confirmed w/ Ab testing
In sexually active males: urethral cultures and gram stain, U/A and culture
Imaging:
US doppler- r/o torsion and will demonstrate inflammation of testis or epididymis

45
Q

Supportive care for orchitis

A

Bed rest
Hot/cold packs for pain relief
Scrotal elevation
If viral (Mumps) usually resolves in 3-10 days

46
Q

Antibitics for orchitis

A

Empirically start antibiotics based on suspected bacterial cause

47
Q

Complications for orchitis

A

Most cases of bacterial orchitis resolve w/o complications
Infertility- 7-13% if bilateral, rare if unilateral
May develop an associated hydrocele

48
Q

What is Testicular Torsion

A

Twisting of the spermatic cord causing obstructed blood flow (venous return) leading to compromised arterial flow and ischemia
SURGICAL EMERGENCY

49
Q

What is Torsion of appendix testis

A

Remnant of Mullarian duct and is located on superior anterior pole of testicle
Wide age range

50
Q

What is Torsion of testis

A

spermatic cord

Primarily occurs during neonatal period and around puberty

51
Q

epidemiology of testicular torsion

A

Uncommon

4.5 cases per 100,000 males per year

52
Q

pathophys of testiculr torsion

A

Results in obstruction of venous return
equalization of pressures
testicular ischemia
Degree of ischemia depends on duration and degree

53
Q

Risk Factors for testicular torsion

A

90% associated w/ “bell-clapper deformity” of intravaginal torsion (congenital malformation)
Testicular tumor
History of cryptorchidism (undescended testicle)
Testicles that lie horizontally
Long intrascrotal portion of spermatic cord

54
Q

Complications of testicular torsion

A

Ischemia
Can develop w/in 4 hours of onset of torsion and always after 24 hours
Infertility d/t loss of testicle

55
Q

Salvage rates after detorsion:

A

90% if w/in 6 hrs
50% if w/in 12 hrs
<10% if after 24 hrs

56
Q

Signs and symptoms of testicular torsion

A

Severe, unilateral scrotal pain
+/- scrotal swelling
Abdominal pain
Nausea/vomiting

57
Q

Physical exam findings for testicular torsion

A 
Epididymis is displaced (depending on degree of torsion)
Testicle is not in it’s normal position
Testicle may be higher in the scrotum
Affected testicle may be enlarged
Cremaster reflex is absent
58
Q

What would be found on physical exam of torsion of appendix testis

A

Pain is usually located at the superior pole
Point tenderness early
Blue dot sign is diagnostic (tender nodule w/ blue discoloration on the upper pole of testicle)
Cremaster reflex is usually present

59
Q

imaging for torsion

A

U/S w/ doppler only if the diagnosis is in question and there is a low suspicion of torsion, or pain has been present >6 hours

60
Q

Imaging (torsion of appendix testis)

A

Low echogenic lesion w/ central hypoechoic area located at superior pole of testis

61
Q

Treatment of testicular torsion

A

Immediate surgery to restore blood flow to testes- treatment of choice
If testicle is nonviable remove testicle and perform orchioplexy of contralateral testis
If testes is salvagable orchioplexy of affected and contralateral testis

62
Q

Treatment of appendix testis

A

Conservative tx w/ rest and pain medication

Resolves in up to 1 week

63
Q

What is manual detorsion

A

Quick and noninvasive
Not a definitive treatment
Patient is laying supine, provider stands at patients feet and rotates the testicle away from midline (medial to lateral)
Performed with or w/o anaesthesia
Successful if associated w/ immediate pain relief, normal PE and return of blood flow confirmed by US doppler study
If successful, patient still requires orchioplexy

64
Q

What is urethritis

A

Inflammation of the urethra

Most common cause is STD

65
Q

How to classify urethritis

A

Gonococcal urethritis (GCU)- gonorrhea
Nongonococcal urethritis (NGU)- chlamydia (most common), Mycoplasma genitalium, Trichomonas, Mycoplasma hominis, Gardnerella vaginalis
Idiopathic- in absence of above
Trauma related-

66
Q

Pathophys of urethritis

A 
Local mucous membrane epithelial cell damage or invasion (bacteria, fungus, virus)
Inflammatory changes (accumulation of leukocytes and chemical mediators)
Swelling, discharge and pain
67
Q

Epidemiology of urethritis

A

Primarily a disease of adolescent and adult men

Increased prevalence in men <25yo

68
Q

4 complications of urethritis

A

Urethral strictures
Urethral stenosis
Abscess formation (rare)
Sexual transmission

69
Q

4 risk factors of urethritis

A

Increased number of sexual partners
Lack of condom use
Prior STD/urethritis
Recent urethral catheterization (medical) or insertion of foreign body

70
Q

Signs and symptoms of urethritis

A 
Urethral discharge
GCU- opaque yellow or white d/c
NGU- scant, mucoid or clear d/c 
Dysuria
Urethral pruritis
Hematuria
Painful intercourse/ejaculation
71
Q

What are some physical exam findings for urethritis

A

Normal vital signs
Urethral meatus may be erythematous, tender with or w/o swelling
Urethral d/c (confirms diagnosis)

72
Q

gram stain for urethritis

A

gram negative intracellular diplococci gonorrhea

Presence of WBCs and PMN is highly suggestive

73
Q

PCR/nucleic acid amplification testing (NAAT) for urethritis

A

Urine or urethral swab
Insert swab 1 cm into the urethra and gently twist
Testing the d/c alone is less sensitive
Recent voiding does decrease sensitivity of urethral swab test

74
Q

Treatment for urethritis

A

GCU:
Ceftriaxone 125mg IM x 1 or Cefixime 400mg po x1
NGU:
Azithromycin 1g po x 1 or Doxycycline 100mg bid x 7 days
Trichomonas:
Metronidazole 2g po x 1

75
Q

Follow up for urethritis

A

Recurrent or persistent symptoms

Retest in 3 months is recommended

76
Q

How to prevent urethritis

A

Abstinence x 1 week following treatment as long as symptoms have resolved
All sexual partners should be treated (during the last 60 days)
Safe sex practices

Clin Med- Renal/GU (7 decks)

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