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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
Symptoms found for spermatocele
Typically asymptomatic | Often found incidentally on exam
26
How to diagnose spermatocele
Clinical diagnosis based on hx and exam | Confirmed by US
27
What is epididymitis
Inflammation/infection of the epididymis
28
Incidence of epididymitis
600,000 cases annually in US (CDC) Most common in men aged 18-35y Bimodal distribution, age 16-30yo and age 51-70yo
29
Etiology of Epididymitis
Infectious | Men 35yo: urinary tract pathogens (most common is E. coli)
30
Risk Factors for epididymitis
All sexually active men | In prepubertal boys and men >35yo: recent urinary tract surgery/instrumentation, anatomic abnormalities
31
Complications of epididymitis
``` Sepsis Spreading infection Testicular infarction Testicular atrophy Abscess oligospermia ```
32
Signs and symptoms of epididymitis
``` 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
physical exam findings for epididymitis
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
how do you make a diagnosis of epididymitis
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
Treatment for epididymitis
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
Abx treatment choice for epididymitis
``` 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
follow up for epididymitis
Recommend f/u in 2-7 days after starting treatment to evaluate clinical response If no response, consider alternative response
38
Prognosis for epididymitis
Typically responds w/in 1-3 days of tx | Induration if present, may take up to 4 weeks to resolve
39
What is Orchitis
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
Epidemiology for orchitis
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
Etiology for orchitis
Mumps is most common cause of isolated orchitis | Coxsackie virus, infectious mononucleosis, varicella, echovirus
42
Signs and symptoms for orchitis
Acute onset Testicular pain and swelling (mild to severe) +/- fever, chills, nausea, malaise, myalgias In mumps, orchitis develops 4-7 days after parotitis
43
what can be found on physical exam for orchitis
Enlargement of testicle w/ induration Testicular tenderness Skin of scrotum erythematous and edematous
44
Labs and imaging for orchitis
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
Supportive care for orchitis
Bed rest Hot/cold packs for pain relief Scrotal elevation If viral (Mumps) usually resolves in 3-10 days
46
Antibitics for orchitis
Empirically start antibiotics based on suspected bacterial cause
47
Complications for orchitis
Most cases of bacterial orchitis resolve w/o complications Infertility- 7-13% if bilateral, rare if unilateral May develop an associated hydrocele
48
What is Testicular Torsion
Twisting of the spermatic cord causing obstructed blood flow (venous return) leading to compromised arterial flow and ischemia SURGICAL EMERGENCY
49
What is Torsion of appendix testis
Remnant of Mullarian duct and is located on superior anterior pole of testicle Wide age range
50
What is Torsion of testis
spermatic cord | Primarily occurs during neonatal period and around puberty
51
epidemiology of testicular torsion
Uncommon | 4.5 cases per 100,000 males per year
52
pathophys of testiculr torsion
Results in obstruction of venous return equalization of pressures testicular ischemia Degree of ischemia depends on duration and degree
53
Risk Factors for testicular torsion
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
Complications of testicular torsion
Ischemia Can develop w/in 4 hours of onset of torsion and always after 24 hours Infertility d/t loss of testicle
55
Salvage rates after detorsion:
90% if w/in 6 hrs 50% if w/in 12 hrs <10% if after 24 hrs
56
Signs and symptoms of testicular torsion
Severe, unilateral scrotal pain +/- scrotal swelling Abdominal pain Nausea/vomiting
57
Physical exam findings for testicular torsion
``` 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
What would be found on physical exam of torsion of appendix testis
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
imaging for torsion
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
Imaging (torsion of appendix testis)
Low echogenic lesion w/ central hypoechoic area located at superior pole of testis
61
Treatment of testicular torsion
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
Treatment of appendix testis
Conservative tx w/ rest and pain medication | Resolves in up to 1 week
63
What is manual detorsion
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
What is urethritis
Inflammation of the urethra | Most common cause is STD
65
How to classify urethritis
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
Pathophys of urethritis
``` Local mucous membrane epithelial cell damage or invasion (bacteria, fungus, virus) Inflammatory changes (accumulation of leukocytes and chemical mediators) Swelling, discharge and pain ```
67
Epidemiology of urethritis
Primarily a disease of adolescent and adult men | Increased prevalence in men <25yo
68
4 complications of urethritis
Urethral strictures Urethral stenosis Abscess formation (rare) Sexual transmission
69
4 risk factors of urethritis
Increased number of sexual partners Lack of condom use Prior STD/urethritis Recent urethral catheterization (medical) or insertion of foreign body
70
Signs and symptoms of urethritis
``` Urethral discharge GCU- opaque yellow or white d/c NGU- scant, mucoid or clear d/c Dysuria Urethral pruritis Hematuria Painful intercourse/ejaculation ```
71
What are some physical exam findings for urethritis
Normal vital signs Urethral meatus may be erythematous, tender with or w/o swelling Urethral d/c (confirms diagnosis)
72
gram stain for urethritis
gram negative intracellular diplococci gonorrhea | Presence of WBCs and PMN is highly suggestive
73
PCR/nucleic acid amplification testing (NAAT) for urethritis
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
Treatment for urethritis
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
Follow up for urethritis
Recurrent or persistent symptoms | Retest in 3 months is recommended
76
How to prevent urethritis
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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