male gu disorders Flashcards
what is a hydrocele?
Abnormal, painless collection of fluid in tunica vaginalis that leads to swelling of scrotum
what are the 2 types of hydrocele’s?
communicating and non-communicating
what is a communicating hydrocele?
Congenital, most common in children <12 yo
Secondary to a patent process vaginalis
Congenital patent processus vaginalis which allows peritoneal fluid to travel into the tunica vaginalis
what is a non-communicating hydrocele?
Acquired No defects Imbalance in rates of fluid secretion and reabsorption w/in a closed tunical vaginalis MC in adults Iatrogenic acute epidymitis viral dz malignancy torsion trauma
what are the S/S of a hydrocele?
painless swelling n groin or scrotum
may be described as heaviness
may increase in size through out the day
what would you want to ask a person in HPI about with hydrocele?
ask about onset
Hx of prior panful swelling in groin or scrotum
hx of surgeries
what is the diff on PE between communicating vs non-communicating?
comm: fluctuant that can be manually reduced
non-comm: fluctuant that cannot be manually reduced
Can transilluminate will glow soft red color
what is the tx for hydrocele?
in children watchful waiting
or surgery
in adults surgery
what is a vericocele?
dilated vein of spermatic cord
MC correctable cause of infertility in men
what is the etiology of varicocele
valve insufficiency
pathogensis increased pressure in veins d/t valve insufficiency
what are s/s of varicocele
often asymptomatic
occasionally painful or heavy sensation that is worse w/ prolonged standing and improved when supine
what will the PE findings be like for a varicocele?
bag of works appearance
increases w/valsalva, decrease when supine
what labs/imagining would you want to order?
Scrotal US w/doppler used to assess for venous reflux and assess testicular volume for hypoplasia
semen analysis
consider Abdominal US if varicocele does not decrease when supine
what are the Grade I,II,III varicocele classification
I: palpable during valsalva only
II: palpable w/o valsalva
III: visible from distance
what is Tx for varicocele
symptomatic scrotal support, analgesics
surgery venous ligation or embolization
what is a spematocele?
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
what is the epidemiology of spermatocele
prevalance unknown
30% of cases identified on US that is being performed for other reasons
what are the signs/symptoms
PE findings?
typically asymptomatic accidentally found on exam
PE: arise from head of epipdidymis therefore they are superior to testicle and are round and smooth cyst will transilluminate
how is a spermatocele dx
clinical dx based on hx and exam and confirmed by US
what is the tx for a spermatocele
if asymptomatic no tx just monitor
if symptomatic, progressively enlarging or bothersome to pt then surgical excision or sclerotherapy
what is the prevalence of epididymitis
600,000
MC in men 18-35
Bi-modal distribution 16-30 years old and 51-70yrs old
what is the etiology of epididymitis
men35 UTI MC ecoli
what are Rf for epididymitis
sexually active
pubertal boys and men>35: recent urinary tract surgery, BPH, cysts
what are signs/symptoms of epididymitis?
fever/chills
testicular pain and swelling
dysuria, urgency, frequency
hematuria
what are the PE finding like for epididymitis?
scrotal erythema
pain may be releaved with testicular elevation
may have suprapubic tenderness or CVA if UTI
urethral d/c
what is the tx for epididymitis?
tx empirically do not delay while waiting for culture
symptomatic scrotal elevation ice and rest
Abx: if STD ceftriaxone or doxy
if enteric organism: Levofloxacin or ofloxacin
Follow up 2-7 days after tx
may take upto 4 wks
what is orchitis
acute inflammatory rxn of the testes secondary to infx
most cases are associated with viral mumps, other viruses or bacteria can cause this
what is epidemiology of orchitis
20% of prepubertal boys w/ mumps will develop orchitis
happens primarily in boys under 10yrs old
men> 50yrs old d/t obstruction
what is the MCC of orchitis?
mumps
s/s of orchitis?
acute onset
testicular pain and swelling
fever, chills, nausea, malaise, myalgia
in mumps orchitis develops 4-7 days after parotitis
PE findings of orchitis?
enlargement of testicle w/ induration
testicular tenderness
skin of scrotum erythematous and edematous
diagnosis of orchitis
mumps- based of hx and PE alone
sexually active males urethral cultures and gram stain and U/A culture
US doppler r/o torsion and show inflammation
tx for orchitis
supportive care: bed rest, hot/cold pack for pain scrotal elevation if viral mumps will reslove in 3-10days Abx start empirically based on bacteria
what is testicular torsion?
Twisting of the spermatic cord causing obstructed blood flow (venous return) leading to compromised arterial flow and ischemia
what types of torsion are there?
torsions of testes- spermatic cord occurs during neonatal period and puberty
torsions of appendix- remnant of mullarian duct and located superior anterior
Rf of testicular torsion
90% associated with bell clapper deformity of intravaginal torsion
testicular tumor
hx of undescended teste
long intrascrotal portion of spermatic cord
s/s of testicular torsion
severe unilateral scrotal pain
scrotal swelling
abdominal pain
n/v
PE findings of testicular torsion
epididymis diplaced teste not in norm position testicle may be higher in scrotum affected testicle may be enlarged cremater reflex absent
PE for torsions of appendix testis
pain usually located at superior pole
point tenderness
blue dot
cremaster reflex present
testicular torsion dx
U/S doppler only if dx in question and low suspicion of torsion or pain >6hrs
will show low echogenic lesion w/central hypoechoic area
tx for testicular torsion
manual detorsion
-quick, non-invasive
pts is supine and provider rotates testis away from midline if successful immediate pain relief and still needs orchioplexy
what causes urethritis
STD MC
classifications of urethritis
gonorrhea urethritis
non-gonococcal urethritis
idopathic
trauma related- catheter, FB
epidemiology urethritis
men>25
urethritis RF
incresed # of sex partners
lack of condoms
prior STD/Urethritis
recent catheter or FB insertion
s/s urethritis
urethral d/c: GCU opaque, yellow or white NGU:scant, mucoid, clear dysuria urethral pruritis hematuria painful intercourse/ejaculation
urethritis PE findings
urethral meatus may be erythematous, tender w or w/o swelling
Urethral discharge
how to Dx urethritis
gram stain discharge
PCR/ (NAAT)
urine or urethral swab 1cm in urethra with a gentle twist
urethritis TX
GCU: ceftriaxone 125mg IM or cefixime
NGU: azithromycin or doxy
Trichomonas: get metronidazole
urethritis follow up
if recurrent symptoms
retest in 3mths is recommended
abstinance x 1wk following tx
Tx all sexual partners
