Male GU Disorders Flashcards
Define hydrocele
- Abnormal, painless collection of fluid in tunica vaginalis
- Leads to swelling of scrotum
Types of hydrocele
- Communicating (congenital, MC in children under 12)
- Noncommunicating (acquired, imbalance in rates of fluid secretion/reabsorption)
Etiology of communicating hydrocele
Congenital patent processus vaginalis which allows peritoneal fluid to travel into tunica vaginalis
Etiology of noncommunicating hydrocele
- Imbalance of fluid movement
- Iatrogenic (prior surgery)
- Acute epididymitis
- Trauma
Presentation of hydrocele
- Painless swelling in groin/scrotum
- May increase in size throughout the day
Describe transillumination of hydrocele
NOT diagnostic
Diagnosis of hydrocele
- Clinical
- US to confirm
Treatment of hydrocele in children
Watchful waiting
Treatment of hydrocele in adults
Surgery
- Open hydrocelectomy and endoscopic (low recurrence rate)
- Aspiration and sclerotherapy (high recurrence rate)
Define varicocele
Dilated vein of spermatic cord
“bag of worms” appearance
What is the MC correctable cause of infertility in men?
Varicocele
Presentation of varicocele
- Often asymp in children
- Occasionally painful or heavy sensation worse w/prolonged standing (improved when supine)
- Infertility
Treatment of varicocele
- Symptomatic (scrotal support, analgesics)
- Surgery (venous ligation or embolization)
Define spermatocele
Benign cystic accumulation of sperm that arises from head of epididymis
Treatment of spermatocele
No tx if asymptomatic
Etiology of epididymitis
Infectious
- Men under 35: STD (GC/chl)
- Men over 35: urinary tract (E coli)
Risk factors of epididymitis
- All sexually active men
- Prepubertal and men over 35: recent urinary tract surgery, anatomic abnormalities
Presentation of epididymitis
- Testicular pain and swelling (usually gradual onset, often unilateral)
- Fever/chills
- Urinary tract symptoms may be present
PE findings of epididymitis
- Swollen and tender
- Testes in normal anatomic position
- Pain may be relieved w/testicular elevation
- Cremaster reflex intact
Diagnosis of epididymitis
- Based on PE findings and confirmed by lab testin
- Imaging not warranted unless you suspect torsion (but performed in most cases)
Treatment of epididymitis
- Treat empirically then adjust based on culture results
- Symptomatic tx
Define orchitis
Acute inflammatory reaction of the testis secondary to infection
Most cases of orchitis are a/w what?
Viral Mumps infection (but other viruses/bacteria can cause orchitis)
What are most bacterial orchitis cases a/w?
Epididymitis (and occurs in sexually active men or over 50 d/t obstruction)
Who is MC affected by orchitis?
Children w/mumps
Treatment of orchitis
- Supportive care
- Antibiotics if bacterial
Complications of orchitis
Most resolve w/o complications
Define testicular torsion
Twisting of spermatic cord causing obstructed blood flow
*Surgical emergency!
Types of testicular torsion
- Torsion of testis (more severe)
- Torsion of appendix testis
Risk factors of testicular torsion
- Bell clapper deformity of intravaginal torsion (congenital, 90%)
- Testicular tumor
- Hx of cryptorchidism (undescended testicle)
PE findings of testicular torsion:
- Testicle is NOT in normal position
- Cremaster reflex absent
What is diagnostic for torsion of appendix testis?
Blue dot sign (tender nodule w/blue discoloration on upper pole of testicle)
Treatment of testicular torsion
Immediate surgery
Treatment of appendix testis
Conservative tx w/rest and pain meds
MC cause of urethritis
STD
Types of urethritis
- Gonococcal
- Nongonococcal
- Idiopathic
- Trauma related
What confirms diagnosis of urethritis?
Urethral discharge
Treatment of gonococcal urethritis
Ceftriaxone or cefixime
Treatment of nongonococcal urethritis
Azithromycin or doxy
Treatment of trichomonas urethritis
Metronidazole
Prevention/patient education of urethritis
- Abstinence x 1 wk after treatment as long as symptoms have resolved
- All sexual partners from last 60 days should be treated
