Male GU Disorders Flashcards
What is cryptorchidism
a hidden ball, one doesn’t descend
What are the two phases of testes descent
- transabdominal- dependent on insulin like hormone 3
2. inguinoscrotal descent- dependent on androgens
Where do most balls get stuck?
-high scrotal
then
inguinal canal
then
abdominalWhat is associated with cryptorchidism
low birth weight/ prematurity
Why does cryptorchidism occur
the gubernaculum is not firmly attached to the scrotum and the testis is not pulled into the scrotum
Does cryptorchidism put a male at a higher risk for testicular cancer
YES
What should primary care providers palpate the testes for
quality and position
When should a patient with cryptorchidism be referred? To who?
if testis does not descend before six months refer to surgical specialist
What should not be done before referring a male with cryptorchidism
US or other imaging modalities to find testicle
What should not be done to treat crptorchidism
hormone therapy
When should surgery be preformed if testis has not descended by 6 months
within the next year
What do you need to do for unilateral or bilateral descended testes with hypospadias or bilateral nonpalpapble testes?
-CONSULT
-determine sex
Measure:
17- hydroxylase progesterone
testosterone
LH
FSH
Imaging for cryptorchidism
CONSULT
- US/CT/MRI
- diagnostic laparoscopy
Treatment for cryptorchidism
- orchiopexy
- human chorionic gonadotropin (low success rate)
What are the complications with an undescended testes
-inguinal hernia
What are many undescended testes associated with
patent tunica vaginalis
What is a hydrocele
fluid build up in the scrotum
What is the etiology of a pediatric hydrocele
congenital abnormality that typically resolves in the first year of life
What is a non communicating hydrocele
due to minor trauma, inflammatory conditions, epididymitis, testicular torson, tumor
What is a communicating hydrocele
due to a patent processus vaginalis that occurs during a period of increase abdominal fluid or pressure
S/S of hydrocele
scrotal swelling and pain
Physical exam for hydrocele
- palpate for masses
- transillumination to asses for fluid
Where do varicoceles occur more often
on the left
Why do varicoceles form
dilation of the pampiniform plexus
What is the give away that a patient has a varicocele
scrotum feels like a bag of worms
S/S of varicocele
- tortuous swelling
- scrotal mass
- discoloration
Why do you treat a varicocele
fertility
What is hypospadias
abnormal location of urethra/urethral opening
Three locations of hypospadias
- anterior
- middle
- posterior
Where does hypospadias typically occur
anterior (glanular or subcoronal)
What causes hypospadias
failure of fusion of the urethral folds, endodermal differentiation adn ectodermal ingrowth in gestation weeks 8 to 20
Treatment of hypospadias
- ?nothing
- dont circumcise
- surgery (?testosterone pretreatment)
What is phimosis
the foreskin cannot be fully retracted over the glans penis (foreskin is fused to gland)
What causes phimosis
- tip of the foreskin is too narrow to pass over the glans
- inner surface of the foreskin is fused with the glans
- the frenulum is too short to allow complete retraction
When is phimosis pathological?
if difficulty urinating or associated with abnormal sexual functions
Treatment of phimosis
- steroid creams
- manual stretching
- changing masturbation habits
- circumcision
What is paraphimosis
SURGICAL EMERG
-foreskin cannot be retracted back once pulled behind the glans
What is a complication of paraphimosis
ischemia to gland
S/S of paraphimosis
- penile pain, swelling, enlargement
- if prolonged ischemia–>autoamputation
How do you treat a paraphimosis
- manual retraction
- circumcision
- bedside emergency dorsal slit
