Male GU Disorders

Question 1

What is cryptorchidism

Answer 1

a hidden ball, one doesn’t descend

Question 2

What are the two phases of testes descent

Answer 2

1. transabdominal- dependent on insulin like hormone 3

2. inguinoscrotal descent- dependent on androgens

Question 3

Where do most balls get stuck?

Answer 3

-high scrotal
      then
inguinal canal
       then 
abdominal

Question 4

What is associated with cryptorchidism

Answer 4

low birth weight/ prematurity

Question 5

Why does cryptorchidism occur

Answer 5

the gubernaculum is not firmly attached to the scrotum and the testis is not pulled into the scrotum

Question 6

Does cryptorchidism put a male at a higher risk for testicular cancer

Answer 6

YES

Question 7

What should primary care providers palpate the testes for

Answer 7

quality and position

Question 8

When should a patient with cryptorchidism be referred? To who?

Answer 8

if testis does not descend before six months refer to surgical specialist

Question 9

What should not be done before referring a male with cryptorchidism

Answer 9

US or other imaging modalities to find testicle

Question 10

What should not be done to treat crptorchidism

Answer 10

hormone therapy

Question 11

When should surgery be preformed if testis has not descended by 6 months

Answer 11

within the next year

Question 12

What do you need to do for unilateral or bilateral descended testes with hypospadias or bilateral nonpalpapble testes?

Answer 12

-CONSULT
-determine sex
Measure:
17- hydroxylase progesterone
testosterone
LH
FSH

Question 13

Imaging for cryptorchidism

Answer 13

CONSULT

• US/CT/MRI
• diagnostic laparoscopy

Question 14

Treatment for cryptorchidism

Answer 14

• orchiopexy

- human chorionic gonadotropin (low success rate)

Question 15

What are the complications with an undescended testes

Answer 15

-inguinal hernia

Question 16

What are many undescended testes associated with

Answer 16

patent tunica vaginalis

Question 17

What is a hydrocele

Answer 17

fluid build up in the scrotum

Question 18

What is the etiology of a pediatric hydrocele

Answer 18

congenital abnormality that typically resolves in the first year of life

Question 19

What is a non communicating hydrocele

Answer 19

due to minor trauma, inflammatory conditions, epididymitis, testicular torson, tumor

Question 20

What is a communicating hydrocele

Answer 20

due to a patent processus vaginalis that occurs during a period of increase abdominal fluid or pressure

Question 21

S/S of hydrocele

Answer 21

scrotal swelling and pain

Question 22

Physical exam for hydrocele

Answer 22

• palpate for masses

- transillumination to asses for fluid

Question 23

Where do varicoceles occur more often

Answer 23

on the left

Question 24

Why do varicoceles form

Answer 24

dilation of the pampiniform plexus

Question 25

What is the give away that a patient has a varicocele

Answer 25

scrotum feels like a bag of worms

Question 26

S/S of varicocele

Answer 26

- tortuous swelling - scrotal mass - discoloration

Question 27

Why do you treat a varicocele

Answer 27

fertility

Question 28

What is hypospadias

Answer 28

abnormal location of urethra/urethral opening

Question 29

Three locations of hypospadias

Answer 29

- anterior - middle - posterior

Question 30

Where does hypospadias typically occur

Answer 30

anterior (glanular or subcoronal)

Question 31

What causes hypospadias

Answer 31

failure of fusion of the urethral folds, endodermal differentiation adn ectodermal ingrowth in gestation weeks 8 to 20

Question 32

Treatment of hypospadias

Answer 32

- ?nothing - dont circumcise - surgery (?testosterone pretreatment)

Question 33

What is phimosis

Answer 33

the foreskin cannot be fully retracted over the glans penis (foreskin is fused to gland)

Question 34

What causes phimosis

Answer 34

- 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

Question 35

When is phimosis pathological?

Answer 35

if difficulty urinating or associated with abnormal sexual functions

Question 36

Treatment of phimosis

Answer 36

- steroid creams - manual stretching - changing masturbation habits - circumcision

Question 37

What is paraphimosis

Answer 37

SURGICAL EMERG | -foreskin cannot be retracted back once pulled behind the glans

Question 38

What is a complication of paraphimosis

Answer 38

ischemia to gland

Question 39

S/S of paraphimosis

Answer 39

- penile pain, swelling, enlargement | - if prolonged ischemia-->autoamputation

Question 40

How do you treat a paraphimosis

Answer 40

- manual retraction - circumcision - bedside emergency dorsal slit