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Clin Med 3 > Male GU Disorders - Cooper - Exam 2 > Flashcards

Male GU Disorders - Cooper - Exam 2 Flashcards

1
Q

2 phases of testis descent?

A

transabdominal descent
-dependent on insulin-like hormone 3 (INSL3)

inguinoscrotal descent
-dependent on androgens

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2
Q

what is cryptorchidism?

A

undescended testicle

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3
Q

cryptorchidism common in who?

A

premature infants/low birth weight infants

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4
Q

what is a prerequisite for testicular descent?

A

A normal hypothalamic-pituitary-gonadal axis

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5
Q

how does cryptorchidism occur?

A

in these pts gubernaculum is not firmly attached to the scrotum -> teste is not pulled into the scrotum

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6
Q

clinical manifestations of cryptorchidism?

A

empty, small scrotum

non-palpable testes

most common in inguinal canal (near internal ring)

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7
Q

complications of cryptorchidism?

A

infertility (esp if bilateral disease)

increased risk of testicular cancer (even if had surgery to fix it)

inguinal hernia - indirect -> d/t patent processus vaginalis

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8
Q

when should PCPs palpate testes according to AUA guidelines?

A

PCPs should palpate testes for quality and position at each recommended well-child visit

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9
Q

when should providers refer infants for cryptorchidism according to AUA guidelines?

A

Providers should refer infants w/ a hx of cryptorchidism (detected at birth) who don’t have spontaneous testicular descent by 6 months to an appropriate surgical specialist

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10
Q

should providers perform U/S or other imaging prior to referral for cryptorchidism according to AUA guidelines?

A

NO!!!

Providers shouldn’t perform US or other imaging studies in the evaluation of boys with cryptorchidism prior to referral as these studies rarely assist in decision making

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11
Q

should providers use hormonal therapy for tx of cryptorchidism according to AUA guidelines?

A

NO!!!

Providers shouldn’t use hormonal therapy to induce testicular descent as evidence shows low response rates and lack of evidence for long-term efficacy

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12
Q

when should specialists perform surgery for cryptorchidism according to AUA guidelines?

A

In the absence of spontaneous testicular descent by 6 months, specialists should perform surgery w/in the next year

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13
Q

who should providers counsel on cryptorchidism long-term risks and what risks according to AUA guidelines?

A

Providers should counsel boys w/a hx/of cryptorchidism and/or monorchidism and their parents regarding potential long-term risks and provide education on infertility and cancer risk

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14
Q

if pt has unilateral cryptorchidism w/out hypospadias, what’s the work-up?

A

just a consult

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15
Q

if pt has unilateral or bilateral cryptorchidism w/hypospadias or bilateral non-palpable testes, what’s that work-up?

A
  • CONSULT!!!
  • Sex (need to know if it’s a boy or a girl)
  • 17-hydroxylase progesterone
  • testosterone
  • LH and FSH

(measure these hormones, but usually lead it to the specialist)

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16
Q

imaging for cryptorchidism?

A

CONSULT FIRST!!!! (if can’t do consult then do U/S)

U/S is FIRST CHOICE B/C NO RADIATION

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17
Q

what dx study for cryptorchidism has 100% sensitivity and specificity?

A

laparoscopy - also allows for concurrent surgical correction

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18
Q

tx for cryptorchidism before 6 months of age?

A

just follow the pt

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19
Q

tx for cryptorchidism after 6 months of age?

A

Orchiopexy - brings the test down and secures it to the scrotum

(ideally done before 1 y/o)

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20
Q

what is hydrocele?

A

fluid around the testicle

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21
Q

issue with hydrocele?

A

bigger scrotum than it needs to be and it also messes w/temperature regulation

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22
Q

pediatric hydroceles, acquired or congenital? resolve?

A

congenital and resolve w/in 1 year of life

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23
Q

adult hydroceles, acquired or congenital?

A

acquired

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24
Q

3 etiologies of hydroceles

A

idiopathic, non-communication, communicating

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25
Q

non-comunicating hydrocele d/t?

A

d/t minor trauma, inflammatory conditions

acute reactive hydrocele:
-epididymitis, testicular torsion, varicocele operation, testicular tumor

PROCESSUS VAGINALIS OPENS AND CLOSES IN THIS ONE

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26
Q

communicating hydroceles d/t to? discovered when? occur following?

A

Usually discovered in infancy

Due to patent processus vaginalis (STAYS OPEN ALL THE TIME)

Occur following increased intra-abdominal fluid or pressure

  • Due to shunts, peritoneal dialysis, or ascites
  • Likely from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis
27
Q

what pts have a high risk of communicating hydroceles?

A

pts with connective tissue disorders

28
Q

signs and sx’s of hydrocele?

A

painless scrotal swelling

29
Q

physical exam of hydrocele?

A

***transillumination to assess for fluid - if get glow, then there is fluid = hydrocele

palpate for masses

differentiate from hematocele, hernia, or solid mass

30
Q

hydrocele evaluation?

A

scrotal U/S

-to evaluate for reactive hydrocele due to testicular neoplasm or other etiology

31
Q

tx for idiopathic hydroceles?

A

Often asymptomatic or with only scrotal swelling

Observation - surgical treatment only if increased pressure, pain, or chronic irritation of scrotal skin

32
Q

tx for communicating hydrocele?

A

Due to patent processus vaginalis -> ***requires surgical closure (similar to hernia surgery)

33
Q

what is a varicocele? caused by?

A

cystic testicular mass of varicose veins

caused by dilation of pampiniform plexus

34
Q

what side is most common for varicocele?

A

Left side!!!

35
Q

b/c varicocele is d/t dilation of pampiniform plexus, what can occur with pt if have this?

A

Pampiniform plexus maintains specific temperature for sperm production -> can result in testicular growth retardation during puberty

36
Q

how many grades of varicoceles?

A

3

37
Q

grade 1 varicocele

A

small - palpable only w/valsalva

38
Q

grade 2 varicocele

A

medium - palpable at rest -> invisible

39
Q

grade 3 varicocele

A

large - easily visible

40
Q

M/C sign of varicocele?

A

scrotal mass feels like BAG OF WORMS!!! -> disappears in supine position

41
Q

physical exam for varicocele?

A
  • Fullness, usually in spermatic cord
  • Bag of worms
  • Should be examined in upright position, in a warm room
42
Q

dx for varicocele?

A

scrotal U/S

Left testicular venogram

43
Q

if child has right-sided varicocele (or bilateral), what could be the cause?

A

a retroperitoneal mass

44
Q

what is the main reason to treat a varicocele?

A

b/c can cause infertility

45
Q

when is tx recommended for varicocele?

A

Varicocele is palpable on physical exam of the scrotum (may be d/t retroperitoneal mass if on right side or bilateral)

Couple has known infertility

Female partner has normal fertility or a potentially treble cause of infertility

Male partner has abnormal semen parameter or abnormal results from sperm function tests

46
Q

tx for varicocele?

A

embolization

47
Q

what is hypospadias? caused by?

A

abnormal urethral placement (subcoronal, mid shaft, penoscrotal)

Caused by failure of fusion of the urethral folds, endodermal differentiation, and ectodermal ingrowth in gestational weeks 8-20

48
Q

hypospadias is one of the most common what?

A

one of the most common birth defects

49
Q

hypospadias risk factor?

A

low birth weight

50
Q

hypospadias tx?

A
  • Maybe nothing
  • Don’t circumcise

Surgical

  • short procedure that’s same day
  • 6-12 months old, but can be done anytime
  • May need testosterone pretreatment
51
Q

what is phimosis? can be normal up to?

A

The foreskin cannot be fully retracted over the glans penis

Foreskin fused to the gland at birth and not retractable

Can be normal up to adolescence

52
Q

causes of phimosis?

A
  • The tip of the foreskin is too narrow to pass over the glans penis
  • The inner surface of the foreskin is fused with the glans penis
  • The frenulum is too short to allow complete retraction -> frenulum breve
  • Pathological if difficulty urinating or associated with abnormal sexual function
53
Q

tx for phimosis?

A

Steroid creams (not recommended by Coops)

Manual stretching (overtime will pull it back)

Changing masturbation habits
(slow down - going too fast is a common cause of paraphimosis)

Preputioplasty

Circumcision
-M/C reason to do a circumcision in an adult (usually b/c can’t keep it clean)

54
Q

what is the M/C reason to do a circumcision in an adult?

A

phimosis tx

55
Q

what is paraphimosis?

A

Foreskin of the penis once pull back behind the glands -> cannot be retracted back -> ischemia to gland of penis

Foreskin starts to swell -> cuts off blood supply to corona of penis -> if stays this way cuses gangrene of the penis

56
Q

is paraphimosis an emergency?

A

YES!!! it’s a urological emergency!!!

57
Q

who does paraphimosis only occurs in?

A

Occurs only in uncircumcised or partially circumcised males

58
Q

what else can lead to the same pathophysiological derangements as seen with paraphimosis?

A

External objects may constrict the mid to distal shaft

ex: string, metal rings, rubber rings

59
Q

who is at an increased risk of paraphimosis?

A

uncircumcised people

60
Q

signs and sx’s of paraphimosis?

A
  • Penile pain
  • Swelling/enlargement
  • Congestion with edematous foreskin
  • Discoloration
  • N/V in adults

If prolonged ischemia -> severe paraphimosis -> distal penis has begun the process of autoamputation

In peds -> may manifest as acute urinary tract obstruction -> obstructive voiding symptoms

61
Q

paraphimosis tx?

A

Conservative therapy initially with gentle retraction of foreskin
-If that doesn’t work, then do circumcision

Severe paraphimosis refractory to conservative therapy -> bedside emergency dorsal slit procedure to save penis

Circumcision can be performed in the operating room at a later date -> Ultimate tx

62
Q

what is the ultimate tx of paraphimosis?

A

circumcision

63
Q

if pt has severe paraphimosis refractory to conservative therapy, what’s the tx?

A

bedside emergency dorsal slit procedure to save penis

Clin Med 3 (21 decks)

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