Male GU Path (Sigdel +Norton) - Melissa*** Flashcards
Define Hypospadias.
With what other congenital anomaly may it also be associated?
What causes it?
Urethra opens on VENTRAL (HYPO= below) side of penis
- Asstd. w undescended testes
- **Failure of urethral folds to close
Define Epispadias.
With what TWO congenital anomalies may it also be associated?
What causes it?
How frequent?
Urethra opens on DORSAL (EPI= upon)
- Asstd. w undescended testes + bladder Exstrophy
- **Abnormal positioning of genital tubercle
-Much less common than hypospadias, needs corrected because it leads to recurrent infection.
What is a…
- Micropenis
- Diphallus
- Bifid Scrotum
- VERY LITTLE WEENIE
- TWO WEENIES
- TWO BALL SACS
What is Phimosis?
What causes it and what are TWO possible complications that might ensue?
Congenital or Inflammatory Process–>
Orifice or prepuce too small to retract–>
Infection or Carcinoma
Balanoposthitis
Nonspecific, NON-STI infection or glans and prepuce
Herpes of the Penile Variety:
- Name the 2 viruses and describe their genome + capsid
- What kind of infections can it cause (2)
- High yield dx test?
- Treatment?
HSV2*** or HSV1 (linear dsDNA; icosahedral)
- TORCH infection
- Superficial PAINFUL ulcer
- DX: with Tzanck smear (“Tzanck God I don’t have Herpes!)
- TX: Valacyclovir within first 48
Syphilis:
- Causative organism
- Describe PRIMARY infection
- How is it diagnosed?
- How is it treated?
Treponema Pallidum (spirochete)
NONPAINFUL CHANCRE; red shallow ulcer on testes –> epididymis
-DX: dark field microscopy FTA-ABS PCR
-TX: PEN-G
Pemphigus Vulgaris of the Penis: Describe the blister Describe the autoimmune process Describe the IF stain pattern Nikolsky + or - ?
Vulgaris:
- Suprabasal acantholytic blisters
- IgG against desmosomes
- IF stain = net-like
- Nikolsky (+)
pemphigu(S) (s)uperficial blisters
pemphigoi(D) (d)eeper blisters
Bullous Pemphigoid of the Penis:
Describe the autoimmune process
Describe the IF stain
Nikolsky + or - ?
Bullous Pemphigoid:
- IgG against hemidesmosomes
- IF stain = Linear
- Nikolsky (-)
Lichen Planus of the Penis:
What causes the disease?
What do the lesions look like?
- Typically autoimmune; otherwise unknown etiology
- Self limited flat-topped pink-purple macules
Fournier’s Gangrine
Where in the penis is the infection?
What might you see in he lesion (2)?
How dangerous is the infection?
SubQ infection –>
Gas production + necrosis–>
May spread; 40% fatal
Peyroine’s Disease: What happens in this disease? What does the lesion CAUSE? Is it painful? What medical problem may be associated with this disease?
- Fibrous thickening of penile CT
- Causes Penis curves TOWARDS lesion
- PAINFUL
- Asstd w chronic urethritis
Condyloma Acuminatum:
Causative infection
What do the lesions look like?
What are 3 components of the histology?
HPV6, 11
- Sessile or Pedunculate lesions
- BENIGN but RECUR
-Histo: Acanthosis (epidermal thickening), hyperkeratosis, KOILOCYTOSIS (look for perinuclear clearing)
Giant Condyloma:
Who gets this?
What do the lesions look like?
Are they dangerous?
Population: Elderly
- Multiple large cauliflower-like lesions
- Can be verrucous carcinoma
Erythroplasia de Queryat:
Describe the lesion (specific location):
Does it cause visceral malignancy?
Erythroplakia on glans penis –> ~ squamous cell ca.
- Not asstd. with visceral cancer
Bowen’s Disease Who gets this? Describe the lesion Are they associated with visceral malignancy? Describe the histo:
- Population: Elderly
- Leukoplakia (single bright red plaque w moist surface) ~squamous cell ca.
- 30% Asstd. with visceral malignancy
- Histo: Dysplastic cells in epi layer
Bowenoid Papulosis
Who gets this?
Describe the lesions and disease progression
Describe the histo
With what infection is this lesion associated?
Population: Sexually active patients UNDER 40 yoa
- Multiple reddish papules NO PROGRESSION to squamous cell ca.
- Histo: identical to Bowen’s disease
- Exceptionally strong assn. with HPV 16
Squamous Cell Ca. of Penis
Population?
What can be done to prevent the disease?
Describe the lesion and disease progression?
How common is it?
With what infections is it associated?
Briefly describe the histo.
Population: Elderly; protect with circumcision and good hygiene
- Slow growing and starts as plaque/ precursor lesion
- # 1 malignancy of penis
- HPV 16/ ~18
- Histo: intercellular bridging; keratin pearls
Cryptorchid Testis: How common is it? Where is it? What are the risks assc? Histo: 2 changes + result of untreated testis.
Population: 1% of 1yom, usually unilateral idiopathic
- Testes stuck in inguinal canal or abdomen
- Sterility if bilateral; ^ risk cancer by age 2
histo: ^^ hyaline and leydig cells, atrophy if not repaired
(balls not meant to live in abdomen, they will die here.)
Testicular Atrophy
What are some potential causes?
What are two histo changes?
What is the result?
Age/ Atherosclerosis/inflammation/ cryptorchidism etc –>
Histo: scarring; BM thickening
Result: STOP spermatogenesis
Mumps Orchitis: Who gets this? What is the causative virus (describe genome and capsid) What are the histo changes? Final sequelae?
Population: Adolescents/ Adults (NOT CHILDREN)
Paramyxovirus: linear (-)ssRNA; helical nucleocapsid
Histo: mononuclear infiltrate +/- neutros and abscesses
Result: atrophy/ infertility
Gonorrhea:
Who gets this? What is the causative organism? Where is the infection? Is the libido effected? List some complications (4) How is it treated?
Population: YA
Gram (-) Diplococcus
-Infection spreads from epididymis –> testes
-spares Leydig cells and thus libido
Complications: abscesses = risk sterility
also: Reiters/ PID/ Fitz Hugh Curtis
Tx: Third gen. Ceph or Pen G
Syphilis:
Where is the infection?
Why do you see histologically? (3)
Treponema Pallidum, spirochete
Infection spreads from testes –> epididymis
Histo: GUMMAS (chronic granulomas); Obliterative endarteritis; perivascular cuffing
Chronic Orchitis: most common cause?
Usually nonspecific
TB in the testes or epididymis:
What do you see?
Where does the infection start?
Caseating granulomas
-Infection spreads from epididymis–> testes
(opposite of syphillis)
***NOTE: if NONCASEATING granulomas think SARCOID, that shit can happen anywhere.
Torsion of Testes: Who gets this? what causes it? What is the ultimate result? What do you see on PE?
-Adolescents/ Kids
-Testes don’t attach to processus vaginalis
-Spermatic cord twists–> STOP venous drainage–>
Hemorrhagic infarction
-acute pain/ swelling + ABSENT cremasteric reflex
Varicocele
What is the most common cause?
What is the classic PE finding?
what might be the end result if not treated?
- Obstruction of lt. renal vein–> Dilation of spermatic vein -scrotal swelling “bag of worms”
- infertility if untreated