Male Problems Flashcards
cause of penile fracture?
usually intercourse
presentation of penile fracture
pop/crack that was heard pain discolouration swelling urethral injury (haematuria)
management of penile fracture
circumcision with degloving to expose all 3 compartments
repair
what is testicular torsion?
cord rotates around arterial supply causing ischaemia and cell death
presentation of testicular torsion
bell clapper deformity
extreme pain that can refer to lower abdomen
N&V
diagnosis of testicular torsion
testes high in scrotum
absence of cremasteric reflex
doppler USS
management of testicular torsion
prompt exploration
if necrotic remove
what is torsion of appendage?
twisting of tissue above th etesticle
presentation of torsion of appendage
tenderness at upper pole
blue dot sign
cremasteric reflex is present
management of torsion of appendage
often resolves spontaneously
causes of epididymitis
UTI
urethritis
catheterisation
instrumentation
presentation of epididymitis
dysuria
pyrexia
cremasteric reflex present
diagnosis of epididymitis
doppler USS
urine for culture
chlamydia PCR
what does a doppler USS for epididymitis show?
swollen epididmyitis and increased blood flow
management of epididymitis
analgesia
scrotal support
ofloxacin
what is paraphimosis?
painful swelling of foreskin distal to phimotic ring
cause of paraphimosis
often due to foreskin retraction and not replaced
management of paraphimosis
iced glove, granulated sugar 1-2 hours
multiple punctures in oedematous skin
manual compression of glans with distal traction, dorsal slit
what is priapism?
prolonged erection >4hours that is not associated with sexual arousal
causes of priapism
injection for ED trauma haematological dyscrasias (sickle cell) neurological idiopathic
classification of priapism
- ischaemic
2. non-ischaemic
what is ischaemic priapism?
compartment syndrome
corpora cavernosa are rigid and tender
what is non-ischaemic priapism?
traumatic disruption to artery
diagnosis of priapism
- aspiration of blood from corpus cavernosum= if dark with low and high CO2 then ischaemic
- Colour duplex USS= minimal flow in vascular and normal flow in non-ischaemic
management of ischaemic priapism
aspiration +/- irrigation with saline and alpha agonist
if delay do penile prosthesis
management of non-ischaemic priapism
observe as most can resolve
arterial embolisation
what is Fournier’s gangrene?
necrotising fasciitis around male genitalia
presentation of Fournier’s gangrene
toxicity out of proportion with exam
diagnosis of Fournier’s gangrene
XR
USS
management of Fournier’s gangrene
antibiotics
surgical debridement
three examples of infective emergencies
- Fournier’s gangrene
- emphysematous pyelonephritis
- perinephric abscess
what is emphysematous pyelonephritis?
acute necrotising parenchyma and perirenal infection
cause of emphysematous pyelonephritis
E. coli
presentation of emphysematous pyelonephritis
fever
vomiting
flank pain
diagnosis of emphysematous pyelonephritis
KUB shows gas
management of emphysematous pyelonephritis
nephrectomy
cause of perinephric abscess
rupture of an acute cortical abscess into perinephric space or haematogenous spread
presentation of perinephric abscess
insidious onset
pyrexia
flank mass
pyuria
diagnosis of perinephric abscess
high CK
CT
management of perinephric abscess
antibiotics
percutaneous or surgical drainage
