Male Repro Problems

Question 1

What is hydrocoele? What is it due to?

Why may it enlarge in young when coughing?

Answer 1

Serous fluid in the tunica vaginalis
Commonly due to failure of tunica vaginalis
When youn, hydrocoeles are still connected to peritoneal cavity so enlarge when cough due to raised pressure.

Question 2

What is hematocoele?

Answer 2

Blood in the tunica vaginalis

Question 3

How can hydrocoele and haematocoele be distinguished?

Answer 3

Transillumination as light can pass through serous fluid but not blood.

Question 4

What is varicocoele? How does it feel?

Answer 4

Varicositeis (abnormal dialtion) of the pampiniform venous plexus.
Feels like a bag of worms.

Question 5

Why does varicocoele occur most commonly on left?

Answer 5

Left testicular vein travels superiorly and connects with the left renal vein, while right rrains into the inferior vena cava.
LRV is much higher.
Varicosities form when valve system between two veins all and blood fassl backwards under the pull of gravity.
Right testicular vein drains directly into the inferior vena cava at an oblique angle, further down.
Valves do not have to support the same weight of blood.
The left drains into a smaller vessel - LRV, at a perpendicular angle.

Question 6

What does right sided varicosity suggest?

Answer 6

Raised IVC pressure due to obstruction.

Question 7

What is spermatocoele?

Answer 7

Retention cyst within the epididymis.
Contains turbid fluid that inhibits transillumination.
Segment is marginally connected to the rete testis and contains degenerate products of spermatogenesis.

Question 8

What is an epididymal cyst?

Answer 8

Contains clear fluid and transilluminates brightly.

Arises from unconnected segments of the efferent tubules.

Question 9

Epididymitis?

Answer 9

Inflammation of the epidermis, usually due to infection.

Question 10

Describe inguinal hernia, direct and indirect.

Answer 10

Contents of abdominal cavity can protrude into scrotum via the inguinal canal.

Direct:
Hernia directly into inguinal area
Medial to epigastric vessels

Indirect
Hernia indirectly into inguinal area via inguinal canal.
Latera to inferior epigastric vessels
Reopening fo processus vaginalis gives potential continuity between peritoneal cavity and tunica vaginalis.

Question 11

What is testicular torsion? Where does it occur?

Answer 11

Twisting of the spermatic cord
Risk of necrosis of the testes.
Usually occurs just above upper pole of testes.

Question 12

What is cryptorchid?

Answer 12

Maldescended testis
Spermatogenesis is impaired due to elevated temperature
Germ cells are absent while sertoli cells and leydig cells secrete male sex hormones.
Increased risk of malignancy

Question 13

What is orchitis?

Answer 13

Inflammation of the testis
Impaired spermatogensis
Sometimes leading to seminiferous tubule degeneration and infertility.

Question 14

Where does benign prostatic hyperplasia occur?

Answer 14

Occurs mainly in central zone/middle lobule

Question 15

What symptoms does BPH present with? Why?

Answer 15

Dysuria, noturia, urgency due to zone’s close proximity to the urethra.

Question 16

Where do prostatic malignancies usually occur?

Answer 16

Peripheral zone

Question 17

Why do prostatic malignancies present late

Answer 17

Need to get very large to compress urethra.

Question 18

How do prostatic malignancies metastiasize?

Answer 18

Lymphatics (internal iliac and sacral lymph nodes)
Venous route (internal vertebral plexus to vertebrae and brain)

Question 19

Describe PSA testing

Answer 19

In BPH, prostate specific antigen is normal/slightly raised.

In Carcinoma - markedly raised

Question 20

What part of the prostate is felt on DRE

Answer 20

Posterior (median groove) of prostate