Male Reproductive Flashcards
Dick Necrotizing Fasciitis
Dx/Tx =
Fournier’s
Debridement in OR
Testicular Torsion tx:
Bilateral Orchiopexy
Risk factors for Priapism include:
excess Testosterone
Trazodone
(3)
Cocaine
Etoh
Sickle Cell Anemia
2 treatments for Priapism:
- Aspirate blood from Corpus Cavernous
2. Intracavernous Phenyleprine injection
alpha 1 agonist
BPH can increase risk of what infection?
UTI
BPH most likely to arise in what 2 zones?
Central and Transition
Prostate cancer most likely to arise in what zone?
Peripheral
PSA levels in BPH versus Prostate Cancer:
BPH: wnl/elev PSA
Prostate cancer: elevated PSA
Nodular and firm prostate concerning for:
Prostate cancer
Risk factors for Prostate cancer:
Age > African American > FMH
Recurrent UTIs with intermittent relief and
painful ejaculation is consistent with ____.
Treatment:
Chronic Bacteria Prostatitis
Fluoroquinolone (Ciprofloxacin)
Painful prostate on palpation consistent with
Acute Bacterial Prostatitis
Painful, unilateral testicular mass
(↑ AFP/hCG/LDH)
what do next? what is likely dx & tx?
Scrotal u/s
Testicular Cancer
Orchiectomy
Ropey bag of worms
worse with standing
better with laying
NO translumination
Varicocele
dilation of pampiniform plexus → retrograde flow
Treatment of varicocele in young/fertile patients
Gonadal vein ligation to prevent infertility
*old men get NSAIDs & scrotal sac surgery
Finasteride is a _____ used for treatment of ____
5 alpha inhibitor
BPH
Leuprolide is a _____ which can be used as an adjuvant for treatment of ____
GnRH agonist
BPH s/p TURP
What is a surgery that can be used to treat BPH?
Transurethral Resection of Prostate (TURP)
can recur so give finasteride + leuprolide
In a penile fracture you repair the ___
Tunica alba
s/p penile fracture patient has urinary retention, dysuria, or blood at the urethral meatus.
What do next?
Urethrogram
Unilateral varicocele that does not improve when supine what is the likely diagnosis and what is the next best step in management?
Tumor blocking L Renal vein or IVC
Get a CT scan
A painless enlargement may be present
Dull, aching pain of the hemiscrotum (typically left-sided)
Soft bands/strands are palpable in the upper pole of the affected scrotum (“bag of worms”)
Symptoms worsen when standing or when performing the Valsalva maneuver.
Negative transillumination
Varicocele
(abnormal dilation/tortuosity of the pampiniform plexus s/t proximal obstruction of the spermatic vein)
MCC of scrotal enlargement
Initial imaging and follow up imaging for varicocele :
Ultrasound
Dilated (> 2 mm) hypoechoic pampiniform vessels
Doppler ultrasonography
*Grade based on the extent of vein dilation/reflux during Valsalva
A unilateral right-sided varicocele is uncommon and should raise suspicion of a mass in the ____ blocking the spermatic vein.
Retroperitoneal space
lymphoma, RCC, Ormond disease
Fluctuant, painless swelling of affected scrotum
Positive transillumination
Hydrocele
fluid in tunica vaginalis
A hydrocele must be differentiated from an
inguinal hernia
Congenital hydrocele usually resolves spontaneously within ____ of birth.
6 months
Indications for hydrocele surgery:
If spontaneous resolution does not occur by __ of age
If ____ is a concern
1 year
infertility
Cryptorchidism typically resolves without treatment via spontaneous descent of testicles by ____ of age.
6 months
if not do surgery ASAP
Cryptorchidism complications include:
Infertility
Inguinal hernia
_____
_____
Testicular cancer (germ cell tumors)
Testicular torsion
Pt presents with unilateral scrotal pain and swelling which radiates to the flank. Pain is alleviated when the scrotum is elevated or sitting
On physical exam
There is tenderness along the posterior testis. Scrotal skin overlying the epididymis appears red, shiny, and edematous
Pt has Low-grade fever and urinary sxs.
Diagnosis?
Acute epididymitis
Acute epididymitis treatment if:
suspected UTI source: ___
suspected STI source (chlamydia/gonorrhea): ___
UTI → levofloxacin
STI → ceftriaxone + doxycycline
Pt presents with painless or dull, achy L scrotum.
Aching worsen when standing or when performing the Valsalva maneuver.
Physical exam reveals soft bands/strands palpable in the upper pole of the affected scrotum (“bag of worms”)
Negative transillumination.
Diagnosis?
Varicocele
Most common cause of scrotal enlargement in men
Varicocele
Abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum due to proximal obstruction of the spermatic vein.
Varicocele
Suspected varicocele on physical exam.
Next best step in management?
U/S (dilated, hypoechoic pampiniform)
*Doppler U/S (assess grade and reflux during Valsalva)
Invasive treatment for Varicocele indications:
- Pain
- Infertility
Laparoscopic ______
Varicocelectomy
affected dilated pampiniform veins are ligated by
percutaneous embolization.
Cryptorchidism complications include:
Testicular cancer (germ cell tumors)
Testicular torsion
_____
_____
Infertility
Inguinal hernia
The testicle is located between the external and internal inguinal ring, preventing adequate mobilization: ___ testis
Inguinal
What testicular tumors present with elevated Tumor markers: alpha fetoprotein (AFP) human chorionic gonadotropin (HCG)
Germ cell tumors
seminoma, dysgerminoma, teratoma, & yolk sac
1st diagnostic step for suspected testicular tumor?
Testicular ultrasound
Then tumor markers & biopsy
If a testicular tumor is suspected, the testis should be ____ and sent to pathology .
____ is contraindicated because of the risk of tumor seeding!
excised
transscrotal biopsy
Presents with Palpable painless lump or ulcerative lesion of the penis.
Swollen inguinal lymph nodes. Diagnosis?
Carcinoma of the penis
tx: surgery
What is the diagnostic (gold standard) for carcinoma of the penis?
Excision biopsy
