Male Reproductive System Flashcards
Priapism: Overview
- prolonged and painful erection for several hours (≥2-4 hours), not associated w/ sexual stimulation or desire
- pt may awaken w/ an erection
- bimodal distribution w/ peak incidence in children 5-10 years and adults 20-50 years
- can be idiopathic or caused by certain meds and disease states (secondary priapism)
- Most common cause in adults (25%) is meds, such as intracavernosal injections to tx erectile dysfunction
- Males w/ sickle cell disease are at very high risk (35-45%) of ischemic priapism
Other RF:
- high doses of erectile dysfunction drugs
- cocaine
- quadriplegia
TWO types: ischemic and nonischemic
** Ischemic priapism is considered a urologic emergency!
Paraphimosis: Overview
- occurs when foreskin cannot be returned back to its original position because of swelling of head (glans) of penis; glans is swollen, reddened, and painful
- highest incidence is among uncircumcised infants and toddlers
- if glands become red, swollen, and painful, it may not return back to its original state
- REQUIRES EMERGENCY TREATMENT! because may cause ischemic changes
- a small slit in the foreskin (w/ topical anesthesia) can help relieve pressure
- in severe cases, a circumcision may be needed
- considered a urologic emergency → Refer to ED!
Testicular Cancer: Overview
- teenage to young adult male c/o nodule, sensation of heaviness ora ching, one larger testicle, and/or tenderness in one testicle
- can present as a new onset of a hydrocele (from tumor pressing on vessels)
- usually painless and asymptomatic until metastasis
- More common in white males, 15-30 years
- rare in African Americans
Testicular Cancer: Overview
- teenage to young adult male c/o nodule, sensation of heaviness ora ching, one larger testicle, and/or tenderness in one testicle
- can present as a new onset of a hydrocele (from tumor pressing on vessels)
- usually painless and asymptomatic until metastasis
- More common in white males, 15-30 years
- rare in African Americans
Prostate Cancer
- Older to elderly man
- complains of new onset of low-back pain and rectal area/perineal pain or discomfort accompanied by obstructive voiding sx such as weaker stream and nocturia
- may be asymptomatic
- more common in older (>50 years), obese, and African Americans, + men w/ fam hx of prostate CA (father, brother)
Torsion of the Appendix Testis (Blue Dot Sign)
- school-age boy c/o abrupt onset of blue-0colored round mass located on testicular surface
- mass resembles a “blue dot”
- appendix testis is a round, small (0.03 cm), pedunculated, polyp-like structure that is attached to testicular surface (on the anterior superior area)
- blue dot is caused by infarction and necrosis of appendix testis d/t torsion
- Cremasteric reflex is present< NOT testicular torsion
- Torsion of the appendix testes rarely happens in adults
- Most cases occur in children ages 7-14 years (mean age is ~10.5 years)
Testicular Torsion: Overview
- A male (usually adolescent) reports waking up in the middle of the night or in the morning w/ abrupt onset of an extremely painful and swollen red scrotum
- usually <12 hrs in duration
- some have inguinal pain or lower abdominal pain as presenting complaint
- frequently accompanied by nausea and vomiting
-affected testicle/scrotum, located higher and closer to the body than the unaffected testicle - cremasteric reflex is MISSING!
- majority of cases, 2/3, occur between ages of 10-20 years
- SURGICAL EMERGENCY! Refer to ED!
Fournier’s Gangrene: Overview
- rare, rapidly progressing polymicrobial necrotizing fasciitis of external genitalia and perineum
RF:
- diabetes
- trauma to the urethral/penile area
- use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (e.g., canagliflozin, dapagliflozin, empagliflozin); ↑ risk for this infection
S/Sx
- abrupt onset of severe pain, redness, and swelling of skin in perineum
- spreads rapidly
- skin will turn black (gangrene)
- can include scrotum and penis or labia in females
SURGICAL EMERGENCY! Requires surgical debridement and IV antibiotics
Normal Findings: Spermatogenesis (Spermarche)
- Ideal temp for sperm production is 1º C to 2º C (33.8º F-35.6º F) lower than core body temp
- sperm production begins in late puberty (Tanner stage IV) and continues for entire lifetime
- sperms are produced in seminiferous tubules of testes
- sperms require 64 days (~3 months) to mature
Normal Findings: Testes
- Cryptorchidism (undescended testes) ↑ risk of testicular cancer
- production of testosterone/androgens is stimulated by release of luteinizing hormone
- Spermatogenesis is stimulated by both testosterone and follicle-stimulating hormone
- the left testicle usually hands lower than the right
Normal Findings: Prostate Gland
- heart-shaped gland growing throughout life cycle of male
- produces prostate-specific antigen (PSA) and prostatic fluid
- prostatic fluids (alkaline pH) helps sperm survive in vagina (acidic pH)
- prostate grows throughout a man’s life
- up to 50% of 50-year-old men have BPH, an enlargement of prostate
Normal Findings: Epididymis
- coiled tubular organ located at posterior aspect of testis
- storage area of immature sperm (sperm takes 3 months to mature)
- resembles a “beret” on the upper pole of the testes
Normal Findings: Vas Deferens (Ductus Deferens)
- tubular structures that transport sperm from epididymis toward urethra in preparation for ejaculation
- tubes are cut/clipped during a vasectomy procedure
Normal Findings: Cremasteric Reflex
- testicle is elevated toward body in response to stroking or lightly puinching the ipsilateral inner thigh (or thigh on the same side as testicle)
- cremasteric reflex is absent w/ testicular torsion
Normal Findings: Transillumination - Scrotum
- useful for evaluating for undescended testicle (cryptorchidism), hydrocele, spermatocele, and other types of scrotal mass
- direct a beam of light behind one scrotum (turn off room light); hydrocele will transilluminate (serous fluid inside scrotum) and will have a larger glow than unaffected side
- testicular tumor will not transilluminate (solid tumor blocks light)
- Varicocele (“bag of weorms”) will not transilluminate
Testicular Cancer
1. Definition/Etiology
2. Clinical Presentation
3. Physical/objective Findings
4. Lab/Diagnostics
5. Treatment Plan
- Most common tumor in males aged 15-30 years
- more common in white males - teenage to young adult male
- c/o nodule
- sensation of heaviness or aching
- one larger testicle
- tenderness in one testicle
- may present a new onset of hydrocele (from tumor pressing on vessels)
- usually painless and asymptomatic until metastasis
- teenage to young adult male
- affected testicle feels” heavier” and more solid
- may palpate a hard, fixed nodule (most common site is lower pole of testes)
- 20% of cases will have a concomitant hydrocele
- affected testicle feels” heavier” and more solid
- US of testicle reveals solid mass
GOLD STANDARD: Testicular biopsy
- US of testicle reveals solid mass
- Refer to urologist for biopsy and management
- Surgical removal (orchiectomy)
- Refer to urologist for biopsy and management
Testicular Torsion
1. Definition/Etiology
2. Clinical Presentation
3. Treatment Plan
- When spermatic cord becomes twisted, the testis’s blood supply is interrupted
- permanent testicular damage results if not corrected within first few hours (<6 hrs)
- if not corrected within 24 hrs, 100% of testicles become gangrenous and must be surgically removed
- more common in males w/ “bell clapper deformity,” which causes the testicle to lay more sideways than longitudinally
- adolescent or adult male - sudden onset of severe testicular pain
- has extremely swollen red scrotum
- some may have acute hydrocele (severe edema)
- c/o severe N/V
- affected testicle is higher than normal testicle
- Cremasteric reflex is missing**
- sudden onset of severe testicular pain
- Call 911 ASAP!
- Preferred test in ED is doppler US with color flow study
- Treatment can be manual reduction or surgery w/ testicular fixation using sutures
- Call 911 ASAP!
Prostate Cancer
1. Definition/Etiology
2. Clinical Presentation/Objective Findings
3. Labs/Diagnostics
4. Treatment Plan
- most common CA in men (incidence)
- African American males have higher risk of prostate CA
- Average age of diagnosis: 71 years
- most common CA in men (incidence)
RF:
- >50 years
- African American
- obesity
- positive family hx (1º relative will double risk)
- Routine prostate CA screening (digital rectal exam [DRE] w/ PSA is not recommended
- Study shows that absolute risk reduction of prostate CA deaths w/ screening is very small
- Individualized management, based on pt’s risk factors and age
- Painless and hard fixed nodule (or indurated area) on prostate gland on an older male, detected by DRE
- ↑ PSA >4.0 ng/mL
- Diagnostic test: Biopsy of prostatic tissue (obtained by transurethral US)
- Screening Test: Not recommended; if pt wants to be tested, order PSA level /w DRE; if limited life span (<10 years), not recommended
- ↑ PSA >4.0 ng/mL
- Refer to urologist if PSA >4.0 ug/mL; suspect prostate CA
- Individualize screening is based on RF; discuss risk (bleeding, infection, impotence, procedures, and psychological trauma) vs benefits
- Most CA are not aggressive and are slow growing; watchful waiting/monitoring by urologist is common
- If symptomatic (nocturia, weak stream, hesitancy, dribbling), alpha-blockers (terazosin/Hytrin) are FIRST-LINE therapy → * Initiate drug therapy w/ antiandrogens (Proscar), hormone blockers (e.g., Lupron), and others
- Refer to urologist if PSA >4.0 ug/mL; suspect prostate CA
Benign Prostatic Hyperplasia
1. Definition/Etiology
2. Clinical Presentation
3. Objective Findings
- Seen in 50% of men >50 (up to 80% of men >70 years)
- rarely in those younger than 40
- Rule out prostate CA
- Use the American Urological ASsociation (AUA) urinary sx score/International Prostate Symptom Score (IPSS) questionnaire to assess the severity of the pt’s BPH sx
- Seen in 50% of men >50 (up to 80% of men >70 years)
- older men
- c/o gradual development (years) of urinary obstructive sx
- weak urinary stream
- postvoid dribbling
- feelings of incomplete emptying
- occasional urinary retention
- Nocturia is very common
- older men
- PSA is elevated (norm is 0-4 ng/mL)
- Prostate that is symmetrical in texture and size (rubbery texture) is enlarged
- Lifestyle changes may help ↓ sx and include reduction of caffeine and alcohol intake, avoidance of fluids before bedtime, and avoidance of diuretic meds (if possible)
- PSA is elevated (norm is 0-4 ng/mL)
Benign Prostatic Hyperplasia
4. Medications
FIRST LINE: Alpha-adrenergic antagonists
- Tamsulosin (Flomax)
- terazoasin (Hytrin) 5 mg
- doxazosin (Cardura)
5-alpha-reductase inhibitors (binds to prostate gland directly)
- Finasteride (Proscar) → inhibits type 2 5-alpha-reductase (blocks androgen receptor) and acts directly on the prostate gland to shrink it (temporarily) while on meds; if pt stops taking Proscar, the size of prostate gland returns back to its original size
- shrinks by 50% while on Proscar (so PSA must be doubled or multiplied by 2)
- Category X drug (teratogenic); should NOT be touched w/ bare hands by reproductive-aged females (adversely affects male fetus)
Avoid drugs that worsen symptoms
- anticholinergics and sympathomimetics (cause urine retention)
Ex: antihistamines, decongestants, cold meds, caffeine, atropine, antipsychotics, and TCA
Herbal
- Saw palmetto (mild improvement for some)
- does NOT work for everyone
- Duration of treatment ranges from a few months to daily for many years
- Watch for an adverse effect of alpha-blockers, which is orthostatic hypotension
- Advise pt that they may have dizziness d/t low BP
- Pts w/ HTN and BPH can use alpha-blockers that ↓ BP ( terazosin, doxazosin)
- Instruct pts to take medication at bedtime
- Tamsulosin may have less effect on BP than the other alpha-blockers
- If hypotension is a problem, discontinue and start on a trial of finasteride (Proscar)
** Male w/ BPH and HTN: start w/ alpha-blocker that affects BP (Hytrin, Cardura) first; works by relaxing x smooth muscles on prostate gland and bladder neck
Chronic Bacterial Prostatitis
1. Definition/Etiology
2. Clinical Presentation
3. Objective Findings
4. Labs/Diagnostic
5. Medications
- Chronic (>6 weeks) infection of prostate
- some men report hx of acute UTI or acute bacterial prostatitis
- others are asymptomatic
- more common in older men
- caused most commonly by: E. coli and Proteus
- Nonbacterial prostatitis has same sx but is culture negative - Elderly man w/ hx of several weeks of suprapubic or perineal discomfort
- accompanied by irritative voiding sx
- dysuria
- nocturia
- frequency
- NOT accompanied by systemic sx
- Some men are asymptomatic
- Elderly man w/ hx of several weeks of suprapubic or perineal discomfort
- Prostate may feel normal (or slightly “boggy”) to palpation; not tender
- UA: normal (unless pt has prostatitis, epididymitis, cystitis)
- Prostate may feel normal (or slightly “boggy”) to palpation; not tender
- UA, urine culture and sensitivity (C&S), PSA
- PSA goes up w/ BPH, after sexual intercourse, infection, or inflammation
- Transurethral US can measure prostate volume
- UA, urine culture and sensitivity (C&S), PSA
- Ciprofloxacin (Cipro) 500 mg PO BID x 4 weeks
- Alternatives: Trimethoprim-sulfamethoxazole (Bactrim DS) one tablet PO BID x 1-3 months
- Refer to urologist
- Ciprofloxacin (Cipro) 500 mg PO BID x 4 weeks
Acute Prostatitis
1. Definition/Etiology
2. Clinical Presentation
3. Objective Findings
4. Labs/Diagnostics
5. Treatment/Medications
- Acute infection of prostate
- Infection ascends into urinary tract
- most common non-sexually transmitted cause is Enterobacteriaceae (E. coli, Proteus)
- if condition occurs in a male <35 years of age, it is treated like gonococcal or chlamydial urethritis
- Acute infection of prostate
- Adult to older man c/o sudden onset of fever
- chills w/ suprapubic and/or perineal pain/discomfort
- pain sometimes radiates to back or rectum
- accompanied by UTI sx such as dysuria, frequency, and nocturia w/ cloudy urine
- DRE reveals extremely tender prostate that is warm and boggy
- pt may have an accompanying infection of bladder (cystitis) or epididymitis
- Adult to older man c/o sudden onset of fever
- Gently examine prostate; prostate will be extremely tender and warm
► Warning!!! Vigorous palpation and massage of an infected p[rostate can cause bacteremia
- Gently examine prostate; prostate will be extremely tender and warm
- CBC: Leukocytosis w/ shift to the left (presence of band cells)
- UA: large amount of WBC (pyuria), hematuria
- Urine C&S: if possible, also obtain urine after gentle prostatic massage
- CBC: Leukocytosis w/ shift to the left (presence of band cells)
- Based on age and presumptive organism
- Age <35 years (or high risk for STD): Ceftriaxone 250 mg IM and doxycycline 100 mg BID x 10 days
- Age >35 years or unlikely sexual transmission: Ciprofloxacin or ofloxacin PO BID or levofloxacin (Levaquin) PO daily x 10-14 days (minimum); some experts recommend 4-6 weeks of therapy
- Antipyretics, stool softener w/out laxative (Colace), sitz baths, hydration
- Pt should be hospitalized if septic or toxic
- Learn to distinguish b/t chronic prostatitis and acute prostatitis
- chronic is of gradual onset; prostate can feel normal w/ DRE (older males)
- Acute prostatitis presents as sudden onset; prostate is swollen and very tender (younger males)
- SSRIs cause erectile dysfunction in men
- SSRI that has the highest risk of ED is paroxetine (Paxil)**
Acute Bacterial Epididymitis
1. Definition/Etiology
2. Clinical Presentation
3. Lab/Diagnostics
4. Treatment/Medications
- bacteria ascend urethra (urethritis) and reach epididymis, causing infection
- AKA bacterial epididymo-orhitis
- R/O testicular torsion (can mimic condition)
- sexually active males <35 yo → more likely to be infected w/ STD (chlamydia, gonorrhea)
- Males >35 yo → usually d/t gram- E. coli - adult to older man c/o acute onset of swollen red scrotum, hurts
- unilateral testicular tenderness w/ urethral discharge
- scrotum is swollen and erythematous
- induration of posterior epididymis
- sometimes accompanied by hydrocele
+/- s/sx of URI
- may have systemic sx such as fevers
- Discharge: green-colored purulent or serous clear (e.g., chlamydia, viral, chemical)
- Positive Prehn’s sign: relief of pain w/ scrotal elevation
- adult to older man c/o acute onset of swollen red scrotum, hurts
- CBC: Leukocytosis
- UA: Leukocytes (pyuria), blood (hematuria), nitrates
- Urine C&S
- Urine nucleic acid amplification test (NAAT) for gonorrhea and chlamydia
- CBC: Leukocytosis
- Age <35 yo (or suspect STD) → Doxycycline PO BID x 10 days + ceftriaxone 250 mg IM x 1; do NOT forget to treat sex partner
- Age >35 yo → Ofloxacin (Floxin) 300 mg PO x 10 days or levofloxacin (Levaquin) 500 mg PO x 10 days; caution pt regarding risk of tendon injury and discourage vigorous LE exercise while on fluoroquinolone
- Treat pain w/ NSAIDs (ibuprofen, naproxen) or acetaminophen w/ codeine (severe pain)
- employ scrotal elevation
- scrotal ice packs
- bed rest for few days
- give stool softeners (e.g., docusate sodium or Colace) if constipation
- Refer to ED if septic, severe intractable pain, abscessed, and so forth
- Age <35 yo (or suspect STD) → Doxycycline PO BID x 10 days + ceftriaxone 250 mg IM x 1; do NOT forget to treat sex partner
Positive Prehn’s sign
relief of pain w/ scrotal elevation
Erectile Dysfunction
1. Definition/Etiology
- Organic
- Drug-induced
- Psychogenic
- inability to produce an erection firm enough to perform sexual intercourse
- several kinds of male sexual dysfunction
- incidence ↑ w/ age
- men 50-59 (18%), 60-69 (25%), 70-79% (37%), 80-89 (80%)
- men ≥50 → more likely r/o organic causes
- check med hx, CONTRAINDICATED is nitrates
- inability to produce an erection firm enough to perform sexual intercourse
- Organic Causes → Inability to have a satisfactory erection
- can be caused by aging, neurologic (diabetic neuropathy, MS, spinal cord damage)
- vascular or hormonal (hypogonadism), or other disorders
- Drug-induced
- SSRIs (esp paroxetine [Paxil], antipsychotics, recreational drugs, alcohol [large amount], beta-blockers, thiazide diuretics); if smoker, advise smoking cessation
- Psychogenic causes → Spontanously has early-morning erection or normal nocturnal tumescence or can achieve a firm erection w/ masturbation
- can be caused by performance anxiety, depression, relationship issues, stress
- Reduced libido → affects 4-15% of men, ↑ w/ age
*Check cremasteric reflex; if missing, RULE OUT neurologic causes
Erectile Dysfunction
2. Labs
3. Treatment/Medications + adverse effects
4. Contraindications
- R/O diabetes (FBG, A1C), thyroid disorder (TSH), morning serum testosterone
- FIRST LINE: treat w/ phosphodiesterase type 5 inhibitor drug class
* Sildenafil citrate (Viagra):
- 24/50/100 mg; take 1 dose 30-60 mins before sexy
- duration of 4 hours
- use only one dose Q24 hrs
► Another use is for pulmonary HTN (brand name Revatio)
► Do NOT combine Viagra w/ Revatio or guanylate cyclase-C meds such as riociguat (Adempas) → will cause severe hypotension
► Careful w/ alpha-blockers, hx of MI in past 6 months, or unstable angina; risk of hypotension
► Do NOT use w/ drugs that prolong QT interval (macrolides)
► Advise pt to take med on empty stomach and avoid fatty foods for optimal effectiveness; food and fats delay drug action
!! WARNING !! - can ↓ blood flow to optic nerve, causing sudden vision loss; has occurred in pts w/ diabetes, heart disease, HTN, or other preexisting eye problems
- FIRST LINE: treat w/ phosphodiesterase type 5 inhibitor drug class
- Vardenafil (Levitra) → 1 dose of 30-60 mins before sex, duration is 4 hrs
- Tadalafil (Cialis) → 5-20 mg; can be taken several hours before sex d/t long duration (8up to 36 hrs); may also be prescribed as a daily dose for combined BPH and ED (5-10 mg)
Adverse effects
- headache
- facial flushing
- dizziness
- hypotension
- nasal congestion
- priapism
- changes in vision
Other treatments
- vacuum-assisted erection devices
- penile self-injection (intracavernosal injection of alprostadil)
- penile implant
- CBT (for psychogenic causes)
- Concomitant nitrates (↑ hypertensive effects)
- use caution w/ alpha-blockers, recent post-MI, post-CVA, major surgery, or any condition which exertion is contraindicated
- avoid combining w/ grapefruit juice or alcoholic drinks
- Concomitant nitrates (↑ hypertensive effects)
Peyronie’s Disease
1. Definition/Etiology
2. Clinical Presentation/Labs
3. Treatment
- an inflammatory and localized ds of penis resulting in fibrotic plaques on the tunica albuginea → penile pain that primarily occurs during erection
- may resolve spontaneously in small cases, but nearly half cases worsen over time
- psychological issues because it affect man’s ability to have erection, which can be distressing
- an inflammatory and localized ds of penis resulting in fibrotic plaques on the tunica albuginea → penile pain that primarily occurs during erection
- palpable nodules
- penile deformity (crooked penile erections)
- palpable nodules
Labs: none; clinical diagnosis
- Refer to urologist
- Surgical correction if needed
Balanitis
1. Definition/Etiology
2. Clinical Presentation
3. Treatment
- Candidal infection of glans penis
- when foreskin (prepuce) is involved → called balanoposthitis
- more common in uncircumcised men, diabetes, and/or immunocompromised men
- use of SGLT2 inhibitors for diabetes management, such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance), ↑ risk of balanitis, UTIs, and vaginal yeast infection
- Candidal infection of glans penis
- redness, pain, tenderness, or pruritis of glands and/or foreskin that developed over 3-7 days
- PE of penis will show redness and shallow ulcers w/ curd-like discharge on glans penis
- redness, pain, tenderness, or pruritis of glands and/or foreskin that developed over 3-7 days
- OTC azole creams (clotrimazole 1% or miconazole 2%) BID daily for 7-14 days
- if partner has candidiasis, treat at the same time
- OTC azole creams (clotrimazole 1% or miconazole 2%) BID daily for 7-14 days
Cryptorchidism
Testicle that doe snot descent spontaneously by 4 months of age
- up to 30% of premature infants are bone w/ undescended testes
- can affect or only one testicle
- 70% will descend spontaneously by 12 months of age
- markedly increases risk of testicular CA
- usually corrected during infancy
- look for empty scrotal sac
Phimosis
1. Physiologic
2. Pathologic
- seen in almost all newborn males
- considered normal
- foreskin should NOT be red or swollen
- avoid forcible retraction → causes tearing, which will cause scarring and development of pathologic phimosis - when foreskin is truly nonretractable; foreskin cannot be pushed back from the glans penis d/t inflammation
- in adults, d/t chronic inflammation and edema of foreskin
- can complicate sexual function, voiding, and hygiene
→ Refer to urologist
Paraphimosis`
- when foreskin cannot be returned back to its original position d/t swelling of head (glans) of the penis
- glans is swollen, reddened, and painfuil
- highest incidence among uncircumcised infants and toddles
- if glans become red, swollen, and painful, it may not return back to its original state
** Requires emergency treatment because may cause ischemic changes - a small slit in foreskin (with topical anesthesia) can help relieve pressure
- in severe cases, a circumcision may be needed
*** Considered a UROLOGIC EMERGENCY! → Refer to ED!
Varicocele
- varicose veins in scrotal sac (feels like “bag of worms”
- new-onset varicocele can signal testicular tumor (20%) or a mass that is impeding venous drainage
NEEDS US of scrotum!
- can contribute to male infertility of large enough (↑ temp of affected testicle)
Tx: Surgical removal of varicosities if infertile
- Most benign varicoceles are left-sided
Unilateral R-sided varicoceles may be indicative of a tumor inside the chest, abdomen, or pelvis that is compressing a large vein, such as vena cava
- another abnormal finding is a varicocele that does not reduce or drain in the supine position
- benign varicoceles ↓ in volume when the pt is supine d/t blood draining (gravity) from the abnormally dilated scrotal veins
Hydrocele
- serous fluid collects inside tunica vaginalis
- during scrotal exam, hydroceles are located superior and anterior to testes
- most hydroceles are asymptomatic
- more common in newborns; most cases resolve spontaneously
- rill glow w/ transillumination
- glow is larger on affected scrotum compared w/ unaffected scrotum
- if complaints of testicular pain and scrotal swelling or new-onset hydrocele in an adult or enlarging hydrocele → order scrotal Doppler US to R/O tumor, testicular hematoma, rupture, testicular torsion, orchitis, or epididymitis
- Refer to urologist!
Spermatocele
- a spermatocele (or epididymal cyst) is a fluid-filled cyst containing nonviable sperm
- will transilluminate d/t filled w/ fluid
- can be palpated as a separate smooth and firm lump at the head of the epididymis, which lies above and behind each testicle
- does NOT affect fertility
- treated only if they cause pain, discomfort, or embarrassment (Surgical excision)
- US is imaging test of choice
