Miscellaneous

Question 1

What are the medical benefits of circumcision?

Answer 1

Reduces the risk of penile cancer
Reduces the risk of UTI
Reduces the risk of acquiring STIs including HIV

Question 2

What are medical indications for circumcision?

Answer 2

Phimosis
Recurrent balanitis 
Balanitis xerotica obliterans
Paraphimosis
(Important to exclude hypospadias prior to circumscision as may be used in surgical repair)

Question 3

What is an epididymal cyst/spermatocele?

Answer 3

A painless, fluid-filled cyst in the long, tightly coiled tube that lies above and behind each testicle (epididymis).

Question 4

How does an epididymal cyst/spermatocele present?

Answer 4

Smooth, painless firm lump in the scrotum on top of the testicle/posterior to the testicle.
Separate from the body of the testicle.

Question 5

What conditions are associated with epididymal cysts/spermatoceles?

Answer 5

Polycystic kidney disease
Cystic fibrosis
von Hippel-Lindau syndrome

Question 6

How may diagnosis of epididymal cyst/spermatocele be confirmed?

Answer 6

Ultrasound

Question 7

What is epididymo-orchitis?

Answer 7

An infection of the epididymis +/- testes resulting in pain and swelling.

Question 8

What is the most common cause of epididymo-orchitis?

Answer 8

Local spread of infections from the genital tract such as Chlamydia trachomatis and Neisseria gonorrhoea

Question 9

What is the most important differential diagnosis of epididymo-orchitis?

Answer 9

Testicular torsion

Question 10

What are the features of epididymo-orchitis?

Answer 10

Unilateral testicular pain and swelling
Urethral discharge (possibly)

(Testicular torsion more likley if <20, severe pain and acute onset)

Question 11

What is the management of epididymo-orchitis?

Answer 11

Ceftriaxone (500mg IM)

Doxycycline (100mg TD, 2/52)

Question 12

With what fractures are bladder injuries most commonly seen?

Answer 12

Pelvic fractures

Question 13

What are the two types of urethral injury?

Answer 13

Bulbar rupture - most common, saddle type injury, signs (urinary retention, perineal haematoma, blood at meatus)

Membranous rupture - can be extra or intraperitoneal, penile or perineal oedema/haematoma, prostate displaced upwards.

Question 14

What is the investigation for urethral injury?

Answer 14

Ascending urethrogram

Question 15

What is the management of urethral injury?

Answer 15

Suprapubic catheter (surgical placement, not percutaneously)

Question 16

What are the typical causes of external genitalia injuries?

Answer 16

Penetration
Blunt trauma
Continence
Sexual pleasure-enhancing devices
Mutilation

Question 17

What are the types of bladder injury?

Answer 17

Intra or extraperitoneal

Question 18

How does bladder injury typically present?

Answer 18

Haematuria or suprapubic pain
History of pelvic fracture and inability to void
Inability to retrieve all fluid used to irrigate the bladder through a Foley catheter

Question 19

What are the investigations for bladder injury?

Answer 19

IVU or cystogram

Question 20

What is the management of bladder injury?

Answer 20

Laparotomy if intraperitoneal, conservative if extraperitoneal

Question 21

What charts and scoring systems can be used in someone presenting with LUTS?

Answer 21

Urinary frequency-volume chart: distinguish between urinary frequency, polyuria, nocturia, nocturnal polyuria.

(Male): International prostate symptom score (IPSS): assess the impact on the patient’s life. Classifies as mild, moderate or severe.

Question 22

What is the management of LUTS in a male with predominantly voiding symptoms?

Answer 22

Conservative: pelvic floor training, bladder training, prudent fluid intake.

Alpha-blocker (doxazosin)

Prostate: 5-alpha reductase inhibitor

antimuscarinic

Question 23

What is the management of LUTS in a male with predominantly overactive bladder symptoms?

Answer 23

Conservative: monitor fluid intake, bladder retraining

Antimuscarinic drugs should be offered if symptoms persist (oxybutynin).
Mirabegon 2nd line

Question 24

What is the management of LUTS in a male with predominantly nocturia symptoms?

Answer 24

Advise about fluid intake at night

Furosemide 40mg in late afternoon

Desmopressin

Question 25

What is a Nephroblastoma?

Answer 25

(Wilm's tumour)
<4 yo usually
Mass associated with haematuria
Often metastasise early to the lung
Treatment - nephrectomy
Younger children better prognosis