Miscellaneous Flashcards
What are the medical benefits of circumcision?
Reduces the risk of penile cancer
Reduces the risk of UTI
Reduces the risk of acquiring STIs including HIV
What are medical indications for circumcision?
Phimosis Recurrent balanitis Balanitis xerotica obliterans Paraphimosis (Important to exclude hypospadias prior to circumscision as may be used in surgical repair)
What is an epididymal cyst/spermatocele?
A painless, fluid-filled cyst in the long, tightly coiled tube that lies above and behind each testicle (epididymis).
How does an epididymal cyst/spermatocele present?
Smooth, painless firm lump in the scrotum on top of the testicle/posterior to the testicle.
Separate from the body of the testicle.
What conditions are associated with epididymal cysts/spermatoceles?
Polycystic kidney disease
Cystic fibrosis
von Hippel-Lindau syndrome
How may diagnosis of epididymal cyst/spermatocele be confirmed?
Ultrasound
What is epididymo-orchitis?
An infection of the epididymis +/- testes resulting in pain and swelling.
What is the most common cause of epididymo-orchitis?
Local spread of infections from the genital tract such as Chlamydia trachomatis and Neisseria gonorrhoea
What is the most important differential diagnosis of epididymo-orchitis?
Testicular torsion
What are the features of epididymo-orchitis?
Unilateral testicular pain and swelling Urethral discharge (possibly)
(Testicular torsion more likley if <20, severe pain and acute onset)
What is the management of epididymo-orchitis?
Ceftriaxone (500mg IM)
Doxycycline (100mg TD, 2/52)
With what fractures are bladder injuries most commonly seen?
Pelvic fractures
What are the two types of urethral injury?
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.
What is the investigation for urethral injury?
Ascending urethrogram
What is the management of urethral injury?
Suprapubic catheter (surgical placement, not percutaneously)
What are the typical causes of external genitalia injuries?
Penetration Blunt trauma Continence Sexual pleasure-enhancing devices Mutilation
What are the types of bladder injury?
Intra or extraperitoneal
How does bladder injury typically present?
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
What are the investigations for bladder injury?
IVU or cystogram
What is the management of bladder injury?
Laparotomy if intraperitoneal, conservative if extraperitoneal
What charts and scoring systems can be used in someone presenting with LUTS?
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.
What is the management of LUTS in a male with predominantly voiding symptoms?
Conservative: pelvic floor training, bladder training, prudent fluid intake.
Alpha-blocker (doxazosin)
Prostate: 5-alpha reductase inhibitor
antimuscarinic
What is the management of LUTS in a male with predominantly overactive bladder symptoms?
Conservative: monitor fluid intake, bladder retraining
Antimuscarinic drugs should be offered if symptoms persist (oxybutynin).
Mirabegon 2nd line
What is the management of LUTS in a male with predominantly nocturia symptoms?
Advise about fluid intake at night
Furosemide 40mg in late afternoon
Desmopressin
What is a Nephroblastoma?
(Wilm's tumour) <4 yo usually Mass associated with haematuria Often metastasise early to the lung Treatment - nephrectomy Younger children better prognosis
