Non-Neoplastic Male GU - Fremont-Smith Flashcards
embryo of male
not on exam
phimosis
cannot retract foreskin over penis
congenital and acquired
acquired - recurrent infection uncircumcised adult males
hypospadias
more common
opening bottom of penis
epispadias
rare**
opening top of penis
associated with bladder exstrophy**
undescended testicles
cryptorchidism
usually before 6 months old
hydrocele
fluid collection around teste
-usually resolve spontaneously
transillumination
firm nontender testicle with discoloration
testicular torsion - prenatal
foreskin
in newborn - tight and adherent
white sebaceous cyst at tip - normal
paraphimosis
excessive retraction of foreskin
-CANNOT be returned to normal
strangulation of venous flow
physiologic phimosis
congenital
-resolves with age
adhesions epithelial layer of skin
acquired phimosis
pathologic
secondary - balantic, malignancy, etc.
poor hygiene
forceful retraction
tx phimosis
weak topical corticosteroid cream
surgery
circumcision - only permanent cure
smegma
extruded as part of normal separation process of glans penis and foreskin
majority of penile conditions
traumatic
swelling of penis and penile pain
paraphimosis
urinary obstruction
need to reduce paraphimosis
cause of hypospadias
unknown
possible hormonal imbalance
as hypospadias go further down shaft
more complications
extrophy of bladder
failure of cloacal membrane development
bladder connects to surface
requires surgical repair
with epispadias
testicular descent
form in abdomen - urogenital ridge
coelomic cavity envaginates through abdomen wall to scrotal swelling
over time testis drawn in processus vaginalis (coelomic cavity) pulled by caudal genital ligament
descent into scrotum - guided by gubernaculum - forms inguinal canal
processus vaginalis - obliterates after birth
testes and spermatic cord descend
lining of peritoneum
to scrotal sac
-communication with peritoneum
muscles of inguinal canal
form direct path for descent to occur
- over time - muscles overlap
- less communication with peritoneum
will obliterate eventually
hydrocele
communicating or non-communicating
communicating - sac communicates with peritoneal fluid**
- can be narrow or wide
- can reduce sac - push fluid up
non-communicating - with partial obstruction
communicating hydrocele
bulging scrotal mass in infant
normal and common
with increased intraabdominal pressure - pushes fluid into scrotum
more common right**
right testicle
descends after left
-so processus vaginalis obliteration behind left side
patent processus vaginalis
communicating hydrocele
increase with valsalva
fluid from mesothelial lining of tunica vaginalis
non-communicating hydrocele
transillumination of cyst in scrotum
hydrocele
hydrocele
must be distinguished from testicular mass
varicocele
collection of dilated and tortuous veins in pampiniform plexus in spermatic cord
increased pressure and incompetent valves
more on left** - left renal vein enters at 90 degree - less continuous flow
dull ache in scrotum with standing, bag of worms on PE
varicocele
varicocele primary vs. secondary
primary - idiopathic - more in upright position
secondary - no change with positional change
varicocele and fertility
can reduce it
spermatocele
epididymal cyst
painless fluid filled cyst of head of epididymis
palpated as distinct from tetis - do transilluminate**
can drain
testicular tumor - does not transilluminate
direct hernia
more medial
indirect hernia
majority
pass lateral to epigastric vessels
widely patent processus vaginalis
-bowel through inguinal canal
inguinal canal
infants - external ring over internal ring
-higher risk for inguinal hernia
adults - oblique angled opening
male trichomonas
asymptomatic or very sympatomatic
urethral smear - wet mount - motile organisms
condyloma
HPV 6 >11
cancer of penis
not usually with HPV
-50/50
balanitis
inflammation of glans
usually with those who have been circumcised
balanoposthitis
foreskin and glans inflamed together
posthitis
inflammation of prepuce
frenular artery and vein
frenulum - ridge of tissue base of prepuce at coronal sulcus of penis
significant bleeding during circumcision
group A strep
toxic shock syndrome in males
reiter syndrome association
reactive arthritis
-joints, eyes, GU tract
with chlamydia trachomatis
circinate balanitis
shallow ulcers - painless
goes away few months
circinate balanitis
shallow ulcer on glans penis and shaft
painless
chlamydia - reiter syndrome
lichen sclerosis et atrophicus
white lesion on penis
painful erection
possibly premalignant
can ulcerate - bleeding, painful
thick epidermis atrophic with follicular hyperkeratosis
