Part two - urology

Question 1

Define spermatocele

Answer 1

Benign cystic accumulation of sperm that arises from the head of the epididymis and is > 2cm

Question 2

Define epididymal cyst

Answer 2

Benign cystic accumulation of sperm that arises from the head of the epididymis < 2cm

Question 3

Define hydrocele

Answer 3

Fluid accumulation between the parietal and visceral layers of the tunica vaginalis

Question 4

What are the layers of the scrotum and from which abdominal wall stuctures are they derived from?

Answer 4

• Skin
• Dartos muscle
• Colles fascia - Scarpa’s fascia
• External spermatic fascia - EOM
• Cremaster - IOM
• Internal spermatic fascia - Transversalis fascia
• Tunical vaginalis - peritoneum

Question 5

Define variococele

Answer 5

A collection of dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord.

On physical examination, the spermatic cord has a “bag of worms” appearance that increases with standing or the valsalva maneuver.

Question 6

What is the pathogenesis of left sided varicocele?

Answer 6

Left spermatic vein is one of the longest in the body and enters renal vein at a perpendicular angle. Intravascular pressure in the left renal vein is higher than on the right because it is compressed between the aorta and the SMA coming off above the renal vein -> nutcracker effect

Increased pressure in left gonadal vein -> dilatation -> incompetence of valve leaflets -> retrograde flow of blood towards testes in erect position

Venous complex in testis dilates producing minimal fullness on valsalva to a large soft scrotal mass / “bag of worms”

Question 7

Define cryptorchidism

Answer 7

Failure of testis to descend from its intra-abdominal or inguinal location into the scrotum

Question 8

Define ascending testis

Answer 8

A testicle that was in the scrotum but ascends with age

Question 9

Ectopic testis

Answer 9

Testis outside the line of normal descent

Femoral, perineal, root of penis, pelvic

Question 10

Staging of testicular cancer

Answer 10

TMN and S

USS - T stage

CT abdo/pelvis - retroperitoneal nodes

CXR or CT chest - pulmonary mets

Tumour markers - AFP, hCG, LDH

Radical orchidectomy +/- RPLND (NSGCT)

Question 11

Classify testicular tumours

Answer 11

• Germ cell tumours - 95%
  
  • Seminomas
  • Non-seminomatous germ cell tumours
    
    • Choriocarcinoma
    • Yolk sac tumour
    • Teratoma
    • Embryonal tumour
• Stromal tumours
  
  • Leydig cell tumour
  • Sertoli cell tumour
  • Granulosa cell tumour
  • Mixed type
• Lymphoma