Penile and scrotal pathology Flashcards

1
Q

How to assess a mass of the scrotum

A
Size 
Site
Shape
Symmetry
Skin changes/scars
Palpation
-Temp
-Tenderness
-Transillumonation 
(campfire)
-Consistency
-Attachments
-Mobility
-Pulsation
-Fluctuation
-Irreducibility
-Regional lymph nodes
-Edges
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2
Q

Painless scrotal lumps

A
Tumour
Haematocele
Epiddymal cyst
varicocele
Hydrocele
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3
Q

Painful scrotal lumps

A

Strangulated inguinal hernia

Torsion of testis

epididymis-orchitis

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4
Q

What is varicocele

A

Abnormal dilatation of the testicular veins in the pampiniform plexus caused by venous reflux

-More common on left (those on right are refereed urgently)

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5
Q

Presentation of varicocele

A

Bag of worms appearance

Lump with a dragging sensation

Disappears on lying down and reappears on standing, ++ with Valsava

Dull ache/painless

Associated with infertility

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6
Q

Management of varicocele

A

Embolisation or surgical ligation of veins only when

  • painful
  • Oligospermia
  • children
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7
Q

What is hydrocele

A

Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis that envelopes the testis

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8
Q

How does hydrocele present

A

Painless fluctuant swelling that will transilluminate either unilateral or bilateral

Swelling usually occurs anteriorly and below the testis

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9
Q

What is a communicating hydrocele

A

Persistence of the processes vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus

Mostly congenital but may occur later if increased intra-abdominal pressure, peritoneal dialysis, or fluid overload

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10
Q

What is non communicating hydrocele

A

Due to imbalance between secretion and reabsorption of fluid

Can occur secondary to minor trauma, testicular torsion, epididymitis

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11
Q

What is a epididymal cyst

A

Benign fluid filled sacs arising from the epididymis

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12
Q

What is a spermatocele

A

Benign sperm-filled sacs arising from epididymis

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13
Q

Presentations of spermatoceles or epididymal costs

A

Chronic onset
Smooth, well defined and fluctuant
Transilluminate
Separately palpable to the testes

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14
Q

Management of spermatoceles or epididymal cysts

A

None

Only surgery if large or painful

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15
Q

What is epididymo-orchitis

A

Inflammation of the epididymis and testicle

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16
Q

Cause of epididymis-orchitis

Most common cause in men<35yo, and in men >35yo

Other causes of it

A

Infection that has spread from urethra or bladder.

Most common cause <35yo= STI (chlamydia
Most common cause >35yo UTI (e.coli, pseudomonas)

Mumps can cause orchitis
Extrapulmonary TV

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17
Q

Presentation of epididymis-orchitis

What is Phren’s sign

A
Unilateral scrotal pain and swelling 
Onset over hours/days
Oedematous swelling
Dysuria
Fever
Urethral discharge 

Phren’s sign- pain relief on elevation of testicles

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18
Q

Management of epididymo-orchitis

A

Analgesia, scrotal support
Abx
STI screen and abstain from sex
Never be diagnosed in males<15 in absence of UTI symptoms because of torsion

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19
Q

What is testicular torsion

A

Spermatic cord twists within tunica vaginalis
Leads to occlusion of testicular blood vessels
Compromised blood supply leads to ischaemia

20
Q

Risk factor for testicular torsion

A

Bell clapper deformity- lack of normal fixation of the posterior lateral aspect of the testes to the tunica vaginalis

Bell clapper testis- Horizontal lie of the testis rather than vertical

21
Q

presentation of testicular torsion

A
Sudden onset pain in one testis makes walking uncomfortable 
Can be intermittent
Can come on during physical activity 
N&V
Abdo pain 
Inflammation
Testis may be high lying and transverse 
Lifting testis up worsens pain 
Absent cremasteric reflex
22
Q

Differential of testiclar torsion

A

Indirect inguinal hernia that has herniated into scrotum- positive cough impulse and you would not be able to get above the lump indicating it is bowel in origin

23
Q

testicular cancer types

A

Germ cell tumour

Non-germ cell tumour

24
Q

Types of germ cell tumours

A

Seminoma

Non-seminoma

  • Teratoma
  • embryonal
  • yolk sac tumour
  • choriocarcinoma
25
Q

Types of non-germ cell tumour

A

Lymphomas
Lydia cell tumours
Sertoli cell tumours

26
Q

Clinical presentation of testicular cancer

A
Painless testicular lump
Irregular, fixed, firm
Not transilluminate
Weight loss, back pain or dyspnoea
Can have secondary hydrocele 
Gynaecomastia possible
27
Q

Investigating testicular cancer

A

USS scan diagnosis

Elevation of tumour markers can support diagnosis but normal tumour markers don’t indicate lack of cancer

28
Q

Tumour markers used in testiuclar cancer and where produced

A

Alpha-fetoptotein - produced in yolk sac tumours

B-hCG produced in teratomas and seminomas

Can be staged via CT CAP

29
Q

What is phimosis

A

Inability to retract the foreskin back

30
Q

Causes of phimosis

A

Physiological
Pathological
Caused by chronic infection (balanitis) caused by poor hygiene or trauma from forcible retraction

31
Q

Clinical presentation of phimosis

A

Dribbling on micturition, weak stream, haematuria, painful erections, recurrent UTI

32
Q

Management of phimosis

A

Good hygiene
Steroid cream
Circumcision

33
Q

What is paraphimosis

A

Result of tight foreskin being retracted and then unable to be replaced. Acts as a constricting band causing oedema (EMERGENCY)

34
Q

Clinical features of paraphimosis

A

Swelling after the constriction
Painful erection
May progress to necrotic glans

35
Q

Risk factors for paraphimosis

A

Scarring of foreskin, vigorous sexual activity, chronic balanitis , urinary catheterisation

36
Q

Management of paraphimosis

A

Analgesia
Manual reduction
Swelling reduction (compression, ice, swab soaked in dextrose, puncture technique)
Surgical reduction and circumcision

37
Q

What is priapism

Which tissue is affected

A

Continued erection >4 hours which does not subside with ejaculation

Corpus cavernosum

38
Q

Risk factors for priapism

A

Sickle cell disease, sildenafil, antidepressants, cannabis, cocaine, leukaemia, pelvic tumours

39
Q

What is low flow priapism and treatment

A

Blood does not drain

  • Most common. Painful.
  • Nerve block + needle aspiration
  • Shunt surgery
40
Q

What is high flow priapism treatment

A

Increased arterial flow

  • Usually due to trauma
  • LEss painful. Cold packs and compression (wee, walk, drink, shower)
41
Q

What sort of carcinoma is carcinoma of the penis

A

Squamous cell

42
Q

Risk factors for carcinoma of the penis

Presentation

Management

A

risk factors: phimosis, HPV
Presentation:burning sensation, itch, ulceration which progresses to a mass. Mets to liver or lung

Management: partial/total penectomy. Limited response to chemo/radio

43
Q

What is a urethral stricture and cause

A

Narrowing of urethra

Causes: injury, urethral instrumentation, infection, non infectious inflammation, lichen sclerosus

Congenital or arise from malignancy

44
Q

Urethral stricture presentation

A

Weak urinary stream, lower urinary tract symptoms and inability to empty bladder completely. Can present as an emergency in urinary retention

45
Q

Diagnosis and management of urethral stricture

A

Cystoscopy

Endoscopic dilatation, stenting, urethroplasty