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Clin Med: GU (block 3) > Penile & Testicular Disorders > Flashcards

Penile & Testicular Disorders Flashcards

1
Q

Peyronie Dz RFs

A
  • penile trauma
  • genetics
  • tobacco
  • excessive alcohol
  • pelvic surg (radical prostatectomy)
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2
Q

Describe penile pain in acute inflammatory phase of peyronie dz

A
  • often occurs w/ erection but can occur in flaccid state, w/ palpation, and/or during coitus
  • rarely severe but may interfere w/ sexual function
  • usually dissipates as inflammation settles (w/n 6-18 months)
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3
Q

Describe changes in penile shape seen in acute inflammatory phase of Peyronie dx

A
  • curvature
  • hinging
  • hourglass
  • narrowing
  • shortening
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4
Q

ED RFs

A
  • age
  • obesity
  • DM
  • dyslipidemia
  • metabolic syndrome
  • lack of exercise
  • smoking
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5
Q

Drug Associated w/ ED

A
  • Antihypertensives
  • Antidepressants
  • Recreational (Ethol, cocaine, mary)
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6
Q

Examples of antihypertensives associated with ED

A
  • CCB
  • Methyldopa
  • Clonidine
  • Reserpine
  • BB
  • Guanethidine
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7
Q

Examples of antidepressants associated with ED

A
  • SSRIs
  • Tricyclic antidepressants
  • Lithium
  • Monoamine oxidase inhibitors
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8
Q

Examples of recreational things associated with ED

A
  • alcohol
  • Cocaine
  • Marijuana
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9
Q

What do we look for in a patients Hx who presents w/ ED?

A
  • sexual orientation
  • previous & current relationship status
  • current emotional state
  • pts self-assessment of sexual perf.
  • pts attitude & knowledge of sex
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10
Q

What do ask about with patients who presents w/ ED?

A
  • morning or nighttime erections (presence may suggest psychogenic etiology)
  • symptom onset and duration
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11
Q

In ED, what are we looking for when evaluating the penis?

A
  • size
  • scars
  • fibrosis or plaques (Peyronie?)
  • urethral meatus
  • elasticity
  • curvature
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12
Q

In ED, what are we looking for when evaluating the scrotum?

A
  • testicular size (small testes suggests hypogonadism)
  • testicular consistency
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13
Q

Hypospadias RFs

A
  • FHx
  • maternal exposure to DES
  • advanced maternal age
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14
Q

What do we ask about in pts presenting w/ Hypospadias/Epispadias?

A
  • maternal intake of progestins, estrogens, & anti-androgenic compounds during preg
  • ## maternal illness during preg
  • FHx of Hypospadias/Epispadias
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15
Q

In Hypospadias/Epispadias, doing additional testing does what?

A

exclude disorders of sex development in infancy

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16
Q

Hypospadias/Epispadias hormonal testing including which hormones?

A
  • cortisol
  • estradiol
  • glucose
  • HCG
  • progesterone
  • testosterone
  • thyroid function
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17
Q

Hypospadias/Epispadias Tx

A

Surgical repair by peds urologist

18
Q

Phimosis Tx

A
  • < 2 no tx needed
  • physiologic (primary) phimosis
    usually resolves w/ time
    –> conservative tx w/ steroid ointment or cream
    –> circumcision
    –> don’t delay tx if recurrent balanitis or recurrent urinary tract infx

pathologic (secondary) phimosis
- consult peds urologist
- circumcisionis indicated tx in case of lichen sclerosis or scarred phimosis

19
Q

Paraphimosis Tx

A
  • tx immediately; emergent
  • manually compress edematous tissue, then attempt to retract foreskin over glans penis
    –> If unable call Urology STAT
20
Q

What is balanitis?

A

infx of glans penis

21
Q

Balanitis/
Balanoposthitis
RFs

A
  • Uncircumcised status
  • Phimosis (can’t retract foreskin)
  • Poor hygiene
22
Q

Balanitis/
Balanoposthitis Tx

A
  • proper hygiene, esp uncircumcised
    & diabetic men

-Abstinence from sexual activity during infx

Specific etiology:
Irritant: d/c the irritant + topical steroid
Candida: clotrimazole or miconazole cream
Anaerobic: topical metro
STD: test & tx appropriately

23
Q

Squamous Cell Carcinoma of the Penis RFs

A
  1. HPV
  2. Lack of neonatal circumcision
  3. Smoking
  4. HIV
  5. Chronic Balanitis
24
Q

Squamous Cell Carcinoma of the Penis Tx

A
  • Early stages: excision of tumor or penis amputation
  • Lymph node involvement: can resect lymph nodes
  • Later stages: chemotherapy, radiation
25
Q

Cryptorchidism Tx

A

Surgery (orchidopexy)

26
Q

Hydrocele Infant Tx

A
  • Watchful waiting for 12 months
  • Surg if doesn’t resolve, or if there is a hernia as well
27
Q

Hydrocele Adult Tx

A
  • period of watch & wait if small + asymp
  • further tx if persist >1yr or symp
28
Q

Varicocele Tx

A
  • Goal of treatment–> incr fertility/future fertility
  • In adults, tx if very painful or if trying to conceive

In kids, tx is controversial, but may do surg if painful or if there is significant testicular atrophy

29
Q

Spermatocele PE

A

US–>soft, smooth, & transilluminate

30
Q

Is Testicular Torsion a medical emergency?

A

YES!!!

31
Q

What is a “blue dot” sign?

A

tender nodule w/ blue discoloration on upper pole of testicle

32
Q

Testicular Torsion Tx

A
  • Can attempt manual de-torsion
  • Will req urgent surg exploration
  • Ischemic damage occurs in 4-8 hrs
33
Q

When suspecting Orchitis, what else should be on your DDx?

A

Cancer, abscess, & Torsion

34
Q

Orchitis Tx

A
  • STD tx if likely cause:
    –> Ceftriaxone 250 mg IM PLUS
    –> Doxycycline* 100 mg BID for 10 days
  • enteric organisms (anaerobes) likely causes:
    –> Levofloxacin 500mg po daily for 10 days –OR—
    –> Ofloxacin 300mg po BID for 10 days
35
Q

Describe acute epididymitis

A

inflammation of epididymis < 6 wks duration

36
Q

Epididymitis age range?

A

20-30 yo

37
Q

Epididymitis RFs

A
  • Congenital abnormalities
  • Incr sexual activity/new or multiple partners
  • Anal intercourse
  • Urinary tract obstruction
38
Q

Epididymitis Tx

A
  • Don’t delay txt for labs - tx empirically
  • STD tx if likely cause:
    –> Ceftriaxone 250 mg IM PLUS
    –> Doxycycline* 100 mg BID for 10 days
  • enteric organisms (anaerobes) likely causes:
    –> Levofloxacin 500mg po daily for 10 days –OR—
    –> Ofloxacin 300mg po BID for 10 days
39
Q

Testicular Cancer RFs

A
  • FHx
  • Genetic factors (Down Syndrome, Klinefelter Syndrome)
  • Cryptorchidism
  • Cannabis use
40
Q

Other potential presentations of testicular cancer due to spread of the cancer include:

A
  • back pain (kidneys)
  • Cough (lungs)
  • Hemoptysis (lungs)
  • Headaches (brain)
41
Q

What are the serum tumor markers found in testicular cancer?

A
  • beta-human chorionic gonadotropin (beta-hCG)
  • lactate dehydrogenase (LDH)
  • alpha fetoprotein (AFP
42
Q

Testicular Cancer Tx

A

Dependent on TMN staging
- Orchiectomy
- chemo/radiation depending on staging

Clin Med: GU (block 3) (7 decks)

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