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Urology > Penis, scrotum, testes > Flashcards

Penis, scrotum, testes Flashcards

1
Q

Balanitis is?

A

Inflammation of glans penis

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2
Q

Balanoposthitis is?

A

Inflammation of glans penis and/or foreskin

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3
Q

Balanitis and Balanoposthitis is commonly due to?

A

Candida albicans related to poor hygiene

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4
Q

Common complication of phimosis is?

A

Balanitis and Balanoposthitis

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5
Q

TXT of Balanitis and Balanoposthitis

A

swab/TXT w/ appropriate ABX

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6
Q

Phimosis is?

A

Contracted foreskin that cannot be retracted back over glans

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7
Q

What can develop under foreskin esp if phimosis is present?

A

Smegma
Calculi
SCC

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8
Q

Phimosis presentation

A

pain or TTP of foreskin

chronic yeast infections

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9
Q

TXT of phimosis

A

circumcision may be indicated (only after inf TXT’d)

If infection > broad spectrum ABX

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10
Q

Paraphimosis is?

A 
retracted foreskin is trapped behind glans penis which causes > 
- vascular congestion
- swelling glans
- pain
May lead to arterial occlusion/necrosis
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11
Q

Is paraphimosis a medical emergency?

A

Yes!

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12
Q

Paraphimosis TXT

A

1st try - manual reduction

Failure > immediate urology referral (incision w/ local)

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13
Q

Following a successful reduction of paraphimosis pts req?

A

urological referral for circumcision (PVT recurrence)

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14
Q

MC congenital malformation is a?

A

ABNL urethral meatus location

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15
Q

Hypospadias is?

A

Meatus opens on ventral aspect of penis/scrotum/periuneum

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16
Q

Epispadias is?

A

Meatus opens on dorsal aspect of the penis

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17
Q

Which penis malformation is MC and has a better prognosis?

A

Hypospadias

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18
Q

Hypospadias is ass/w?

A

Feminization OR

Chordee (ventral curvature)

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19
Q

Hypospadias repair should be repaired by?

A

Prior to 18mo (typically done at 6mo)

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20
Q

Should you circumcise infants w/ Hypospadias?

A

NO - can be used as a graft to fix Hypospadias

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21
Q

What is a common finding w/ Epispadias?

A 
Urinary inontinence (improper development of urinary sphincter)
Dorsal curvature
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22
Q

Chordee is?

A

ABNL congenital ventral curvature of penis due to short urethra or fibrosis tissue around corpus spongiosum

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23
Q

Peyronie Dz is?

A

Fibrous D/O of the tunica albuginea w/ varying degrees of penile pain, curvature, deformity

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24
Q

What type of malformation is Peyronie Dz?

A

Acquired malformation (sexual accident)

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25
Q

What causes Peyronie Dz?

A

Most likely -
minor penile trauma >
Inflammation of corpora cavernosa >
ABNL collagen disposition

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26
Q

Peyronie Dz MC affects what pop?

A

Middle aged/older men

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27
Q

Peyronie Dz can impair?

A

Sexual fx and impact self-esteem

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28
Q

Pts w/ Peyronie Dz present how?

A

W/ painful erections (no pain when flaccid)

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29
Q

Peyronie Dz PE reveals?

A

Palpable dense fibrous plaque involving tunica albuginea near dorsal midline.

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30
Q

Peyronie Dz may require what type of imaging?

A

U/S to visualize extent of a deep plaque

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31
Q

Peyronie Dz is ass/w what other condition?

A

Dupuytren contractures of the hand

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32
Q

Peyronie Dz TXT

A

10% spon improvement
Medical therapies
-Collagenase clostridial histolyticum inj (FDA approved)
-CCB or interferon intraplaque inj
Surgery if sex dysfx due to severe curve or instability

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33
Q

What is a priapism?

A

Erection lasting >4hrs - not ass/w sexual arousal/desire

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34
Q

Priapism etiology is often?

A

Idiopathic

  • Leukemia
  • SCA
  • Pelvic tumors/infections
  • Penile trauma
  • Spinal cord trauma
  • Rx
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35
Q

Two types of priapism

A

Non-ischemic and ischemic

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36
Q

Non-ischemic priapism notes

A

High-flow priapism
AV shunting > unregulated high blood flow
Due to perineal/spinal cord trauma
Erectile Fx spared

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37
Q

Ischemic priapism notes

A 
Low-flow priapism
Venous congestion and arterial inflow cessation >
-ischemic injury to corpora cavernosa
Painful erection
Req emergent TXT to PVT fx loss
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38
Q

Causes of ischemic priapism?

A

RBC dyscrasias
Drug use
ED treatments

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39
Q

TXT of ischemic priapism?

A 
Large bore - needle blood aspiration
Adrenergic meds (phenylephirine
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40
Q

Both non-ischemic/ischemic priapisms req?

A

Urology consult

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41
Q

Which priapism type has spared erectile fx?

A

Non-ischemic

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42
Q

Which priapism type may not req TXT?

A

Non-ischemic

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43
Q

Which priapism type is ass/w high flow AV shunting?

A

Non-ischemic

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44
Q

Which priapism type is ass/w low flow (venous congestion/arterial cessation)?

A

Ischemic

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45
Q

Which priapism type is characterized w/ painful erections?

A

Ischemic

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46
Q

MC age range of penile cancer?

A

6th decade

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47
Q

RF’s pf penile cancer?

A

Uncircumcised (poor hygeine)
Phimosis
HPV infections (PVT = Gardasil vaccine)

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48
Q

How to PVT HPV infections?

A

Gardasil vaccine

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49
Q

Penile cancer morphology is typically?

A

SCC - seen on glans

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50
Q

Bowens disease is?

A

SCC in situ (red plaque on shaft)

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51
Q

Erythroplasia of Queyrat is?

A

Velvety red lesion w/ ulcerations on glans

AKA - bowen disease of the glans

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52
Q

Penile cancer W/U?

A

Bx is mandatory to R/O benign conditions such as -

-syphilis, chancroid, condylomata

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53
Q

Penile cancer TXT depends on?

A

Pathology/location

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54
Q

Proper eval of scrotum req?

A

Testes palpated between fingertips of both hands

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55
Q

NL testes dimensions

A

4.5 x 2.5 cm and rubbery

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56
Q

Where does epidiymis lie in relation to testis?

A

Posteriolateral w/ varying degrees of testicular detachment

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57
Q

How to distinguish between Solid vs Cystic lesions of the scrotum?

A

Transillumination

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58
Q

MC referral scrotum referral to urologist is?

A

Mass eval

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59
Q

Most important aspect of eval masses within the scrotum?

A

Determine if lesion is related to epididymis/cord structures OR confined to scrotum

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60
Q

Masses arising from testes are usually?

A

Malignant

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61
Q

Masses arising from epididymis/spermatic cord are usually?

A

Benign

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62
Q

S/S of malignant Testes are?*

A

Painless
Firm/solid lesions
located w/in the substance of testicle
Does NOT transilliuminate*

63
Q

Scrotal vs Testicular mass reflex if in doubt?

A

U/S - good if pt is in anxiety

64
Q

Types of scrotal/testicular masses?

A 
HaVE SHiT
H- hydrocele
V- varicocele
E- epidiymal cyst
S- spermatocele
H- hernia
T- testicular cancer
65
Q

Hydrocele is

A

Collection of fluid between 2 layers (parietal/visceral) of tunica vaginalis

66
Q

Hydrocele is 2/2?

A

Congenital causes (patent processus vaginalis)
Infection (Epididymitis)
Trauma/testicular torsion
Tumors (testicular cancer)

67
Q

MC age range of Hydrocele

A

1st yr of life

68
Q

Hydrocele presents how?

A

Painful - if LRG/Infected

69
Q

Hydrocele Dx?

A 
Transillumination
Testicular exam (R/O tumors ass/w Hydrocele)
70
Q

If in doubt of Hydrocele Dx reflex?

A

Scrotal U/S

71
Q

Hydrocele TXT?

A

Observe w/ regular F/U
Surgery - excise hydrocele sac
DO NOT aspirate*

72
Q

Do you aspirate a Hydrocele?

73
Q

Epididymal cyst is?

A

<2cm Cysts occuring at caput of the epididymis distinct from testicle

74
Q

TXT of Epididymal cyst is?

A

No TXT req > can reassure pt w/ U/S

75
Q

Spermatocele is?

A

> 2cm Benign cystic accumulation arising from the head of the epididymis

76
Q

Spermatocele S/S?

A

Asymptomatic OR

if LRG > heaviness or pain

77
Q

Spermatocele is palpable where?

A

Upper pole of testicle

78
Q

In doubt of Spermatocele Dx reflex?

79
Q

Spermatocele TXT?

A

Observe

Symptomatic > surgery

80
Q

Varicocele is?

A

ABNL dilation of pampiniform plexus of spermatic veins

81
Q

Varicocele represents what percentage of scrotal masses?

82
Q

Varicocele is MC found on which side?

A

Left (33% bilateral)

83
Q

Varicocele presents as?

A

Asymptomatic OR >
Dull ache (pain worsens w/ activity)
Increased size when upright
Decreased size when supine

84
Q

Varicocele may be ass/w?

A

Hx of infertility

  • Increased scrotal temp > increases apoptosis
  • Testicular atrophy
85
Q

Varicocele PE?

A

Bag of worms feels

  • Increased w/ valsalva
  • Decreased while supine
86
Q

Varicocele is usually Dx with?

A

PE (however U/S possible)

87
Q

Varicocele further eval req - warning signs *

A

Right sided and Unilateral
Lesion remains dilated while supine
Sudden onset or Enlarges rapidly

88
Q

Sudden onset of R Varicocele may indicate?

A

R spermatic vein obstruction due to retroperitoneal malignancy *

89
Q

Varicocele further eval W/U?

A

careful abdominal exam

CT Scan

90
Q

Varicocele TXT

A

Initially- symptomatic management

  • Observe
  • Scrotal support
  • Activity modification
  • PRN NSAIDs
91
Q

Varicocele ass/w infertility and/or pain req what TXT?

A

Surgery

  • ligation of gondadal vein via inguinal canal
  • laparoscopy
  • microsurgery
92
Q

Types of hernias?

A

Indirect/direct

93
Q

Indirect hernias notes

A

Men - due to congenital patent processus vaginalis

Protrudes through deep or internal inhuinal ring into inguinal canal and may extend into scrotum

94
Q

Direct hernia notes

A

Acquired

Arises from protrusion of ABD viscera through a weakness of the posterior wall of inguinal canal

95
Q

Hernia PE

A

Palpable bulge which may increase w/ valsalva

96
Q

Hernia Dx

97
Q

Hernia TXT

A

Refer to general surgery for repair

herniorrhaphy -open/laproscopic

98
Q

Testicular masses usually are?

A

Malignant masses arising from w/in the testicle

99
Q

If there is doubt to whether or not a mass is w/in or outside the testicle reflex?

A

Scrotal U/S and urologic referral

100
Q

Essentials of Dx testicular cancer

A

MC neoplasm in men 15-35yo
Pt identified, Painless mass typically
Orchiectomy necessary for Dx

101
Q

What is necessary for testicular Dx cancer Dx?

A

Orchiectomy

102
Q

Testicular cancer is ass/w what S/S?

A

Painless palpable mass
+- heavy sensation
10% ass/w hyrdocele

103
Q

MC cell type of primary testicular tumor?

A

Germ cell tumors

  • Seminoma and non-seminoma
  • Arising from spermatogenic cells w/in seminiferous tubules
104
Q

What side is testicular cancer MC on?

A

Right side

105
Q

RFs of testicular cancer?

A

Cryptorchidism
Testicular trauma/torsion
Infection related testicular atrophy
Chemical exposure/pollutants

106
Q

Testicular cancer labs?

A 
Increased >
-HcG
-AFP (alpha-fetoprotein)
-LDH
Advanced Dz = Anemia w/ CBC and LFT for Mets
107
Q

Testicular cancer imaging?

A

Scrotal U/S - intra-testicular vs extra-testicular

CT/PET after orchiectomy for staging

108
Q

Doubt of Testicular cancer Dx reflex?

A

Scrotal U/S

109
Q

TXT of Testicular cancer?

A

Radical orchiectomy

- further TXT depends on histology/staging

110
Q

Testicular cancer prognosis?

A

Stage I-III - 95% 5 year survival rate

Bulky retroperitoneal malig/advanced Mets 68%

111
Q

Testicular cancer 2/2 are?

A

Rare
MC - lymphoma
other causes - (prostate, lung, melanoma, renal)

112
Q

Is Testicular selfexams recommended?

A

No per USPSTF > grade D

113
Q

Testicular torsion - age range?

A

Can occur w/ any age

- MC neonates and post-pubertal boys

114
Q

Testicular torsion occurs due to?

A

Inadequate fixation of testis onto tunica vaginalis (peritoneal sac)

115
Q

Testicular torsion will have irreversible damage when?

A

Ischemic >12hrs

116
Q

Testicular torsion presents as

A

Sudden onset pain
- often after vigorous exercise or minor trauma
ABD pain
N/V

117
Q

Testicular torsion can occur after?

A

vigorous activity
minor trauma
cremasteric contraction during REM sleep

118
Q

Testicular torsion PE?

A

Classic sign = high-riding testis w/ long axis oriented transversely (AKA bell clapper deformity)
Early sign - profound testicular swelling
Later sign - 12hr (reactive hydrocele/scrotal erythema)
Exquisite TTP
Absent cremasteric reflex on affected side
Negative Prehn sign - elevation of scrotum fails to relieve pain

119
Q

Most sensitive physical finding of Testicular torsion is?

A

Absent cremasteric reflex

120
Q

Prehn sign distinguishes?

A

Testicular torsion (Neg) vs epididymitis (Pos)

121
Q

Cremasteric reflex is performed how?

A

Stroking ipsilateral inner thigh = testicle elevation through a contraction

122
Q

Testicular torsion SOC?

A

Color doppler U/S (do not delay surgery if no access)

123
Q

Testicular torsion TXT

A 
Surgical emergency (urgent evacuation)
- detorsion/fixation(orchipexy to PVT reoccurence)
124
Q

Testicular torsion TXT if surgery is not immediately available?

A

Manual detorsion maybe effective

125
Q

Manual detorsion how to -

A

Open book

  • Right testicle > attempt counterclockwise detorsion
  • Left testicle > Attempt clockwise detorsion
126
Q

Manual detorsion indicators of success?

A

Relief of pain
Resolution of transverse testis axis
Testis returns to lower position
NL arterial pulse returned via Doppler U/S

127
Q

After a manual detorsion for Testicular torsion what doe the pt req?

128
Q

MC scrotal pain in adults is?

A

Epididymitis and epididymo-orchitis

129
Q

Epididymitis and epididymo-orchitis is MC due to?

A

Infectious etiology

130
Q

Infection types causing Epididymitis and epididymo-orchitis

A

sexually transmitted and non-sexually transmitted

131
Q

Sexually transmitted infectious type causing Epididymitis and epididymo-orchitis NOTES

A

Men <40yo
ass/w urethritis
N. Gono/Chlamydia

132
Q

Non-sexually transmitted infectious type causing Epididymitis and epididymo-orchitis NOTES

A

Older men
ass/w UTI’s and prostatitis
GNB

133
Q

Epididymitis/epididymo-orchitis acute presentation?

A

Post physical strain, trauma, or sexual activity
-Fever
-Exquisite TTP
-Swelling of epididymis, testicle, scrotum
Irritative voiding S/S

134
Q

Epididymitis/epididymo-orchitis PE

A

Induration, Edema, TTP

-epididymo-orchitis also will have testicular edema, pain w/ scrotal wall redness, reactive hydrocele

135
Q

Prehn sign w/ Epididymitis/epididymo-orchitis?

A

Positive - scrotal elevation relieves pain

136
Q

Epididymitis/epididymo-orchitis how?

137
Q

Epididymitis/epididymo-orchitis labs?

A

CBC - ^WBC w/ Left shift
UA - Non-STI = pyuria, bacteriuria, hematuria
UA Cx
STI > Gram stain

138
Q

In doubt of Epididymitis/epididymo-orchitis Dx?

A

Scrotal U/S

139
Q

Epididymitis/epididymo-orchitis TXT of STI cause?

A

Ceftriaxone 250mg IM once + Doxycycline 100mg BID 10d’s

TXT partner as well

140
Q

Epididymitis/epididymo-orchitis TXT of Non-STI cause?

A

Ciprofloxacin OR levofloxacin for 3wks

Eval urinary tract for UC

141
Q

Epididymitis/epididymo-orchitis TXT of viral or non-infectious causes?

A

Symptomatic care

142
Q

Non-infectious cause of Epididymitis/epididymo-orchitis is?

143
Q

All Patients w/ Epididymitis/epididymo-orchitis will receive this TXT protocol?

A

Bed rest and Scrotal elevation (tight undergarments)

144
Q

Severe testicular injury due to trauma MC from?

A

Combat trauma (direct blow) or straddle type injury

145
Q

Trauma of testicles result in?

A

Hematocele/rupture

146
Q

Trauma of testicles W/U?

A

U/S and surgical referral

147
Q

Torsion of appendix testis NOTES

A

Rare in adults
Similar S/S to testicular torsion (gradual onset)
Blue dot on scrotum- infarct/necrosis of appendix testis
Req U/S

148
Q

TXT of Torsion of appendix testis?

A

Conservative

Rest, Scrotal elevation, Analgesics

149
Q

Blue dot on scrotum skin may indicate?

A

Torsion of appendix testis

150
Q

Referred pain DDx?

A 
Stones
UTI
Pyelonephritis
Low back pain
AAA
Post surgical (herniorrhaphy)
151
Q

Mumps and acute testicular pain NOTES

A

Anti-vaxers
Causes orchitis (preceding fever/parotitis)
TXT symptomatically

152
Q

Fourniers Gangrene NOTES

A

Necrotizing fasciitis of peineum and scrotal skin
MC - DM
TXT = urgent surgical debridement

153
Q

Post-vasectomy pain syndrome (PVPS) NOTES

A

Chronic pain following vasectomy
Painful granuloma palpable at site of Vas dissection
FOB Rxn
Uncommon

154
Q

Chronic orchalgia Dx is?

A

A dx of exclusion

Urology (7 decks)

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