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Y3(S) - Urology > Peno-scrotal Disease > Flashcards

Peno-scrotal Disease Flashcards

1
Q

What are some differentials for scrotal/testicular lumps?

A

Hydrocoele
Varicocele
Epididymo-orchitis
Epidymal cyst
Testicular cancer
Inguinal hernia
Testicular torsion

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2
Q

What is a painful scrotal/testicular lump in a young male until proven otherwise?

A

Testicular torsion

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3
Q

What are the 3 main questions you assess on examination of a testicular lump?

A

1.Can you get above the lump? (Hernia?)
2. Does the lump transilluminate?
3. Is the lump seperate to the testes?

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4
Q

What is the go to imaging method for peon-scrotal disease?

A

Ultrasound scrotum

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5
Q

What is the most likely diagnoses for a patient that presents like this:

Can get above lump
Transilluminate so
Testes not separate
Painless
May have had recent infection

A

Hydrocoele

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6
Q

What is the pathophysiology of a Hydrocoele?

A

Fluid accumulates between the visceral and parietal layers of the tunica vaginalis (potentially didn’t close properly so some of processus vaginalis is open)

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7
Q

What Ix is done for a patient who you think has Hydrocoele?

A

US scrotum

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8
Q

How is Hydrocoele managed?

A

Only treat if bothers patient

Visceral and parietal peritoneum of tunica vaginalis enveloped on each other and sewed together

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9
Q

What is a varicocele?

A

Venous insufficiency of the pampiniform plexus

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10
Q

How does varicocele typically present?

A

BAG OF WORMS

Can get above lump
Separate to the testicle
WORSE at the end of day (throbbing dull pain)
Pain worse when standing
Dragging sensation
Infertility

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11
Q

Why can patients with varicocele have sub/infertility?

A

Pampiniform plexus distension leads to impaired Thermoregulation of the testicle

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12
Q

Which testicle is typically affected by varicocele and why?

A

Left testicle

Left testicular vein drains into left renal vein which then has to pass anteriorly over the abdominal aorta to drain into the inferior vena cava, theres a higher pressure in the left testicular vein and more chance for valvular dysfunction to occur

Right testicular vein drains straight into the inferior vena cava

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13
Q

What Ix do you do in a patient with a suspected varicocele?

A

US Scrotum
+
US left kidney

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14
Q

Why would you do a left Kidney ultrasound when a patient has a suspected left sided varicocele?

What questions would you also ask?

A

Left sided renal cell carcinoma (RCC) can obstruct the left renal vein leading to increased pressure in the left testicular vein

Any:
-weight loss
-malaise
-fever
-night sweats

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15
Q

How is varicocele managed?

A

Only treat if patient is trying for children, has testicular atrophy or pain is too much

Treat with embolistion of vessels done by interventional radiologist

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16
Q

What is epididymo orchitis?

A

Infection of the epididymis - testis

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17
Q

How does a patient with epididymo-orchitis typically present?

What’s it normally caused by?

A

Can get above lump
Can transilluminate is presents with associated Hydrocoele
Not seperate lump to testes
Painful
Discharge
Other LUTS

Mainly caused by STIs in young people

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18
Q

What are the typical causative organisms of STI that cause epididymo-orchitis?

A

Neisseria gonorrhoeae
Chlamydia trachomatis

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19
Q

What is the imaging done for a suspected epidymo-orchitis?

A

US scrotum.

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20
Q

What investigations are done when suspecting epididymo orchitis?

A

FBC
U+Es
LFTs
CRP
Urine dipstick

First void urine sample for NAAT

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21
Q

What is the management of epididymo-orchitis?

A

Abx and analgesia

Empirical abx can be given before culture results back

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22
Q

What abx are given for enteric causes of epididymo orchitis?

A

Ofloxacin 200mg PO BD for 10-14days

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23
Q

What abx are given for STI causes of epididymo orchitis?

A

Ceftriaxone 500mg IM SINGLE DOSE
+
Doxycycline 100mg PO BD 10-14days

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24
Q

What is phrens test?

A

Patient lies supine and examiner elevates the testes and sees if the patient has any pain relief

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25
What is typically the result of phrens test in a patient with epididymo orchitis?
Positive (pain relieved)
26
Is the cremasteric reflex present in individuals withi epididymo orchitis?
Yes
27
What is the pathophysiology of testicular torsion?
Mobile testis rotates within the tunica vaginalis twisting the spermatic cord impairing venous drainage leading to swelling, oedema and impaired arterial supply to the testis leading to infarction
28
What deformity increases the risk of testicular torsion?
Bell clapper deformity
29
What is. Bell clapper deformity?
When the testis have a horizontal lie within the tunica vaginalis due to lack of connection to tunica. Vaginalis
30
What are the risk factors for testicular torsion?
Young age Family history Previous torsion Cryptotorchidism Bell clapper deformity
31
What is a typical presentation of testicular Torsion?
Extreme acute unilateral scrotal pain (N+V due to pain) Previous trauma Young male Swollen Loss of cremasteric reflex Negative phrens test Affected teste will. Have a high lie
32
What are the imaging techniques for suspected testicular torsion?
IMMEDIATE SURGICAL EXPLORATION US Doppler of scrotum
33
What is the management for testicular torsion?
Emergency surgical exploration with surgical fixation Analgesia + antiemetics
34
How does an Inguinal-scrotal hernia present?
Cant get above lump Doesn’t transilluminate Seperate to testis but might not be able to feel Cough can increase size May or may not be reducible May or may not be painful (strangulated?) May or not lead to bowel obstruction (obstruction)
35
What imaging is done for an Inguinal-scrotal hernia (typically indirect hernia)?
US scrotum
36
What is the management for an indirect inguino-scrotal hernia?
Refer to general surgery for hernia repair
37
What is an epididymal cyst?
Soft fluid filled cyst at head of epididymis
38
What is the presentation of an epdiiymal cyst?
Can get above lump Transilluminate Seperate from testes
39
What imaging is done for an epidiymal cyst?
US scrotum
40
What is the management for an epididymal cyst?
Only needs surgical excision if its symptomatic
41
What age group are testicular tumours most common in?
20-40yrs
42
What is the presentation for a testicular Tumor?
Can get above lump Doesnt transilluminate Not seperate from testes Usually painless Firm irregular mass Weight loss? Back pain? SOB?
43
What are the 2 broad categories of testicular tumours?
Germ cell tumours Non germ cell tumours
44
What are the 2 types of non germ cell tumours?
Sertoli cell tumours Leydig cell tumours
45
What are the 2 sub categories of germ cell tumours?
Seminomatous germ cell tumours Non seminomatous germ cell tumours
46
What are some examples of non seminomatous non germ cell tumours?
Choriocarcinoma Teratoma Yolk sac tumours Embryonal carcinoma
47
What has a better prognosis, germ cell tumours or non germ cell tumours and why?
Non germ cell tumours are typically benign
48
What has a better prognosis seminomatous germ cell tumours or non seminomatous germ cell tumours and why?
Seminomas since they remains localised until quite late stage
49
What imaging is done for testicular cancers?
US scrotum (initial lump exploration) CT CAP with contrast for staging
50
What are the importation investigations to be done with a testicular cancer?
Tumour markers
51
What tumour markers are assessed for with testicular cancer?
AFP bHCG LDH.
52
What does raised AFP indicate?
Indicates non seminomatous germ cell Tumor NEVER RAISED IN SEMINOMAS
53
What does elevated bHCG indicate?
Likely a non seminomatous germ cell tumour but could also be a seminoma
54
Which testicular cancer is bHCG always elevated with?
Choriocarcinoma
55
What is the importance of LDH levels?
Indicates tumour bulk Can be used to measure tumour response to chemotherapy/treatment
56
What are the treatments for testicular tumours?
Depends on the risk of the tumour Low risk = surveillance High risk = chemotherapy with orchidectomy Most tumour cancers have a good prognosis even if they have metastasis
57
What is normally required to diagnose testicular cancer?
Tumour markers + imaging
58
What is phimosis?
Tight foreskin that is unable to be retracted
59
Is phimosis physiological?
Yes most babies have it but it slowly goes away by 16yrs old
60
What causes pathological/scarring phimosis?
Balanitis Xerotica Obliterans
61
What is the pathological process of balanitis xerotica obliterans? How does it cause pathological phimosis?
Chronic inflammation of the glans penis lead to plaques and scarring forming causing fusion of the foreskin to the glans penis making it unuretractable
62
How does pathological phimosis present (caused by balanitis xerotica obliterans)?
Difficulty passing urine Pain Cracking of penis when erect
63
What is the treatment for pathological phimosis/balanitis xerotica obliterans?
Topical steroids Or Circumcision under LA or GA
64
What is paraphimosis?
The foreskin is trapped behind the corona of the glans penis
65
Why is paraphimosis an emergency?
The tightness of the foreskin leads to impaired venous return from the glans penis, this leads to oedema and ischaemia of the glans penis
66
What is the main cause of paraphimosis?
NEGLECT Failure to replace the foreskin by carer after catheterisation
67
What is the treatment for paraphimosis?
Manually compress and replace the foreskin Do a penile block with or without a dorsal slit if unable to just manually compress
68
What is Fourniers gangrene?
Necrotising fasciitis of the perineum, Perianal or Genital areas
69
What are the risk factors for developing necrotising fasciitis?
Poorly controlled diabetes Alcoholism Obesity Indwelling catheter
70
What is the management for necrotising fasciitis?
URGENT ESCALATION Debridement of necrotic tissue Debrided tissue sent for MC+S (can then give targeted abx) Broad spectrum abx
71
Why do patients with necrotising fasciitis need urgent escalation?
Has a 50% mortality Patients often present septic
72
What is Peyronie’s disease?
Significant penile curvature due to damage to the tunica albuginea leading to fibrous plaque formation (like Dupuytrens of the hand)
73
What imaging is done for Peyronie’s disease?
US penis to identify plaque
74
What are the risk factors for developing Peyronie’s disease?
Old Diabetes Mellitus Ischaeamic heart disease Hypertension Certain medications like b blockers
75
What is the management for Peyronie’s disease?
Sildenafil (to help with the erectil dysfunction) Penis pumps Surgical correctiooon
76
What is the mechanism of action of sildenafil?
Phosphodiesterase-5 inhibitor
77
How does sildenafil being a phosphodiesterase-5 inhibitor treat erectile dysfunction?
PDE-5 normally breaks down cGMP If its inhibited it means levels of cGMP remain higher for longer allowing more nitrous oxide to dilate the smooth muscle of the blood vessels to the penis
78
Why is important to assess patients with erectile dysfunction?
Can indicate ischaemic heart disease risk due to vascular risk factors
79
What age should you assess cardiovascular risk factors in men with new onset Erectile dysfunction?
60yrs old
80
What are some causes of erectile dysfunction?
Vascular Neurological Hormones Antidepressants Psychological
81
What are some causes of erectile dysfunction?
Vascular Neurological Hormones Antidepressants Psychological
82
What are some vascular issues that can cause ED?
Ischameic heart disease risk factors: -alcohol -smoking -obesity
83
What are some neurological causes of erectile dysfunction?
Diabetes (diabetic neuropathy) Spinal injury Parkinson’s
84
What medication treats erectile dysfunction?
Sildenafil
85
How is a simple communicating Hydrocoele managed in new born males?
Reassurance that most resolve within 1-2 years. If no resolution consider surgical repair

Y3(S) - Urology (5 decks)

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