prostate 2

Question 1

cryptorchidism

Answer 1

hidden testis

can be absent, undescended to ectopic

Question 2

absent cryptorchidism

Answer 2

from agenesis or atrophy

Question 3

undescended cryporchidism

Answer 3

the testes have stopped short on their journey during foetal development from the abdominal cavity to the scrotum

Question 4

ectopic cryptorchidism

Answer 4

diverted to an aberrant position, like the perineum, penis or thigh

Question 5

testis migration is controlled by

Answer 5

complex system

mullein inhibiting substance and androgens

Question 6

risk factors for undescended testes

Answer 6

prematurity, poor growth in utero, prenatal exposure to diethylstilbestrol, pesticides

Question 7

cryptorchidism complications

Answer 7

inguinal hernia
testicular torsion
sub fertility
malignant transformation

Question 8

epididymo-orchitis

Answer 8

commonly infectious cause, but rarely can be caused by trauma or autoimmune disease
in men <35, usually neisseria gonorrhoeae, chlamydia trachnomatis
in men >35, usually escherichia coli, other coliforms, pseudomonas species

Question 9

epididymo-orchitis symptoms

Answer 9

localised testicular pain 
tenderness and swelling 
scrotal wall erythema 
hydrocele 
if untreated, can be complicated by abscess formation and testicular infarction

Question 10

testicular torsion

Answer 10

a urologic emergency
the testic can twist in the spermatic cord, blocking venous drainage of the testis (and arterial supply if its bad)
haemorrhage infarction if untreated

Question 11

testicular torsion occurs in

Answer 11

neonates and then in adolescence

Question 12

why does testicular torsion occur in adolescence

Answer 12

there can be an underlying anatomical defect, where the lower pole of the testis Is not properly fixed to the tunica vaginalis
can occur spontaneously or after trauma
after 12 hours of ischaemia, the testis suffers irreversible damage
can also be damage to the other testic as anti-sperm antibodies can form causing infertility

Question 13

testicula torsion symptoms

Answer 13

• acute onset, moderate to severe pain,
  profound diffuse tenderness and swelling
  absent cremasteric reflex
  nausea and vomiting

Question 14

appearance of testicular torsion

Answer 14

asymmetrically high rising testis
horizontal rather vertical
testicular swelling with hydrocele

Question 15

what to do in testicular torsion

Answer 15

confirm with ultrasound

refer to surgeon urgently

Question 16

tumours of the testis

Answer 16

between ages 15-35

rarish

Question 17

germ cell tumours of testicular tumours

Answer 17

germ cell :

• seminoma and non-seminoma
  others:
• lymphoma
• sex cord stromal
• metastases

Question 18

germ cell tumours of the testis risk factors

Answer 18

• Caucasian men
• undescended testis
• previous germ cell tumour
• inguinal hernia
• family history

Question 19

presentation of germ cell tumours of testes cancer

Answer 19

• painless testicular swelling
• feels heavy
• hormonal manifestations eg. gynecomastia
• symptoms of metastases eg. abdominal pain from retroperitoneal metastases, haemoptysis from pulmonary metastases

Question 20

seminoma

Answer 20

commonest type of germ cell tumours
men 30-50
strong association with crytorchism

Question 21

seminoma prognosis

Answer 21

good prognosis disease
usually treated with orchidectomy
very sensitive to chemotherapy and radiotherapy
spreads to lymph nodes , particularly para aortic lymph nodes

Question 22

non seminomatous germ cell tumours

Answer 22

approx 1/3 of testicualr cancers
ages 20-30
may be combined with seminoma

Question 23

non seminomatous germ cell tumour types

Answer 23

• embryonal carcinoma
• teratoma
• yolk sac tumour (associated with serum AFP)
• choriocarcinoma (assciated with elevated serum bHCG)

Question 24

work up of suspected testicular tumour

Answer 24

• scrotal ultrasound
• measurement of serum tumour markers
• abdominal CT scan an CXR, looking for metastasis to the retroperitoneal lymph nodes and lungs
• orchidectomy

Question 25

treatment of germ cell tumours

Answer 25

surgery
if early stage seminoma, orchidectomy may be adequate
If early stage NSGCT, treatment depends on presence of poor prognostic factors like LVSI, predominance of embryonal carcinoma, T3 or T4 disease
in advanced disease, options are chemotherapy, radiotherapy, surgery to metastatic deposits

Question 26

hypospadias/epispadias

Answer 26

malformation of the urethral groove and urethral canal

an abnormal urethral opening on the ventral surface of the penis (hypospadias) pr on the dorsal surface (epispasias)

Question 27

hypospadias

Answer 27

urethral orifice is at the underside of the penis

in severe cases - may open at the base of the penis, more of the penis than normal is fused to the body, so it Is smaller

Question 28

epispadias

Answer 28

rare, occurring in 1 in 120 000 live male births

Question 29

phimosis

Answer 29

foreskin cannot be retracted

can be from congenitally small orifice, or the result of repeated infections/scarring

Question 30

condyloma acuminata

Answer 30

genital warts
manifestations of the HPV infection
usually low risk types HPV
common
increased risk with immunosuppression, smoking
tend to recur but only rarely progress to malignancy

Question 31

carcinoma of the penis

Answer 31

rare
presents as a painless lump or ulcer
vast majority are squamous cell carcinoma

Question 32

SCC of the penis

Answer 32

squamous cell carcinoma
rare in western countries
more in africa, Asia and south America

Question 33

risk factors for SCC

Answer 33

• high risk HPV
• phimosis
• HIV
• smoking

Question 34

carcinoma of the penis appearance

Answer 34

red patches 
painless lumps 
ulcers 
often slow growing
metastasises to inguinal lymph nodes 
prognosis related to stage, poor once spread to lymph nodes