prostate 2 Flashcards
cryptorchidism
hidden testis
can be absent, undescended to ectopic
absent cryptorchidism
from agenesis or atrophy
undescended cryporchidism
the testes have stopped short on their journey during foetal development from the abdominal cavity to the scrotum
ectopic cryptorchidism
diverted to an aberrant position, like the perineum, penis or thigh
testis migration is controlled by
complex system
mullein inhibiting substance and androgens
risk factors for undescended testes
prematurity, poor growth in utero, prenatal exposure to diethylstilbestrol, pesticides
cryptorchidism complications
inguinal hernia
testicular torsion
sub fertility
malignant transformation
epididymo-orchitis
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
epididymo-orchitis symptoms
localised testicular pain tenderness and swelling scrotal wall erythema hydrocele if untreated, can be complicated by abscess formation and testicular infarction
testicular torsion
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
testicular torsion occurs in
neonates and then in adolescence
why does testicular torsion occur in adolescence
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
testicula torsion symptoms
- acute onset, moderate to severe pain,
profound diffuse tenderness and swelling
absent cremasteric reflex
nausea and vomiting
appearance of testicular torsion
asymmetrically high rising testis
horizontal rather vertical
testicular swelling with hydrocele
what to do in testicular torsion
confirm with ultrasound
refer to surgeon urgently
tumours of the testis
between ages 15-35
rarish
germ cell tumours of testicular tumours
germ cell :
- seminoma and non-seminoma
others: - lymphoma
- sex cord stromal
- metastases
germ cell tumours of the testis risk factors
- Caucasian men
- undescended testis
- previous germ cell tumour
- inguinal hernia
- family history
presentation of germ cell tumours of testes cancer
- painless testicular swelling
- feels heavy
- hormonal manifestations eg. gynecomastia
- symptoms of metastases eg. abdominal pain from retroperitoneal metastases, haemoptysis from pulmonary metastases
seminoma
commonest type of germ cell tumours
men 30-50
strong association with crytorchism
seminoma prognosis
good prognosis disease
usually treated with orchidectomy
very sensitive to chemotherapy and radiotherapy
spreads to lymph nodes , particularly para aortic lymph nodes
non seminomatous germ cell tumours
approx 1/3 of testicualr cancers
ages 20-30
may be combined with seminoma
non seminomatous germ cell tumour types
- embryonal carcinoma
- teratoma
- yolk sac tumour (associated with serum AFP)
- choriocarcinoma (assciated with elevated serum bHCG)
work up of suspected testicular tumour
- scrotal ultrasound
- measurement of serum tumour markers
- abdominal CT scan an CXR, looking for metastasis to the retroperitoneal lymph nodes and lungs
- orchidectomy
treatment of germ cell tumours
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
hypospadias/epispadias
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)
hypospadias
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
epispadias
rare, occurring in 1 in 120 000 live male births
phimosis
foreskin cannot be retracted
can be from congenitally small orifice, or the result of repeated infections/scarring
condyloma acuminata
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
carcinoma of the penis
rare
presents as a painless lump or ulcer
vast majority are squamous cell carcinoma
SCC of the penis
squamous cell carcinoma
rare in western countries
more in africa, Asia and south America
risk factors for SCC
- high risk HPV
- phimosis
- HIV
- smoking
carcinoma of the penis appearance
red patches painless lumps ulcers often slow growing metastasises to inguinal lymph nodes prognosis related to stage, poor once spread to lymph nodes
