RENAL 138 Testicular Lumps Flashcards
What is epididymitis?
Inflammation of the epididymis
What is orchitis?
Inflammation of the testes
What would you suspect was the cause of epididymo-orchitis in a patient less than 35 years old?
STD
What would you suspect was the cause of epididymo-orchitis in a patient greater than 35 years old?
Urine infection pathogens
What are the clinical features of epididymo-orchitis?
Tender, swollen, dysuria, sweating, fever, possible discharge
Why is testicular torsion a medical emergency?
As it can cut off blood supply to the testes which can cause irreversible damage
Describe testicular torsion
Twisting of the spermatic cord with strangulation of the blood supply
How would a patient with testicular torsion present?
Acute onset of pain in one testes, may have associated nausea and vomiting, inflammation, testis may look high and transverse
What is a varicocoele due to?
Dilated veins of the pampiniform plexus - incompetent venous valves
Define a hydrocoele
A fluid collection within the parietal and visceral layers of the tunica vaginalis
What are the risk factors for testicular cancer?
Undescended testes, family hx, infertility, caucasian, infection
What are some of the symptoms of a testicular cancer?
painless testicular lump, heaviness/dragging and any symptoms associated with metastases
What are primary testicular cancers mainly cancers of?
Germ cells
What lymph nodes do testicular cancers involve?
Para-aortic lymph nodes
How do alkylating chemotherapeutic agents work?
Form covalent bonds between DNA bases interfering with DNA replication
Give some examples of alkylating agents?
metachloratemine, cyclophosphamide, ifosfamide
How do platinum chemotherapeutic agents work?
form adducts/cross-links between DNA strands = strands break
Give some examples of platinum agents
cisplatin and carboplatin
How do anthracyclines work?
Intercalate in the DNA moleculem blocking action of topsoimerase
Give an example of some anthracyclines?
Doxoribillin, epirubillin
How does the anti-metabolite fluorouracil work?
Inhibits thymidine synthesis by mimicking uracil
How does the anti-metabolite methotrexate work?
inhibits a key enzyme in the metabolism of folate
How do anti-microtubule agents work?
Prevent polymerisation and depolymerisation of tubulin
What are the two groups of anti-microtubule agents?
taxanes and vinca alkaloids
Name some risk factors for prostate cancer
Age, family hx, caucasian, BRCA2 gene mutations and lynch syndrome
What are some of the symptoms of prostate cancer?
Obstructive voiding: dribbling, difficulty getting going, poor stream; haemospermia, bone pain and anaemia
Why is PSA not an accurate and specific test for prostate cancer?
It can easily be raised e.g. in UTI and is hormone dependant
When would PSA be relevant to initiate a urology referral?
with an abnormal DRE
How would you treat localised prostate cancer
radial prostatectomy/ radiotherapy +/- hormonal ablative therapy
How would you treat metastatic prostate cancer?
Palliatively depending on the hormonal dependance:
Castration, anti-androgens, LNRH analogues and any bone metastases with bisphosphonates (reduce pain not treat)
How do bisphosphonates work?
By inhibiting osteoclast formation, migration and subsequent osteolytic activity
