S10C96 - Male genital problems Flashcards
1
Q
Penis: anatomy
A
- 3 cylindrical bodies: corpus spongiosum surround urethra and 2 corpora cavernosa (main erectile tissue)
- capped by glans penis
- 3 bodies are encased individually in thick tunica albuginea
- all three are surrounded by buck fascia
- internal pudendal artery supplies blood and branches into deep and superficial penile arteries
2
Q
Scrotal anatomy
A
- from outer to inner layers: skin, dartos fascia (eg. camper fascia), colles fascia (ie. scarpa fascia)
- blood supply is from femoral and internal pudendal arteries
- lymphatics drain to inguinal and femoral nodes
3
Q
Testicular anatomy
A
- size: 5cm long, 3cm wide
- each is encased in fibrous tunica albuginea (except posteriorly )
- tunica vaginalis covers anterior and lateral testes
- superiorly testis is attached to spermatic cord, inferiorly to the gubernaculum (scrotal ligament)
- poor dvpt of tunica vag is what leads to torsion
- hydrocele occurs when tunica vag is prevented from absorbing viscerally secreted fluid
- blood supply : internal/external spermatic arteries (spermatic cord)
- venous return via internal spermatic, epigastric, internal circumflex and scrotal veins
- lymphatic drainage via external/common iliac and periaortic nodes
4
Q
Epididymis: anatomy
A
- fine, tubular structure that promotes sperm maturation and motility
- appendix epididymis and appendix testis = vestigial structures
- appendix epididymis is attached to the head of epididymis (globus major)
- appendix testis is a pear shaped structure of mullerian duct origin situated uppermost portion of testis
- lies on posterolateral aspect of testis, has similar feeling as ear lobe
- has a head, body and tail, normally is sensitive
5
Q
Vas deferens
A
- muscular tube palpable w/in scrotal sac
- extends to spermatic cord from tail of epididymis
- joins seminal vesicles to form the paired ejaculatory ducts in the prostatic urethra
6
Q
Prostate: anatomy
A
- weighs 10-15g
- anterior, median, posterior and lateral lobes
7
Q
Scrotal edema: causes
A
- bites, dermatitis
- young boys: idiopathic edema, unilateral swelling, erythema and pain b/w 3-9yo, resolves in 1-4d with 15% recurrence
- fluid overload, hypoalbuminemia, anasarca
8
Q
Scrotal Abscess
A
- determine whether it is restricted to the skin or more complicated underlying structures
- if simple hair follicle scrotal wall abscess then I+D
- if testis involved then use u/s, refer to urology
9
Q
Fournier Gangrene
A
- polymicrobial
- necrotizing fasciitis of perineal, genital and perianal anatomy
- usually begins as benign infection that becomes virulent
- results in microthrombosis of small subcutaneous vessels leading to dvpt of gangrene of the overlying skin
- RF: immunocompromised, DM, EtOH use
- marked pain and swelling, crepitus, ecchymosis
- aggressive fluid resusc
- requires Abx coverage for gm-, gm+, and anaerobes
eg. imipenem ig IV q8h plus vanco if mRSA - plus wide surgical debridement
- mortality = 40%
- ** genital pain our of proportion or extending beyond the confined area of infxn
10
Q
Balanoposthitis
A
- balanitis: inflm of glans penis
- posthitis: inflm of foreskin
- balanoposthitis: inflm of glans and foreskin
- etiology: poor hygiene or external irritation (candida colonization), candida, gardernella and anaerobes
- o/e: if foreskin is retracted the glans and apposing prepuce appear purulent, excoriated, malodorous and tender
- tx: cleanse with mild soap, ensure dryness, apply antifungal cream (nystatin, clotrimazole), tx with oral azole (fluconazole) and consider circumcision
- bacterial infxn suggested by warmth, erythema, edema of glans/foreskin/shaft, if present use a 1st or 2nd generaiton cephalosporin in addition to aforementioned treatments
-if recurrent: think DM
11
Q
Phimosis
A
- inability to retract foreskin proximally and posterior to glans penis
- cause: infxn, poor hygience, previous preputial injury with scarring
- definitive tx: circumcision
- other tx: topical steroid betamethasone 0.05-0.1% OD from tip of foreskin to glandis corona for 4-6w is 70-90% effective
12
Q
Paraphimosis
A
- urologic emergency
- inability to reduce proximal edematous foreskin distally over the glans penis
- glans edema and venous engorgement can progress to arterial compromise and gangrene
- reduction: compression of glans for several minutes to reduce edema then roll foreskin over glans
- do a local anesthetic block
13
Q
Removing constricting bands from penis:
A
- compression, cooling, cutting
- wrap penis distal to proximal with ubilical tape or thick suture, try to pass tape under the ring/object
14
Q
Hair tourniquet
A
- if it has been present for some time, urethra and dorsal nerve supply may be damaged
- may require a retrograde urethrogram to ensure urethral integrity and a doopler for distal penile arterial blood supply
15
Q
Zipper entrapment:
A
- provide local anesthesia
- try coating zipper with mineral oil or lubricant
- if that doesn’t work then cut zipper free of clothing to make it easier then try cutting the sliding bar of the zipper and the zipper teeth
- can also cut the bottom bar of the zipper apparatus
