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Genitourinary > Scrotal and Penile Disorders (Exam 3) > Flashcards

Scrotal and Penile Disorders (Exam 3) Flashcards

1
Q

Scrotal Masses that will always be painful

A

Epididymitis
Orchitis
Testicular Torsion

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2
Q

Pneumonic for remembering

how to assess and remember or think about scrotal masses.

A

HIMBIN

Hernias (inguinal, femoral)

Infections (epididymitis, orchitis, prostatitis, cellulitis, scrotal abscess)

Masses (Hydrocele, Epididymal cysts, testis cancer)

Blood Flow issues (Testicular torsion, Varicocele)

Inflammation (Non-bacterial, idiopathic, chronic inflammatory pain)

Nerve related (Chronic, normal u/s, history of back injury, referred pain)

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3
Q

what is Epididymitis

A

Bacterial infection of they Epididymis

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4
Q

How many men suffer from these disorders in a given day

A

1/1000 men annually

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5
Q

What is the etiology of Epididymitis

A

<35 y.o. - More likely STI - check for gonorrhea or chlamydia

> 35 y.o. - more like uropathogens- E.coli, Klebsiella, Enterococcus, Enterobacter

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6
Q

Clinical presentation of Epididymitis

A

Acute Scrotal pain, usually unilateral, but can be bilateral

Pain can range from mild to severe

Sudden onset over hours to days

Possible radiation to cord, groin, and even abdomen

General infection symptoms possible, with fever and chills

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7
Q

PE, testing and Epididymitis

A

May or may not have eternal erythema of the scrotum

Swelling and tenderness of the epididymis.

Prehn’s sign - Elevation of scrotum- makes epididymitis better but worsens pain of testicular torsion

STI testing in men < 35 or if potential for STI

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8
Q

Immaging of choice for diagnosis of Epididymitis if unable to make this decision with clinical judgment alone

A

Scrotal Ultrasound

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9
Q

Tx of Epididymitis

A

If Suspicions of STI or proven Gonorrhea/Chlamydia, empiric Abtic therapy with doxycycline 100 mg PO X10 days Plus Ceftriaxone 1 gram IM once

If negative STI screen, then empiric therapy with TMP/SMX or ciproflaxacin X 10-14 days

Supportive therapy: NSAIDs PRN pain, scrotal elevation, rest

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10
Q

Orchitis Definition

A

Infection of the parenchyma of the testis

Associated with about 60 ^ of epididymitis cases

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11
Q

Orchititis presentation

A

Almost identical to epididymitus

Has enlarged testicle with indistinguishable anatomy when trying to differentiate the testis from the epididymis you will have a hard time.

Testies are not transilluminable

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12
Q

Testicular torsion is or is not a medical emergency

A

Medical emergency - they need to return the blood flow to the testicle within four hours to save the testicle

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13
Q

What is the Standard for treating testicle torsion

A

Surgery

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14
Q

What is testicle torsion

A

the twisting and changing of the shape of the testicle to the (bell clapper)

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15
Q

What is the anatomical structure that keeps the testicle (usually) from twisting

A

Gubernaculum

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16
Q

What causes the pain

A

complete ischemia - also causes swelling and elevation of the scrotum

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17
Q

what is the age range that this is common in

A

most common from 12 to 18 with peak at age of 14 rare to be seen in men over 30 years of age

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18
Q

What is the timeframe that blood needs to be returned to the testicle for the “Gold Standard”

A

within 4 hours

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19
Q

torsions always happen by twisting which direction

A

medially - so to try to save a testicle you can twist them outward. However, this is not recommended unless absolute emergency. just let the surgery fix the problem. That and there is anot as much traveling that is happening with the swelling between the legs.

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20
Q

What is a Hydrocele

A

Fluid accumilation between tunica layers of the testis

Present in 80% of newborns but most close by 18 months

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21
Q

What percentage of men will have the hydrocele persist

A

in 1% of men

in practice a relatively common cause of non-painful scrotal pain

Commonly seen incidentally on ultrasound

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22
Q

in adults hydrocyele will grow typically gradually

A

enlarging testicle

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23
Q

why should we do an ultrasound when we find a hydrocele

A

because 10% of the hydroceles are reactice to underlying Testis cancer that cant be evaluated appropriately with exam only

24
Q

Treatment of Hydrocele

A

If it is not cancerous and it is not bothersome… they will not necessarily need anything at all done.

Bothersome- pt definition, this means what is uncomfortable to them., like looks, or cant cross legs or anything at all to them.

25
Q

Tx of hydrocele

A

Drainage - Temporary short lived to drain and help until surgery

Surgery- Excision- excise the sac which will eliminate the possible return of the issue, has complications causing scrotal hematoma in majority cases

26
Q

what is spermatocele

A

Fluid accumulation in the epididymis

27
Q

Most often this is on the head or tail of the epididymis

A

head

28
Q

What are Varicocele

A

The “varicose veins” of the spermatic cord (pampiniform plexus

29
Q

What is the cause of Varicocele

A

Increase intrascrotal temperature = decreased testicular function. Lower testosterone and a higher temperature making the sperm less active and keeping pts infertile

30
Q

Which side are vericocele almost always preside on

A

pts left side This is because of the anatomy of the gonadal vein running up to the renal vein at a 90Degree angle on the left side. the amount of blood coming out of the renal vein back pressure destroys the little valves

31
Q

Grades of varicocele

A

Grade 1- only palpable with valsalva

Grade 2 - palpable without valsalva

Grade 3- Visible externally with or without valsalva

32
Q

Useful in diagnosis if unclear if varicocele

A

Ultrasound

33
Q

what is the phrase that is always associated with varicocele

A

“Bag of worms”

34
Q

Tx of Varicocele

A

Just leave it alone and reassure if the pt has no pain, problems, or is not trying to have kids and demonstrating infertility

35
Q

Peyronie Disease is what

A

Scarring of the connective tissue layer (tunica albuginea) of the shaft of the penis. This causes curvature or waist- like deformity of the penis

36
Q

Progression of Peyronie Disease

A

20% 40% 40%

20 will resolve spontaneously
40 will remain stable over time
40 will worsen with time

37
Q

Complications of Peyronie Disease

A

Painful erections, during sex or even with nocturnal tumescence

Inability to have intercourse leading to infertility, anxiety and depression

38
Q

Peyronie disease Tx / Referral

A 
Referral is always an option, 
Consider time (20 percent) but it does take time most that resolve were 1-2 years
39
Q

Primary treatment for Peyronie Disease

A

Xiaflex- injection of collagenase enzyme to break up collagen bonds in the scarred plaque

40
Q

Phimosis is what

A

Narrowing of the foreskin due to inflammation

41
Q

What is a pathologic phimosis called

A

Acquired phimosis - usually seen in pts that have recurrent balanitis or poor hygiene

42
Q

Phimosis

A

Really tight and not going anywhere when you pull on it without pain.

43
Q

What is Balanitis

A

Inflammation of the glans penis

Generally caused by fungal infection commonly candida

44
Q

Tx of Blanitis

A

Mostly with an Antifungal cream and a steroid

45
Q

Definitive tx for recurrent cases of blanitis

A

circumcision

46
Q

Clinical presentation of Phimosis

A

Tight foreskin, unable to retract

Not usually painful at rest but upon retraction you will see cracks that that will be made as you pull on it to try to open up more

47
Q

The most important to teach a pt about phimosis

A

Make sure they are washing foreskin daily, and retracting the foreskin to completely clean will prevent this from occurring.

Watch for this issue in elderly, pts with mental issues, pt in low-income situation without access to good hygiene

if you can pull the foreskin back make sure you put it back over the glans or it will cause the next problem we will discuss- paraphimosis

48
Q

Phimosis tx and referral

A

Tx can ititially be a tiral of medium to high-potentcy steroid cream, but only effective if able to retract the foreskin completely

49
Q

what is Paraphimosis

A

Tight, inflammatory band of foreskin that can cause loss of blood flow to the distal penis

Always associated with phimosis
Can be very painful at the pint of the ring and distally

very painful at the point of the ring and distally

50
Q

Tx of Paraphimosis

A

reducing the ring. You should not do it if you are inexperienced with reducing them. you should refer to the ER.

  • if you are going to be in the ER or Rural area then this is a good skill to learn
51
Q

what is Priapism

A

pooling of blood in the corpora cavernosa in penis . - O2 deprived blood to dominate the tissue, leading to ischemia causing cell death of the penis over time.

52
Q

Most common cause of Priapism

A

Drugs

trazodone, alcohol, cannabis, cocaine, nitroglycerine, injected vasodilators, and rarely Oral ED drugs (like viagra

53
Q

Other causes of Priapism

A

Sickle Cell disease
Trauma
Spinal cord injury

54
Q

You want to fix priapism in what timeframe

A

within 4 hours the tissues will die if they are unable to return the blood flow within the four hour timeframe

55
Q

Management of Priapsim

A

Try vigorous exerciese to shunt blood away from the pelvis

If >4 hours they need referral to ER with Urology consultation generally

In ER - There will be penile injection of phenylephrine to
to get the constriction of the vessels and get the blood out

56
Q

Other Tx of priapsim

A

Forced fluid evacuation with large-bore needles

last line surgery with a distal shunt procedure to drain the blood from the penis

57
Q

Priapism Prevention

A

Remove the medications that cause a problem.

Get alcoholics off alcohol and in a 12 step program

Have cocaine addicts

Genitourinary (11 decks)

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