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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
Tx of hydrocele
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
what is spermatocele
Fluid accumulation in the epididymis
27
Most often this is on the head or tail of the epididymis
head
28
What are Varicocele
The "varicose veins" of the spermatic cord (pampiniform plexus
29
What is the cause of Varicocele
Increase intrascrotal temperature = decreased testicular function. Lower testosterone and a higher temperature making the sperm less active and keeping pts infertile
30
Which side are vericocele almost always preside on
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
Grades of varicocele
Grade 1- only palpable with valsalva Grade 2 - palpable without valsalva Grade 3- Visible externally with or without valsalva
32
Useful in diagnosis if unclear if varicocele
Ultrasound
33
what is the phrase that is always associated with varicocele
"Bag of worms"
34
Tx of Varicocele
Just leave it alone and reassure if the pt has no pain, problems, or is not trying to have kids and demonstrating infertility
35
Peyronie Disease is what
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
Progression of Peyronie Disease
20% 40% 40% 20 will resolve spontaneously 40 will remain stable over time 40 will worsen with time
37
Complications of Peyronie Disease
Painful erections, during sex or even with nocturnal tumescence Inability to have intercourse leading to infertility, anxiety and depression
38
Peyronie disease Tx / Referral
``` Referral is always an option, Consider time (20 percent) but it does take time most that resolve were 1-2 years ```
39
Primary treatment for Peyronie Disease
Xiaflex- injection of collagenase enzyme to break up collagen bonds in the scarred plaque
40
Phimosis is what
Narrowing of the foreskin due to inflammation
41
What is a pathologic phimosis called
Acquired phimosis - usually seen in pts that have recurrent balanitis or poor hygiene
42
Phimosis
Really tight and not going anywhere when you pull on it without pain.
43
What is Balanitis
Inflammation of the glans penis Generally caused by fungal infection commonly candida
44
Tx of Blanitis
Mostly with an Antifungal cream and a steroid
45
Definitive tx for recurrent cases of blanitis
circumcision
46
Clinical presentation of Phimosis
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
The most important to teach a pt about phimosis
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
Phimosis tx and referral
Tx can ititially be a tiral of medium to high-potentcy steroid cream, but only effective if able to retract the foreskin completely
49
what is Paraphimosis
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
Tx of Paraphimosis
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
what is Priapism
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
Most common cause of Priapism
Drugs | trazodone, alcohol, cannabis, cocaine, nitroglycerine, injected vasodilators, and rarely Oral ED drugs (like viagra
53
Other causes of Priapism
Sickle Cell disease Trauma Spinal cord injury
54
You want to fix priapism in what timeframe
within 4 hours the tissues will die if they are unable to return the blood flow within the four hour timeframe
55
Management of Priapsim
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
Other Tx of priapsim
Forced fluid evacuation with large-bore needles last line surgery with a distal shunt procedure to drain the blood from the penis
57
Priapism Prevention
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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