Scrotal and Testicular Disorders Flashcards
Cryptorchidism
Undescended or absent testes
Incidence related to birth weight and gest age
Can be in full-term infants as well
When doe spontaneous descent usually occur?
Often in first 3 months
Rarely after 6 months
Changes in undescended testi
Delay in germ cell development
Changes in spermatic tubules
Reduced number of leydig cells
undescended testicles increase risk of?
Infertility
Malignancy
Hydrocele
Excess fluid btw tunica vaginalis
Usually peritoneal fluid
Primary congenital hydrocele
Associated w/ indirect inguinal hernia
Usually close spontaneously
Secondary hydrocele
Trauma Infection torsion orchitis CA
Hydrocele dx
Transillumination
US
Hydrocele in young man with no apparent cause =
CA until proven otherwise
Hydrocele tx
If needed, surgery
Treat underlying condition
Hematocele
Accumulation of blood in tunica vaginalis
Looks dark red or purple
Can compromise testicle
Spermatocele
Painless, sperm containing cyst forming at end of epididymis
Seperate from testis
Freely movable, should transilluminate
Varicocele
Varicosities of the pampiniform plexus
Sperm count and mobility decreased
Common in men btw 15 and 35 yrs
Which side os more common for varicocele?
Left side
L spermatic vein enters L renal vein at R angle
Varicocele usually dissapears in ____ position.
supine position
Varicocele looks like a bag of?
worms
varicocele tx
Surgical ligation of gonadal vein
NSAIDS and scrotal support
Testicular torsion
Twisting of the spermatic chord
Usually presents before 18
Acute emergency
COngenital/neonate torsion
Less common
FIrm, smooth and painless scrotal mass
Scrotal skin appears red
Torsion rarely seen after age
30
S/S of torsion
Severe distress/pain
N/V, tachycardia
Large, firm, tender testes
Pain radiates to inguinal area
Torsion tx
manual detorsion (open a book)
Surgical detorsion
Orchiectomy
Epididymitis
Can be STI (young) or non-STI (old)
Associated w/ urethritis
Almost always bacterial
Non-STI epididymitis bugs
E-coli
Pseudomonas
Epididymitis S/S
Unilateral pain and swelling in testis Erythema and edema can be large Tenderness in groin and abdomen Fever dysuria
Epididymitis tx
Bedrest
Scrotal support
Abx
Oral alangesics
Orchitis
Infection of the testes
Caused by GU infxn
Orchitis S/S
Mumps can cause
Urinary symptoms are absent
No treatment
Some have impaired spermatogenesis for life
Carcinoma of SCROTUM is ?
Rare
ALmost all tumors of testicles are?
Malignant
Scrotal CA
Mean presentation of 60 yrs
Small wart like thing that ulcerates
Preceded by many years of irritation
More than 1/2 cases metastasize to lymph nodes
Testicular CA
Most common cause of CA in 15 - 35 yo age group.
Highly curable if discovered early
Testicular CA risks
Cryptorchidism (strongest)
Genetics
Disorders of testicular development
Trauma NOT known precipitant
95% of malignant tumors are ___ cell tumors
Germ cell tumors
Seminoma
Most common type of testicular tumor Most are confined to testicle Grow slowly, don't spread rapidly Most frequent in 4th decade Almost never occurs in kids
Nonseminomas (NSGCT’s)
Most commonly in 20-30 age group
Less differentiated than seminomas
More likely to spread in bloodstream
S/S of testicular CA
Slight enlargement of testicle May be discomfort Aching of abdomen and groin Solid, painless mass Non-transilluminating
Testicular CA metastatic sites
Lymph nodes
Liver
Lung
Brain
Dx and Tx of testicular CA
No biopsy
US or MRI
Excision to confirm
Tumor markers for testicular CA
Alpha-fetoprotein (AFP)
hCG
Lactic dehydrogenase (LDH)
