Scrotal and Testicular Disorders Flashcards
Undescended testes or absent testes (agenesis). Occurs when one or both of the testicles fail to move down into the scrotal sac
Cryptorchidism
What is the incidence of cryptorchidism directly related to?
birth weight and gestational age
When does spontaneous descent of an undescended testicle usually occur?
during 1st three months, rarely after 6 months
Long-term consequences of cryptorchidism
infertility, malignancy, inguinal hernias, testicular torsion
How do you differentiate between undescended and retractable testes?
retractable are palpable at birth, palpation in warm room can bring them down, and assume scrotal position at puberty
Excess fluid collects between the layers of the tunica vaginalis usually peritoneal fluid due to a weakness in the patent processus vaginalis
hydrocele
What are primary congenital hydroceles associated with?
indirect inguinal hernia
How long do you wait before doing surgical treatment of a hydrocele?
2 yrs
How should you evaluate a suspected hyrocele?
transillumination first. ultrasound if transillumination fails
What should a hydrocele in a young man be considered until proven otherwise?
cancer
Symptoms associated with a hydrocele
heaviness in the scrotum and pain in the lower back
Accumulation of blood in the tunica vaginalis. Can compromise testicle. Causes scrotal skin to become dark red or purple
hematocele
Painless, sperm-containing cyst that forms at the end of the epididymis. Located above and posterior to the testes. Attached to the epididymis
spermatocele
What is the treatment for a spermatocele if it has become painful?
excision
Cause of varicocele that results from damage to the elastic fibers and hypertrophy of vein walls
varicosities of the pampiniform plexus
Age group usually affected by varicoceles
15-35 yrs
Why are varicoceles more common in the left testicle besides presence of more incompetent valves?
left internal spermatic vein inserts renal vein at right angle and force of gravity from upright position causes venous dilatation.
Typically disappears in the supine position and feels like a bag of worms on palpations
varicocele
What is the surgical treatment for a varicocele in males showing testicular atrophy?
liagation of the gonadal vein
Twisting of the testes on the long axis of the tunica vaginalis rotates about the spermatic cord. usually presents before 18yrs. Urological emergency
testicular torsion
Patient presents with N/V, tachycardia, large/firm/tender testes with pain radiating to inguinal area. cremasteric reflex is absent. what should you order?
Color Doppler ultrasonography and emergent urology referral since this is the presentation for testicular torsion
Because most torsions twist inward and toward the midline, which way should you twist for manual detorsion?
outward and laterally
What STIs are associated with epididymitis?
gonorrhea and chlamydia
What bacteria are involved with non-sexually transmitted epididymitis that is associated with UTIs and prostatitis?
e. coli, pseudo, gram (+) cocci
Patient presents with unilateral pain/swelling of testes. Erythema and edema of scrotal skin, fever, and dysuria. What tests should you order?
CBC, UA w/culture, urethral culture (or NAAT), gram stain. This is presentation for epididymitis
Treatment for epididymitis besides antibiotics
bedrest, scrotal elevation, avoid sexual activity until sx resolve
Infection of the testes. Caused by primary infection of the GU tract or infection spread to the testes through the bloodstream or lymphatics
orchitis
Systemic source of orchitis that doesn’t occur in prepubertal boys, but affects 20-35% of adolescent boys/young men
parotitis (mumps)
Patient presents with fever, painfully enlarged testes with small hemorrhages into the tunica abluginia, but no urinary symptoms. What is the best management?
none, course for orchitis is 7-10 days and unpredictable
What are the potential residual effects of orchitis?
hyalinization of the seminiferous tubules and testicular atrophy
What is the difference between scrotal and testes tumors?
benign scrotal tumors are common (carcinoma is rare) whereas nearly all tumors of the testes are malignant
Patient who is a road pavement worker presents with a scrotal ulceration that he says used to be a “wart.” What are his treatment options?
excision of tumor w/inguinal and femoral node dissection (this is scrotal cancer)
Most common cancer in 15-35 yr age group that is highly curable if discovered and preventable by monthly self-testicular exams
testicular cancer
Strongest predisposing factor to testicular cancer
cryptorchidism
Most common type of testicular tumor. Confined to the testicle at the time of presentation. Grow slowly and do not spread rapidly. Arises from seminiferous epithelium
seminomas
Nonseminoma that most commonly affects boys up to 3 yrs of age
yolk cell carcinoma
Nonseminoma that occurs in 20-30 yr age group
embryonal carcinoma
Patient presents with solid, painless testicular mass that doesn’t transilluminate. What is your next step?
order testicular ultrasound
What is the only way to confirm the diagnosis of testicular cancer?
inguinal orchiectomy
Metastases sites for testicular cancer
retroperitoneal lymph nodes, liver, lung, brain
Blood tests used in the process of staging testicular cancer and help monitor response to therapy (often first sign of relapse)
alpha-fetoprotein (AFP), hCG, lactic dehydrogenase (LDH)
Describe the stages of testicular cancer
1-cancer is limited to testis. 2- cancer has metastasized to lymph nodes. 3- cancer has spread to other organs
When does relapse of testicular cancer usually occur?
within two years
