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Renal > Scrotal Disease > Flashcards

Scrotal Disease Flashcards

1
Q

What is the most common prostatic disease in males over 50?

A

Benign Prostatic Hyperplasia (BPH)

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2
Q

What is BPH characterised by?

A

Nodular prostatic hyperplasia
Not premalignant

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3
Q

How does BPH cause urine constriction?

A

Hyperplasia of prostatic epithelial, stromal cells > formation of nodules in transition zone of prostate > narrowing of urethral canal > urine flow constricted

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4
Q

What does testosterone + DHT do in BPH?

A

Testosterone + DHT estrogens act on stromal, epithelial cell androgen receptors > hyperplasia and inhibition of normal cell death

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5
Q

What does dysregulation of stromal growth factors do?

A

proliferation, hyperplasia of epithelium
Increased stem cells

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6
Q

Path of BPH

A
  • inner transitional zone of prostate ( muscular gland) proliferates and narrows the urethra
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7
Q

Risk factors of BPH

A

Increased age
Family history of BPH
hEART DISEASE
Beta Blocker use
Obesity
Diabetes
Erectile dysfunction

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8
Q

Complications of BPH

A

Chronic bladder outlet obstruction
Bladder hypertrophy > formation of bladder diverticula
Urinary retention > bladder calculi
Recurrent UTIs
Hydronephrosis > renal failure

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9
Q

Signs and symptoms of BPH

A

Typical LUTS
Urinary issues - frequency, urgency, dysuria, emptying bladder feels incomplete, weak stream

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10
Q

Initial assessment of men presenting with LUTS involves:

A

Digital rectal examination (prostate exam) to assess the size, shape and characteristics of the prostate

Abdominal examination to assess for a palpable bladder and other abnormalities

Urinary frequency volume chart, recording 3 days of fluid intake and output

Urine dipstick to assess for infection, haematuria (e.g., due to bladder cancer) and other pathology

Prostate-specific antigen (PSA) for prostate cancer, depending on the patient preference

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11
Q

Diagnostic imaging for for BPH

A

US - Bladder size, prostate size
Cystoscopy - Reveal bladder divericula/ calculi before schedule invasive treatment

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12
Q

Lab investigations for BPH

A

Urinalysis - haematuria, Pyuria, bacteriuria
Urine culture - exclude UTIs
Blood tests - Increased PSA, electrolytes, blood urea nitrogen, creatinine

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13
Q

What is The international prostate symptom score (IPSS)?

A

scoring system that can be used to assess the severity of lower urinary tract symptoms.

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14
Q

Common causes of raised PSA

A

Prostate cancer
Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation

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15
Q

Benign vs malignant prostate

A

A benign prostate feels smooth, symmetrical and slightly soft, with a maintained central sulcus

A cancerous prostate may feel firm/hard, asymmetrical, craggy or irregular, with loss of the central sulcus

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16
Q

Medical options for BPH

A

Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms

5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate

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17
Q

Surgical options for BPH

A

Transurethral resection of the prostate (TURP)

Transurethral electrovaporisation of the prostate (TEVAP/TUVP)

Holmium laser enucleation of the prostate (HoLEP)

Open prostatectomy

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18
Q

Transurethral Resection of the Prostate

A

most common surgical treatment of BPH. It involves removing part of the prostate from inside the urethra.

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19
Q

Complications of Transurethral Resection of the Prostate?

A

Bleeding
Infection
Urinary incontinence
Erectile dysfunction
Retrograde ejaculation (semen goes backwards and is not produced from the urethra)
Urethral strictures
Failure to resolve symptoms

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20
Q

Transurethral electrovaporisation of the prostate (TEVAP / TUVP)

A

nvolves inserting a resectoscope into the urethra.
A rollerball electrode is then rolled across the prostate, vaporising prostate tissue and creating a more expansive space for urine flow.

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21
Q

Holmium laser enucleation of the prostate (HoLEP)

A

nvolves inserting a resectoscope into the urethra.

laser is then used to remove prostate tissue, creating a more expansive space for urine flow.

22
Q

What is the most common cause of scrotal enlargement?

A

Varicocele

23
Q

Pathology of varicocele

A

Common testicular disorder of young adults

Dilation of pampiniform venous plexus (internal spermatic vein)
Impaired venous drainage > increased venous pressure > vein dilation

24
Q

Which side does varicocele affect?

A

Left sided usually > due to increased flow resistance from left testicular vein drainage into left renal vein; right testicular vein drains directly into IVC

25
Q

Types of varicocele

A

Large - easily identified by inspection as distention
Moderate - identified by palaption as bag of worms
Small - identified only by bearing down > increased abdominal pressure which impedes drainage > increased varicocele size

26
Q

Causes of varicocele

A

Idiopathic
Retroperitoneal pathology (RCC) > can invade renal vein > left sided varicocele

27
Q

Complications of varicocele

A
  • Sperm impairments: Production, quality due to heat,
  • Decreased sperm concentration
  • Decreased motility
  • Testicular damage
28
Q

Signs and symptoms of Varicocele

A

Usually asymptomatic
If symptomatic - Scrotal heaviness or scrotal pain

29
Q

Diagnostic imaging for varicocele

A

Doppler ultrasound - Characteristic reverse blood flow
Ultrasound/ CT scan

30
Q

Lab investigations for varicocele

A

Semen analysis - impairment in semen parameters

31
Q

Treatment for varicocele

A

Surgery
Surgical ligation/ embolization

32
Q

What can varicocele result in?

A

testicular atrophy, reducing the size and function of the testicle.

33
Q

What is the paminiform plexus?

A

venous plexus is found in the spermatic cord and drains the testes.

The pampiniform plexus drains into the testicular vein. It plays a role in regulating the temperature of blood entering the testes by absorbing heat from the nearby testicular artery.

The testicles need to be at an optimum temperature for producing sperm.

34
Q

What are varicocele a result of

A

increased resistance in the testicular vein.

Incompetent valves in the testicular vein allow blood to flow back from the testicular vein into the pampiniform plexus.

35
Q

What does the right testicular vein drain into ?

A

IVC

36
Q

What can varicocele present with?

A

Throbbing/dull pain or discomfort, worse on standing
A dragging sensation
Sub-fertility or infertility

37
Q

Examination findings of varicocele

A

A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle

38
Q

What do Varicoceles that do not disappear when lying down raise concerns about?

A

Retroperitoneal tumours obstructing the drainage of the renal vein.

These warrant an urgent referral to urology for further investigation.

39
Q

Investigations to consider for varicocele are

A

Ultrasound with Doppler imaging can be used to confirm the diagnosis

Semen analysis if there are concerns about fertility

Hormonal tests (e.g., FSH and testosterone) if there are concerns about function

40
Q

Define Hydrocele

A

Hydrocele refers to a collection of serous fluid between the parietal and visceral layers of the tunica vaginalis

41
Q

Two types of hydrocele

A

Communicating
Non communicating

42
Q

Why does communicating hydrocele occur

A

failure of normal closure of the processus vaginalis. This allows the passage of peritoneal fluid into the tunica vaginalis.

43
Q

What is non communicating hydrocele

A

There is no abnormal connection with the peritoneal cavity as seen in communicating hydroceles. Instead fluid is produced by the mesothelial lining of the tunica vaginalis.

44
Q

clinical manifestations of hydrocele

A

SCROTAL SWELLING
- smooth
-non reducible
- non tender
- soft

45
Q

What do communicating hydroceles tend to do

A

change size and increase when standing for prolonged periods of time

46
Q

Investigations for a hydrocele

A

Testicular US

47
Q

Management in infants of hydrocele

A
  • may resolve with first year of life
  • ongoing obs
  • if surgery then open repair with high ligation of patent processuc vaginalis
48
Q

management of hydrocele in adults

A

non communicating- spontaneous repair
communicating- aspiration of hydrocele

49
Q

What is a epididymal cyst

A

Smooth, extra-testicular, spherical sac of fluid in the head of the epididymis (top of testicle). They are usually harmless.

50
Q

Pathophysiology of a epididymal cyst

A

Contain clear or milky (spermatocele) fluid

They lie above and behind the testis
51
Q

signs of a cyst

A
  • Palpable lump (often multiple and bilateral)
  • Well defined and will Transluminate since fluid-filled
52
Q

signs of a cyst

A
  • Can cause dragging and soreness
  • May be pain if cysts are large

Renal (15 decks)

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