Scrotal Disorders Flashcards
what is phimosis
foreskin unable to be retracted over glands of penis
normal in baby/todler
what is paraphimosis
medical emergency
foreskin trapped in retracted position
entrapments becomes edematous and needs to be forcibly reduced
what is a painless mass in the scrotum which tramsillumniates
hydrocele
what is a fluid filled sac around tunica albuginea
hydrocele
what usually causes hydrocele
inflammation, injury, infection, malignancy
what diagnostic test is used for hydrocele
ultrasound necessary, especially age 18-35 (d/t risk of testicular CA)
what is a “bag of worms” in scrotum
varicocele
what side is most common to have varicocele in
left > Right
higher venous pressure in left scrotal veins causing retrograde reflux of blood into pampiniform plexus
where are varicosities located with varicoceles
pampiniform plexus
what is an abnormal cyst that develops in epididymis, separate from testes above upper ple
spermatocele
what are the symptoms of spermatocele
usually asymptomatic
pain or discomfort in affected testicle
heaviness in testicle with spermatocele
fullness behind and above testicles
how do you evaluate for spermatocele
US and/or transillumination
what is epididymitis
inflammation of epididymis, occasionally accompanied by inflammation of testis
how is epididymitis diagnosed
physical examination
what is the treatment of epididymitis
antibiotics, analgesics, scrotal support
what portions of the epididymis is involved with epididymitis
tail
what age groups are epididymitis most common
18-35 yo
what are the causes of epidiymitis
bacterial, non bacterial (viral and mycotic), non-infectious
what is the presentation of epididymitis
present with gradual onset of scrotal pain and symptoms mimicking UTI that has progressed to:
severe unilateral scrotal pain
scrotal inflammation, redness, enlargement and/or reactive hydrocele
+/- urethral discharge
irritative voiding
what is Prehn’s sign
decreased pain on elevation of testes
what is the treatment of STD epididymitis
chlamydia and gonorrhea - most common
Ceftriaxone IM + Doxycycline 10 days
what are complications of epididymitis if untreated
infertility
worsening ascending infection
rare: epididymal abscess
death of testicular tissue
what is infection of tests, typically with mumps virus
orchitis
what is the tx of orchitis
if symptomatic: abx are given only if bacterial infection is identified
what is the presentation of orchitis
unilateral mumps orchitis develosp acutely 4-7 days after parotid swelling
3-%. - disease spreads to other tests in 1-9 days
pain may be of any degree of severity
systemic: malaise, fever, nausea, headache, myalgias
what is seen on testicular exam with orchitis
exquisite tenderness, erythema, enlargement, induration of testis and edema and erythema of scrotal skin
how is orchitis diagnosed/worked up
H&P
color doppler US
Mumps: serum immunofluorescence antibody testing
what is the tx of orchitis
supportive care with analgesics and hot/cold packs if bacterial infection has been ruled out
bacterial infection - abx
urologic follow up highly recommended
what is the most common side of cryptochidism
external inguinal ring
when is descent of testicles completed
7 months gestation
what is gubernaculum
a fibrous cord that connects that fetal tests with the bottom of the scrotum and by failing to elongate in proportion to the rest of the fetus causes the descent of testes
how is cryptorchidism diagnosed
exam and sometimes US or laparoscopy
what is the tx of cryptorchadism
surgical orchiopexy
what is ectopic testis
descends normally through external ring but diverts to abnormal location and lies outside normal course of descent
when should surgery be done for cryptorchidism
~6 months old; early intervention improves fertility potential and may reduce cancer risk
what are complications of cryptorchadism
undescended testes may cause subfertility and are associated with testicular carcinoma
intra-abdominal testes, testicular torsion may occur, manifesting as acute abdomen
what is a strangulation of testes blood supply
testicular torsion - emergency condition
what are symptoms of testicular torsion
acute scrotal pain and swelling, nausea and vomiting
how is testicular torsion diagnosed
physical examination and confirmed by color Dopper US
what is the treatment of testicular torsion
immediate manual detorsion followed by surgical intervention
what side is more common to get a testicular torsion
left > right
what is the clinical presentation of testicular torsion
rapid onset of severe local pain, nausea, vomiting, followed by scrotal edema and induration
cremasteric reflex usually absent on affected side
what is the preferred diagnostic study for testicular torsion
color doppler US of scrotum
