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Year 3 Urology > Testicles > Flashcards

Testicles Flashcards

1
Q

Testicular Torsion

A

• Usually secondary to exertion or minor trauma
• tunica vaginalis invests whole of testicle
- therefore free-hanging testicle can twist on
its mesentery

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2
Q

Presentation of testicular torsion

A
  • Sudden onset severe pain in one testis
  • May have lower abdominal pain (testis supplied by T10)
  • Associated with N/V
  • May be Hx of previous testicular pain or torsion
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3
Q

Examination of testicular torsion

A
  • Inflammation of one testis: hot, swollen, extremely tender

* Testis rides high and lies transversely

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4
Q

Mx of testicular torsion

A 
Mx
• Surgical emergency
- 4-6h window from onset of pain to salvage testis
• Inform senior
• NBM
• IV access
- Analgesia
- Bloods: FBC, U+E, G+S, clotting

• Surgery

  • Consent for possible orchidectomy
  • Bilateral orchidopexy: suture testes to scrotum
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5
Q

Epididymal Cyst

A
  • Develop in adulthood
  • Contain clear or milky (spermatocele) fluid
  • Lie above and behind testis
  • Remove if symptomatic
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6
Q

Varicocele

A
  • Dilated veins of pampiniform plexus
  • Presentation
  • Feel like bag of worms in the scrotum
  • May be visible dilated veins
  • ↓ size on lying down
  • Dull ache

• Mx
- Conservative: scrotal support
- Surgical: clipping the testicular vein (open or
lap)

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7
Q

Pathology of varicocele

A

Pathology
Primary: Left side commoner: drain into left renal vein

Secondary: left renal tumour has tracked down renal vein → testicular vein obstruction.

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8
Q

Hydrocele

A

• Collection of serous fluid within tunica vaginalis

• Primary- patent processus vaginalis
- Commoner, larger, tense, younger men

• Secondary

  • Tumour, trauma, infection
  • Smaller, less tense

• Ix
- USS testicle to exclude tumour

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9
Q

Mx of hydrocele

A
  • May resolve spontaneously

• Surgery:

  • Lord’s Repair: fold the sac
  • Jaboulay’s Repair: eversion of the sac

• Aspiration

  • Usually recur so not 1st line.
  • Send fluid for cytology and MC+S
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10
Q

Epididymo-Orchitis aetiology

A

Local extension of infection

  • STI: Chlamydia, gonorrhoea
  • Ascending UTI: E. coli
  • Mumps
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11
Q

Presentation of epididymo-orchitis

A
  • Sudden onset unilateral tender swelling
  • Dysuria
  • Sweats, fever
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12
Q

Examination of epididymo-orchitis

A

• Tender, red, warm, swollen testis and epididymis
- Elevating testicle may relieve pain - Prehn’s sign
• Secondary hydrocele
• Urethral discharge

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13
Q

Investigations for epididymo-orchitis

A
  • Blood: FBC, CRP
  • first-void urine NAAT - STI
  • Urine: dip, MC+S (first void)
  • Urethral swab and STI screen
  • USS: exclude abscess
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14
Q

Mx of epididymo-orchitis

A
  • Bed rest
  • Analgesia
  • Scrotal support

• Abx:
- Enteric organisms – Ofloxacin 14 days

  • STI organisms – Ceftriaxone IM single dose and Doxycycline PO 10 - 14 days

• Drain abscess if present

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15
Q

Testicular tumours pathology

A 
Germ Cell: 95% 
• Seminoma 40%
- ↑ βhCG 
- ↑ placental ALP 
- metastasise late

• Non-seminoma

  • Mixed - commonest NSGCT
  • Teratoma
  • Yolk Sac
  • Choriocarcinoma - ↑↑ βhCG

Sex-cord Stromal 5% (benign)
• Leydig Cell
- May secrete androgens or oestrogens

• Sertoli Cell

  • Mostly benign
  • May secrete oestrogens
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16
Q

Teratoma

A
  • Arise from all 3 germ layers
  • Common and benign in children
  • Rare and malignant in adults: 15-30yrs
  • Secrete βhCG and/or AFP
  • Chemosensitive
17
Q

Ix for testicular tumours

A 
• Tumour markers - monitoring
• Scrotum USS - initial
• Staging
- CXR
- CT chest, abdomen, pelvis (CAP)
•  Biopsy not done due to seeding risk
18
Q

Tumour markers

A
  • ↑AFP and ↑hCG in 90% of teratomas
  • ↑hCG in 15% of seminomas
  • Normal AFP in pure seminomas
  • LDH - marker of tumour volume
19
Q

Mx of testicular tumours

A

• If both testes are abnormal, semen can be
cryopreserved

Seminomas
• Stage 1-2: inguinal orchidectomy + radiotherapy

• Stage 3-4: as above + chemo (BEP)

Non-seminomas:
• Stage 1: inguinal orchidectomy + surveillance
• Stage 2: orchidectomy + chemo + para-aortic LN
dissection
• Stage 3: orchidectomy + chemo

20
Q

Testicular Ca follow up

A

Close f/up to detect relapse
• Typically w/i 18-24mo
• Repeat CT scanning and tumour markers

21
Q

Intercourse with epididymitis

A

Refrain during abx course

22
Q

Complications of epididymitis

A

Reactive hydrocele

Abscess formation

Testicular infarction

23
Q

Epididymitis causative organism

A

Enteric > 35 yo:

  • E. Coli
  • P. Aeruginosa
  • K. Pneumonia

STI < 35 yo :

  • N. gonorrhoeae
  • Chlamydia trachomatis
24
Q

Non-seminoma GCT behaviour

A

Metastasise early

Worse prognosis

25
Q

Non-seminoma GCTs

A
  • Mixed - commonest NSGCT
  • Teratoma
  • Yolk Sac
  • Choriocarcinoma - ↑↑ βhCG
26
Q

Risk factors for testicular cancers

A

Cryptorchidism - undescended testes

Previous testicular malignancy

FHx

Kleinfelter’s syndrome

27
Q

Clinical features of testicular cancer

A
  • Unilateral painless testicular lump
  • irregular, firm, fixed
  • does not transilluminate
  • Metastasise -weight loss, back pain, dyspnoea
28
Q

Which medication can cause scrotal gangrene

A

Dapagliflozin - SGLT2 - rare

Year 3 Urology (16 decks)

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