testicular and prostate disorders

Question 1

testicular torsion

Answer 1

twisting of spermatic cord causing a loss of blood supply to ipsilateral testicle (EMERGENCY)

Question 2

testicular torsion: intravaginal

Answer 2

• tunica vaginalis attachment to posterior (back) side of testicle too high
• allows the spermatic cord to rotate
• 17% incidence
• common in adolescence: increased weight of testicle and sudden contraction of cremaster muscle (covers testes and spermatic cord) and hormone changes

Question 3

testicular torsion manifestations

Answer 3

• severe distress within hours of symptoms onset, nausea/vomiting, tachycardia
• testis large and tender
• radiating pain to inguinal area

Question 4

testicular torsion: extravaginal

Answer 4

• most common in neonates (undescended testicles)
• inadequate fusion diagnosed in 1st 7-10 days of life
  > firm, smooth, painless scrotal mass
• testicle high in scrotum, abnormal orientation that results in spermatic cord twisting

Question 5

testicular torsion diagnosis

Answer 5

• based on symptoms and presentation
• doppler and color ultrasound for blood flow

Question 6

testicular torsion treatment

Answer 6

• surgery
• prevent tissue necrosis (maintain blood flow)
• testicle function

Question 7

epididymitis

Answer 7

> acute (common) or chronic inflammation of the epididymis
- 19-35 years old, associated with STI

Question 8

epididymitis cause

Answer 8

> infection, UTI (under 14/over 35), STI, trauma, post-prostatic biopsy
- gonorrhea/chlamydia is most common cause in heterosexual men
- children: viral enterovirus/adenovirus infection

Question 9

epididymitis manifestations

Answer 9

• unilateral pain, chills, fever, discharge, dysuria, erythema, edema
• testis and epididymis become one mass
• tenderness over spermatic cord (inguinal area) and lower abd

Question 10

epididymitis diagnosis

Answer 10

• labs: urinalysis/culture/WBC count
• doppler ultrasound

Question 11

epididymitis treatment

Answer 11

• supportive: elevation of scrotum, ice packs, bed rest
• antibiotics, pain meds
• abstinence if STI is positive

Question 12

testicular cancer

Answer 12

• not common (1%)
• ages 15-35
• white men

Question 13

testicular cancer risk factors

Answer 13

• cryptorchidism
• genetic factors
• disorders of testes development (Klinefelter syndrome)
• HIV positive: germ cell tumors (seminomas)

Question 14

testicular cancer pathogenesis

Answer 14

• primary germ cell tumors: seminomas or nonseminomas
• based on tissue origin and if it turns into cancer
• Germ cell origin: multipotential (secretes enzymes/hormones not found in adult men)

Question 15

testicular cancer: seminomas

Answer 15

• most common (under 40)
• from seminiferous epithelium of testes
• produce uniform cell population

Question 16

testicular cancer: nonseminomas

Answer 16

• more than one cell type
• less differentiated

Question 17

testicular cancer manifestations

Answer 17

• common 1st sign: slight enlargement of testicle
• may or may not have discomfort
• can spread before found
• metastasis: swelling of lower extremities, back pain, neck mass, cough, hemoptysis

Question 18

testicular cancer diagnosis

Answer 18

• ultrasound
• CT/MRI
• tumor markers: alpha fetal protein and B-HCG
• clinical staging: TNM

Question 19

testicular cancer treatment

Answer 19

• orchiectomy: removal of testicle
• additional treatment depends on staging and grading

Question 20

prostatitis

Answer 20

• acute or chronic infection of prostate gland
• highest in 20-40 years or over 70
• most cases: ascending urethral infection or intraprostatic reflux

Question 21

prostatitis risk factors

Answer 21

• BPH
• genitourinary infections
• STI
• immune compromised

Question 22

prostatitis causes

Answer 22

• infection after prostate biopsy, STI, transurethral manipulation
• direct lymphatic spread from rectum (bacterial sepsis)
• community acquired (more common) and hospital acquired

Question 23

prostatitis manifestations

Answer 23

• rapid onset
• irritative: dysuria, frequency, urgency
• obstructive: hesitancy, incomplete void, straining, weak stream
• suprapubic, rectal, perineal pain
• painful ejaculation
• systemic symptoms: fever, chills

Question 24

prostatitis diagnosis

Answer 24

• physical exam
• urinalysis
• digital rectal exam/prostatic massage

Question 25

prostatitis treatment

Answer 25

- depends on severity - antibiotics, bedrest, hydration, antipyretics, analgesics, stool softeners - can progress to chronic condition > diagnosed w positive bacterial culture (prostatic fluid w leukocytosis)

Question 26

benign prostatic hypertrophy (BPH)

Answer 26

nonmalignant enlargement of prostate gland

Question 27

BPH etiology

Answer 27

- 2 growth periods: puberty (doubles in size); 25 (enlarges/impinges) - urethra narrowing - formation of large, discrete lesion - aging men > does NOT develop when testes are removed before puberty - decrease active testosterone w age and increased estrogen - DHT hormone production

Question 28

BPH risks

Answer 28

- under 40 - family history/physical inactivity - cardiovascular disease - DM 2 - ED

Question 29

BPH manifestations

Answer 29

- static: increased size - dynamic: related to smooth muscle tone - detrusor instability and impaired bladder contractility - nocturia, urgency, low stream, dribbling, incontinence

Question 30

BPH diagnosis

Answer 30

> size not always correlated with symptom severity - patient experience is key - blood and urine analysis, PSA, digital rectal exam (surface) - prostate specific antigen (PSA) - transabdominal/transrectal ultrasound (other urinary structures)

Question 31

BPH treatment: medical

Answer 31

- lifecycle changes, avoiding caffeine and certain meds (antihistamine, decongestant, diuretics) - pelvic floor training - training bladder - prevent constipation - taking 5^alpha - reductase inhibitors (prevents conversion of testosterone to DHT)

Question 32

BPH treatment: surgical

Answer 32

transurethral prostatectomy (TURP), stents

Question 33

prostate cancer

Answer 33

- most common non-skin cancer

Question 34

prostate cancer incidence

Answer 34

- african american men - disease of aging > 85% of diagnosis are 65+

Question 35

prostate cancer etiology

Answer 35

- unclear - multistep process in genes controlling cell differentiation and growth

Question 36

prostate cancer risk factors

Answer 36

- age, race, heredity - hormone level - environment

Question 37

prostate cancer pathophysiology

Answer 37

- adenocarcinomas - growth is influenced by hormones - cancer can invade bladder - cancer metastis to bone - can spread before found > 1st symptom: prostate is nodular, SOB, anemic

Question 38

prostate cancer diagnosis

Answer 38

- history/physical - biopsy - bone scan (radionucleotide) - prostate specific antigen (PSA) - staging (glesin) TNM

Question 39

prostate cancer treatment

Answer 39

> expectant therapy (watchful waiting): no symptoms, slow growth, small/contained, comorbidities - surgery: radical prostatectomy (seminal vesicles, prostate, ampullae) - radiation: external beam or brachytherapy - hormone support > palliative care: pain control, focal radiation of symptomatic/unstable bone disease > bisphosphonates: inhibit osteoclast activity