Testicular and Prostate Pathology

Question 1

What is the most common congenital male reproductive abnormality?

Answer 1

Cryptorchidism (~1% of male infants)

Question 2

What can commonly cause orchitis?

Answer 2

• Chlamydia trachomatis (D-K) or Neisseria gonorrhoea
• E coli, Pseudomonas (UTI associated - older)
• Mumps virus (kids > 10 years)
• Autoimmune orchitis (granulomas involving seminiferous tubules)
• TB (necrotizing granulomas)

Question 3

What is Prehn sign and what does it prove?

Answer 3

• Pain relief with scrotal elevation

- Prehn +ve = epididymitis

Question 4

What kind of infarction is in testicular torsion?

Answer 4

Hemorrhagic infarction

Question 5

What congenital failure may cause testicular torsion?

Answer 5

Congenital failure of testes to attach to inner lining of scrotum

Question 6

What pathology is varicocele associated with?

Answer 6

Left-sided renal cell carcinoma

Question 7

What does varicocele present with?

Answer 7

Scrotal swelling with bag of worms appearance

Question 8

What is hydrocele?

Answer 8

Fluid collection within tunica vaginalis

Question 9

What is hydrocele caused by in infants?

Answer 9

Congenital hydrocele is caused by an incomplete obliteration of processus vaginalis

Question 10

What is hydrocele caused by in adults?

Answer 10

Secondary to infection, trauma, tumor

- Blockage of lymphatic drainage

Question 11

What does hydrocele present as?

Answer 11

Scrotal swelling that can be transluminated

Question 12

What can varicocele be treated with?

Answer 12

• Surgical ligation or embolization

Question 13

How is testicular torsion treated?

Answer 13

• Surgical correction (orchiopexy) within 6 hrs

- Manual detorsion if surgical option unavailable in timeframe

Question 14

When does orchiopexy need to be performed (time-frame)?

Answer 14

Within 6 hours

Question 15

What maneuver may diagnose varicocele =?

Answer 15

Valsalva (blowing whilst obstructing mouth and nose)

Question 16

What is spermatocele?

Answer 16

Cyst due to dilated epidydimal duct or rete testis

Question 17

What is acute prostatitis due to?

Answer 17

Acute inflammation of the prostate usually due to bacteria

- N gonnorhoea or C trachomatis

Question 18

What does acute prostatitis present with and what does it show on examination?

Answer 18

• Dysuria
• Fever and chills
• Tender and boggy on DRE

Question 19

What does prostatitis secretions show?

Answer 19

• WBCs

- Cultures show bacteria in acute, cultures are negative in chronic

Question 20

What does chronic prostatitis present with?

Answer 20

• Dysuria

- Pelvic or low back pain

Question 21

What is bph?

Answer 21

• Hyperplasia of prostatic stroma and glands

Question 22

Is there an increased risk of prostate cancer with bph?

Answer 22

No

Question 23

What areas does BPH affect?

Answer 23

• Periurethral zone of prostate

- Lateral lobes, anterior lobe, middle lobe (NOT posterior lobe)

Question 24

What lobe is affected by prostate cancer?

Answer 24

Posterior lobe (peripheral zone)

Question 25

What can chronic prostatitis be due to?

Answer 25

- Bacterial 
Non -bacterial
- Secondary to previous infection 
- Nerve problems 
- Chemical irritation

Question 26

What are the treatment options for BPH?

Answer 26

• Finasteride (5-a reductase inhibitor)
• Tamsulosin, terzosin (a1 antagonist)
• Tadalafil (PDE-5 inhibitors)
• Surgical resection (TURP, ablation)

Question 27

How is prostatic adenocarcinoma graded?

Answer 27

Gleason grade

- Based on glandular architecture - correlates w. metastatic potential

Question 28

What are signs/symptoms of prostatic adenocarcinoma metastasis?

Answer 28

• Lower back pain

- Increased serum ALP and PSA

Question 29

What does metastasis to the spine occur via?

Answer 29

Batson (vertebral) venous plexus

Question 30

What are useful tumor markers for prostatic adenocarcinoma?

Answer 30

• PAP - prostatic acid phosphatase

- PSA - prostate specific antigen

Question 31

What kind of biopsy for prostate?

Answer 31

needle core biopsies

- Transrectal