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Surgery > Testicular Disorders > Flashcards

Testicular Disorders Flashcards

1
Q

Types of testicular tumors

A

Primary testicular tumors:
Germ cell tumors ( 95 % ) ; seminoma , non seminoma
Stromal tumors ( 5% ) : Leyding cell tumor, Sertoli cell tumor, granulosa cell tumor
Other tumors ( rare ) : gonadoblastoma

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2
Q

Risk factors of testicular tumors

A

Cryptorchidism = urdesended testis
² HIV infection
² Gonadal dysgenesis autogas genitalia
² Family history
² Personal history of testis cancer of one testis
² Infertility

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3
Q

Testicular tumors presentation

A

Most tumors present with painless mass ( firm and non-tender mass ). hard
Testicular pain in 10% if hemorrhage or infection occur.

Gynecomastia ( mainly with Sertoli or Leydig cell tumor )

Back or abdominal pain with bulky retroperitoneal metastasis

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4
Q

Testicular tumors work up

A

History and Physical examination
Scrotal US Test ( the best )
Serum tumor markers ( AFP , B HCG , LDH )
Chest x ray
CT abdomen and pelvis with contrast

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5
Q

Seminoma usaual age of onset ?

A

30 - 40 years . Rare old age > 50 year

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6
Q

Seminoma tumor markers?

A

10 % has high B HCG and always normal AFP

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7
Q

Seminoma TTx

A

Surgery
Radiosensitive and chemo sensitive = both has 2nd line of management after surgery
On histology it has large uniform cell with clear cytoplasm and the nucleus has 2 nucleoli or eccentric nucleolus.

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8
Q

Types of non seminoma

A
  1. Embryonal carcinoma
  2. Yolk sac tumor
  3. Choriocarcioma
  4. Teratoma
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9
Q

Embryonal carcinoma

A

Usual age of onset 25-35 years
May secret both AFP and β-HCG or maybe normal

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10
Q

Yolksac tumor

A

Pediatric tumor

Usual age of onset < 10 years

May secret both AFP and β-HCG

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11
Q

Choriocarcinoma

A

Usual age of onset 20 - 30 years
Always secrete B HCG and AFP
Has the worst prognosis of all testers tumors

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12
Q

Teratoma

A

Usual age of onset 25 - 35 years
Doesn’t secrete AFP or BHCG
Resistance to chemotherapy or radiation
Only ttt is surgery

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13
Q

Treatment of testicular tumors general role

A

Offer sperm banking prior to cancer treatment
Avoid trans scrotal biopsy and trans scrotal surgey
Radical inguinal orchidectony
Testis sparing is reasonably for
Tumor in solitary testis
Bilateral testes tumors

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14
Q

Seminoma ttt

A

Surveillance follow up

When patient has no L.N metastasis and compliant for surveillance ,if non compliant he should receive chemotherapy or radiation .
Radistion - In presence of L.N metastasis < 5 cm Retroperitoneal radiation

Chemotherapy - In presence of L.N metastasis > 5 cm or non nodal metastasis , followed by RPLND if L.N does not shrink

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15
Q

Non seminoma ttt

A

RPLND or chemotherapy
If no L.N metastasis or L.N metastasis <5cm
Chemotherapy
If L.N metastasis > 5cm or non nodal metastasis. ( note: after chemotherapy if L.N metastasis does not shrink , do my choice RPLND )

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16
Q

Definition of varicocele

A

Dilatation of veins in the pampiniform plexus of spermatic cord

Found in 15% of men in the general population.

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17
Q

…. of males presenting with primary
infertility and …. of men with secondary
infertility.

A
  • 20 - 40%
  • 45 - 80 %
18
Q

Left side affected in …%

A

90%

19
Q

Etiology of varicocele

A

Incompetent valves in the internal spermatic
veins lead to retrograde blood flow, vessel
dilatation, and tortuosity of the pampiniform
plexus.

The left internal spermatic (testicular) vein
enters the left renal vein at right angles and is
under a higher pressure than the right vein which
enters the vena cava obliquely at a lower level.

20
Q

Patho physiology of varicocele

A
  • Testicular venous drainage is via the pampiniform plexus, a meshwork of veins encircling the testicular arteries
  • This arrangement normally provides a countercurrent heat exchange mechanism which cools arterial blood as it reaches the testis.
  • Varicoceles adversely affect this mechanism, resulting in elevated scrotal temperatures and consequent deleterious effects on spermatogenesis.
21
Q

Presentation of varicocele

A
  • The majority are asymptomatic.
  • large varicoceles may cause pain or a heavy feeling in the scrotal area.
22
Q

Examination of varicocele

A
  • Examine, both lying and standing, and ask the patient to perform the Valsalva manoeuvre (strain down)
  • Varicocele is identified as a mass of dilated and
    tortuous veins above the testicle (‘bag of worms’)
    which decompress on lying supine.
23
Q

Grading of Varicocele

A
24
Q

Investigation of varicocele

A
25
Q

Indication for Varicocele repair

A
26
Q

Management of varicocele

A
27
Q

Definition of hydrocele

A
  • Abnormal fluid collection in the tunica vaginalis.
    2nd layer
  • Most acquired hydrocele are idiopathic
  • Other causes may include trauma , infection, tumor or
    lymphatic obstruction.
28
Q

Diagnosis of hydrocele

A

Smooth scrotal swelling
Discomfort
Trans-illuminate during examination
With huge enlargement, testis might not palpable
Because of testicular tumor can be a cause of hydrocele , US assessment is essential tool

29
Q

Management of hydrocele

A
  • Observation, in case of simple hydrocele in pediatrics ( mostly will resolve within 2 years)
  • Inguinal exploration for communicating hydrocele in pediatrics or when associated with hernia
  • In adult hydrocelectomy is indicated when it is symptomatic.
30
Q

Definition Epididymo-Orchitis

A

Inflammation of Epididymis (Epididymitis)
and inflammation of testicle (Orchitis)

Can lead to:

Testis or epididymal abscess
Chronic epididymo-orchitis
Testicular atrophy
Infertility

31
Q

In infectious cause of epididymo-orchitis, in men <36 years, most commonly (….) and usually present with ?

A

STD (Neisseria gonorrhoeae and Chlamydia trachomatis )

32
Q

In men > 35 years, most common infectious causes of epididmo-orchitis …

A

E.coli

33
Q

Presentation of epididymo orchitis

A

➢ Testicular pain ( gradually increase)
➢ Urethral discharge ( if STD ) I from ultra
➢ Fever
➢ On examination ( swelling , tenderness and erythema ).
➢ Hydrocele ( reaction to inflammation, can persist for months after treatment.

34
Q

Work up of Epididymo-Orchitis

A

➢ Urine culture
➢ Urethral swab and culture of the discharge ( if STD suspected )
➢ Scrotal ultrasound with Doppler
Hypervascular

35
Q

Treatment Epididymo-Orchitis

A
36
Q

Types of testicular torsion

A
37
Q

Most common age of testicular torsion is …

A

12 - 18 year

38
Q

Presentation of testicular torsion

A

Acute onset of severe pain with or without swelling
Can happen with trauma or during sleep

39
Q

Examination of testicular torsion

A

Tender, high riding testis ,horizontal axis ,no pain relief with elevation of the testis (Prehn’s sign) and absent cremasteric reflex.
It

40
Q

Diagnosis of testicular torsion

A

• By clinical suspicion (do not delay surgical treatment for radiological)
- US Doppler: will show decrease blood flow to the affected testis compared to normal one.

41
Q

Treatment of testicular torsion

A

Surgery (14 decks)

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