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Urology > Testicular Pathology > Flashcards

Testicular Pathology Flashcards

1
Q

what structures does the spermatic cord contain?

A

vas deferens, lymphatic vessels, testicular artery, cremasteric artery, pampiniform plexus, nerve to cremaster, testicular nerve

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2
Q

what is the pathophysiology of testicular torsion?

A
  • Twisting causes arterial and venous obstruction
  • increase in venous pressure subsequently causes decreased arterial blood flow, leading to decreased oxygen supply to the testicle, and if untreated, testicular infarction.
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3
Q

what are the risk factors to testicular torsion?

A

bell clapper deformity, large size, sudden change in temperature, undescended testis, previous testicular pain

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4
Q

what are the types of testicular torsion?

A

intermittent, extravaginal, intravaginal, torsion of testicular appendix

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5
Q

what are the features of intermittent testicular torsion?

A

o less serious but chronic variant
o intermittent scrotal or testicular pain, followed by eventual spontaneous detorsion and resolution of pain
o risk of complete torsion

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6
Q

what are the features of extravaginal testicular torsion?

A

o outside of the tunica vaginalis, when the testis and gubernaculum can rotate freely
o NEWBORNS
o painless scrotal swelling, discoloration, and a firm, painless mass in the scrotum

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7
Q

what are the features of intravaginal testicular torsion?

A

o testicle rotates on the spermatic cord within the tunica vaginalis
o older children and adults
o high attachment of the tunica vaginalis over the spermatic cord and failure of the normal posterior attachment of the testicle to the inner scrotum

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8
Q

what are the features of torsion of the testicular appendix?

A

o embryonic remnant that has no known function, but is at risk for torsion
o boys aged 7-14
o onset of pain gradual, blue dot sign, cremasteric reflex still active

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9
Q

what are the clinical features of spermatic cord torsion?

A 
Sudden onset of pain
Nausea/vomiting
Referral to lower abdomen
Absence of cremasteric reflex
Acute hydrocele + oedema may obliterate landmarks
Transverse lie
Testis high in scrotum
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10
Q

what are the clinical features of torsion of the appendage?

A 
Similar to spermatic cord
More gradual onset
Localised tenderness at upper pole
Blue dot sign – palpable nodule 
Testies should be mobile
Cremasteric reflex present
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11
Q

how is torsion of the spermatic cord diagnosed?

A

Doppler USS

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12
Q

how is torsion of the appendage diagnosed?

A

Prehns sign

Doppler

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13
Q

what is the management of torsion of the spermatic cord?

A

Prompt exploration
2-3 point fixation with fine non-absorbable sutures
If necrotic remove
Fix contralateral side

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14
Q

what is the management of torsion of the appendage?

A

Resolve spontaneously without surgery

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15
Q

what are the causes of Epididymitis-orchitis?

A

o chlamydia, E. coli, mumps, N. Gonorrhoea, TB

o Also: UTI, urethritis, catherization, urine reflux, surgery, amiodarone

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16
Q

what is the pathophysiology of Epididymitis-orchitis?

A

inflammation of epididymis

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17
Q

what are the clinical features of Epididymitis-orchitis?

A

sudden onset swelling, dysuria, sweats/fever, cremasteric reflex present

18
Q

how is Epididymitis-orchitis diagnosed?

A

1st catch urine sample, STI screen, culture + chlamydia PCR

19
Q

what is the management of Epididymitis-orchitis?

A

o Antibiotics – <35 doxycycline, >35 ceftriaxone

o Analgesia + scrotal support, bed rest

20
Q

what is the cause of idiopathic scrotal oedema?

A

unknown, hypersensitivity

21
Q

what is the pathophysiology of idiopathic scrotal oedema?

A

marked oedema of the skin and dartos fascia

22
Q

what are the clinical features of idiopathic scrotal oedema?

A

no fever, tenderness minimal, may be pruritis, unilateral or bilateral

23
Q

How is idiopathic scrotal oedema managed?

A

self-limiting, resolves 3-5 days, NSAIDs, antibiotics?

24
Q

what are the causes of testicular tumours?

A
  • migration of germ cells
  • undescended testis
  • low physical activity, cannabis use
  • inguinal hernias, Klinefelter’s syndrome, mumps orchitis
25
Q

what are the clinical features of testicular tumours?

A
  • painless insensitive testicular swelling
  • mets – neck nodes, dyspnoea
  • also pain in abdomen, scrotum, back – advanced?
  • +/- haemospermia, secondary hydrocele, pain, dyspnoea, effects of hormones
26
Q

how are testicular tumours diagnosed?

A

US
Serum tumour markers
CT/MRI/CT excision for mets and staging – TNM

27
Q

what are the serum tumour markers of testicular cancer?

A

o α-fetoprotein (AFP)
o β-human chorionic gonadotrophin(HCG)
o Lactate dehydrogenase (LDH)

28
Q

what is the general management of testicular cancer?

A

• Radical orchidectomy

29
Q

what is the management of seminomas testicular tumour?

A

radiosensitive
o Stage I, IIA = radiotherapy to paraaortic nodes
o Stage IIB – radiotherapy or chemo
o Further stages – chemo

30
Q

what is the management of teratoma testicular cancer?

A

o Stage 1 surveillance

o Further stages – 3 cycles of bleomycin + etoposide + cisplatin

31
Q

what are the leydig cell tumours?

A

Rare testicular sex cord stromal tumours (Sertoli cells)

32
Q

what are the features of leydig cell tumours?

A
  • Associated with hormonal activity
  • May present with gynaecomastia before testicular enlargement
  • Majority are benign
  • Histology – eosinophils in columns
33
Q

what is the cell type in seminoma testicular tumours?

A

Germinal epithelium of seminiferous tubules

34
Q

what is the cell type in non-seminoma (teratoma) testicular tumours?

A

Made of different types of tissue – embryonal, yolk sac, choriocarcinoma

35
Q

what age do seminoma testicular tumour commonly present?

A

40

36
Q

what age do non seminoma testicular tumour commonly present?

A

20-30

37
Q

what are the tumour marker levels of seminoma testicular tumours?

A

AFP normal
HCG elevated
Lactate dihydrogen

38
Q

what are the tumour marker levels of non-seminoma testicular tumours?

A

↑AFP

↑HCG

39
Q

what is the pathophysiology of seminoma testicular tumours?

A

Sheet like lobular cells with substantial fibrous component

Fibrous septa contain lymphocyte inclusions and granulomas

40
Q

what is the pathophysiology of non-seminoma testicular tumours?

A

Heterogenous texture with occasional ectopic tissue e.g. hair

Urology (10 decks)

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