Testicular Torsion, Prostate and Scrotal Infections Flashcards
What is testicular torsion
inadequate fixation of the lower pole of the testes to the tunica vaginalis
What are the complications of testicular torsion
- ischemia–>infertility
- disruption of the immunologic blood-testis barrier
Clinical manifestations of testicular torsion
- testicular pain
- swelling
- negative cremasteric reflex
- nausea/vomiting
- high riding testis with long axis oriented horizontally instead of longitudinally
Imaging done for testicular torsion
US with doppler
How do you treat testicular torsion
- manual detorsion
- detorsion surgery with gubernacular fixation (bilateral)
What makes up seminal fluid
- protein
- fructose
- enzymes
- mucus
- vit C
- flavins
- phosphorylcholine
- prostaglandins
Is seminal fluid alkaline or acidic
alkaline
Where is the seminal vesicle
right below the bladder
Function of the vas deferens
propels sperm forward during ejaculation
What does the epididymis connect
the testes and the vas deferens
The prostate is made of what
smooth muscle and glandular tissue
What is Denovillier’s fascia
lies between the prostate and rectum, barrier that prevents prostate cancer from penetrating the rectum
What pathogens cause acute bacterial prostatitis
- e coli
- proteus
- enterobacteria
- psuedomonas
What is typically the route of infection for acute bacterial prostatitis
ascent up the urethera, reflex of infected urine into prostatic ducts
Risk factors for acute bacterial prostatitis
- urogenital tract infection
- prostate bx
- instrumentation
- structural abnormality
Common presentation of acute bacterial prostatitis
- fever
- irritate voiding symptoms
- perineal, suprapubic, and back pain
- may have obstructive urinary sx
What will a DRE show for acute bacteriala prostatitis
tender, edematous, warm prostate
Labs with acute bacterial prostatitis
- leukocytosis with left shift
- UA–> pyuria, bacteriuria, hematuria
- elevated inflammatory markers
- elevated PSA
When is imaging done for acute bacterial prostatitis? Why? What?
- if no improvement after 48 hours
- suspect prostate abscess
- do CT or MRI
Treatment of acute bacterial prostatitis
- cipro
- levoflox
- bactrim
- gentamycin
Risk factors for chronic bacterial prostatitis
- acute episode of bacterial prostatitis
- prostate stones
Big difference between chronic and bacterial prostatitis
chronic will not have tender prostate (may feel normal)
Treatment for chronic bacterial prostatitis
-bactrium (preferred)
quinolones or cephalexin if resistance
Presentation of inflammatory prostatis
- perineum, lower abd, testicle/penile pain
- voiding difficulty
- erectile dysfunction
- ejaculatory pain
Treatment of inflammatory prostatitis
- tamsulosin
- cipro
- dutasteride in older men
What are the two categories of epididymitis
- sexually transmitted (chlamydia and gonorrhea)
- non sexually transmitted (UTI and prostatitis)
Clinical presentation of epididymitis
- unilateral scrotal swelling and pain
- radiation of pain to flank
- urethral discharge
- dysuria
How to tell the difference between testicular torsion and epididymitis
cremasteric reflex in unaltered in epididymitis
Treatment of epididymitis
- bed rest
- scrotal elevation
- ice
if gonorrhea and chlamydia
-doxy, ceftriaxone, azithro
if non sexually trans
-levoflox
Orhcitis is most commonly associated with what
mumps
Clinical presentation of orchitis
- fever
- malaise
- myalgia
- swollen red testicle
Treatment for orchitis
- scrotal elevation
- ice
- NSAIDs
What are the most common causes of urethritis
- n gonorrhoeae
- c trachomatis
Clinical presentation of urethritis
- dysuria
- pruitus and burning at urethral meatus
- prurulent discharge (gonococcal)
Physical exam findings with urethritis
- anxious
- inguinal LAD
- purulent brown/green penile dischage
- white watery discharge
- red/tender urethral meatus
What would the gram stain of urethral discharge of urethritis caused by chlamydia
PMN
What would the gram stain of urethral discharge of urethritis caused by gonorrhea
intra cellular gram negative diplococci
What is the treatment for urethritis?
- NGU: azithro (one dose) or 7 days of doxy
- GU: ceftriaxone and azithro
