Testicular torsion, Prostate, and Scrotal Infections - Exam 2 Flashcards
testicular torsion is a urologic ___
emergency!!!
testicular torsion is most common in?
neonates and post-pubertal boys (babies can be born with this)
what is testicular torsion d/t?
” Inadequate fixation of the lower pole of the testes to the tunica vaginalis
if one teste is torsed, can the other one have damage?
yes!!!
what may testicular torsion result in?
infertility
important finding for testicular torsion that you won’t see in any other testicular problems?
NEGATIVE CREMASTERIC REFLEX
what gives you dx for testicular torsion?
sudden onset testicular pain in PE
what confirm dx for testicular torsion? what does it measure?
US w/Doppler flow
-measures arterial flow into the testes and there won’t be any flow with testicular torsion
tx for testicular torsion?
manual detorsion
-most rotate medially, so detours it laterally (if doesn’t work turn the other way)
detorsion surgery w/gubernacular fixation
-look at both testes
what is the function of the seminal vesicle?
Responsible for a significant amount of fluid that become semen
epididymis connects testes to what? stores what?
connects testes to vas deferens
stores sperm for 2-3 months while they mature
testes produce?
sperm and androgens
what is the Denonvillier’s fascia?
structure b/w the prostate and the rectum
-barrier that prevents prostate cancer from spreading
what does prostate secrete?
fluid that nourishes and protects sperm
what zone of the prostate is felt on exam and has the highest occurrence of cancer?
peripheral zone
most common pathogen for acute bacterial prostatitis?
E. coli and pseudomonas
most likely route of infection for acute bacterial prostatitis?
ascent up the urethra
-reflex of infected urine into prostatic ducts
acute bacterial prostatitis risk factors?
- Urogenital tract infections
- Prostate bx (If just had bx done then usually give abx to prevent acute bacterial prostatitis)
- Instrumentation
- Structural abnormalities
acute bacterial prostatitis s/sx’s?
Fever -> THIS PATIENT LOOKS ILL!!!
Irritative voiding symptoms - dysuria
Perineal, suprapubic, and back pain
May have obstructive sx - urinary retention
acute bacterial prostatitis physical exam?
- pt looks ill
- generalized pelvic tenderness
- DRE -> BE GENTLE!!!
Prostate is tender, edematous, warm
acute bacterial prostatitis lab findings?
Leukocytosis with left shift
UA will show pyuria, bacteriuria and hematuria
UC will grow offending bacteria
Elevated inflammatory markers (CRP, ESR)
Elevated PSA (prostate specific antigen)
is imaging necessary for initial dx of acute bacterial prostatitis? when do you do imaging for it?
NO!!!
Do imaging if no improvement in 48hrs
if pt with acute bacterial prostatitis sx’s don’t improve in 48hrs, what do you do and what should you start thinking?
Do imaging (CT, MRI) and start thinking it may be a prostate abscess
indications for admission of acute bacterial prostatitis?
- Signs of sepsis
- Can’t tolerate oral abx
- Multiple comorbidities
- Or even a pt that won’t follow the treatment plan
acute bacterial prostatitis tx? these meds achieve what?
Empiric abx until cx
-Cipro, Levo, Bactrim, Gentamycin (4-6 wks of tx)
ALL OF THESE ACHIEVE HIGH LEVELS IN PROSTATE TISSUE
what is chronic bacterial prostatitis?
Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate (get bacterial prostatitis over and over)
what may chronic bacterial prostatitis be due to?
inadequate or too short treatment
when does chronic bacterial prostatitis develop?
after an acute infection
most common pathogen for chronic bacterial prostatitis?
E. coli
chronic bacterial prostatitis s/sx’s?
Can be subtle
Irritative voiding sx’s that won’t go away (frequency, dysuria, urgency)
Low grade fever
Can be asymptomatic
chronic bacterial prostatitis physical exam?
often unremarkable
prostate is usually not tender (as it is in acute)
UA for chronic bacterial prostatitis is usually?
normal
what does a urologist do for chronic bacterial prostatitis? what will you see?
expresses prostate secretions
see:
- increased leukocytes
- increased bacteria
chronic bacterial prostatitis tx?
Bactrim, quinolone, cephalexin (6-12 weeks of treatment)
what is most common of the prostatitis syndromes?
inflammatory prostatitis
s/sx’s of inflammatory prostatitis?
- ***subtle sx’s
- Pain in the perineum, lower abd, testicles, penis
- Voiding difficulties
- Blood in sperm
- Identical to chronic bacteria prostatitis
- Erectile dysfunction
- Ejaculatory pain
- ***Depression
inflammatory prostatitis is what type of dx?
dx of exclusion
labs for inflammatory prostatitis?
UA normal
UC no growth
Prostate secretions show increase in WBC, and increase in macrophages
Prostate bx you see inflammatory tissue
treatment for inflammatory prostatitis?
Alpha blockers, antibiotics, 5-alpha-reductase inhibitors are most efficacious
- Tamsulosin 0.4mg PO QD
- Cipro 500mg PO BID
what med for tx of inflammatory prostatitis is for older men?
Dutasteride
2 categories of epididymitis?
sexually transmitted and non-sexually transmitted
sexually transmitted epididymitis (common in who, associated with? pathogens?)
common in men < 35 y/o
associated with urethritis
pathogens: gonorrhea and chlamydia
non-sexually transmitted epididymitis (common in who, associated with? pathogens?)
most common in older men
associated with UTI and prostatitis
pathogens: e. coli
route of infection for epididymitis?
Urethra to ejaculatory duct down the vas deferens to epididymis
epididymitis s/sx’s
- Unilateral
- Acute onset of scrotal pain
- Fever
- Scrotal swelling
- Radiation pain to flank
- Urethral discharge
- Dysuria
- ***Cremasteric reflex unaltered
what is unaltered in epididymitis?
Cremasteric reflex is unaltered -> check it to r/o testicular torsion
epididymitis labs?
UA, UC, urine for GC/Chlamydia
imaging for epididymitis?
Scrotal U/S - want to make sure it’s not orchitis or testicular torsion
epididymitis tx?
- Bed rest
- Scrotal elevation
- Ice
Gonorrhea and chlamydial cause:
-treat with doxy and azithro or ceftriaxone
Non-sexually transmitted cause:
-treat with Levo
what is orchitis?
Acute inflammatory reaction of the testes due to infection
***Most cases associated with mumps
orchitis associated with what?
MUMPS!!! -> M/C cause
older men with bacterial infection and orchitis due to?
BPH
what can orchitis mimic?
testicular torsion, but cremasteric reflex is still present in orchitis
signs/sx’s of orchitis?
fever, malaise, myalgia, swollen red testicle
PAROTITIS (D/T MUMPS)
labs needed for orchitis?
NONE - Hx and PE are sufficient
imaging for orchitis?
scrotal US
treatment for orchitis?
SUPPORTIVE!!!
- scrotal elevation
- NSAIDs
- Ice
urethritis is a common manifestation of what in men?
sexually transmitted infections
urethritis classified as?
gonococcal or non-gonococcal (if non then it’s chlamydia)
urethritis s/sx’s?
- dysuria
- pruritus and burning at the urethral meatus
- ***DISCHARGE (purulent and green/brown = gonococcal and watery = chlamydia)
- ***ANXIETY!!!
labs for urethritis?
UA and first catch urine w/out cleansing
gram stain of chalmydia and gonorrhea for urethritis?
chlamydia -> PMN
gonorrhea -> intracellular gram-negative diplococci
urethritis tx?
When cx is not available, sexually active men should be treated for both (Cx not available for 24hrs)
Treatment for NGU (targets Chalmydia)
-Azithromycin or Doxycycline
Preferred treatment for Gonorrhea:
-Ceftriaxone (Rocephen) IM AND 1 gram Azithromycin PO
Trichomonas suspicion treatment: single dose Metronidazole
urethritis tx if chlamydia?
azithro or doxy
urethritis tx if gonorrhea?
ceftriaxone
partners of pt with urethritis need to be treated when and with what?
Partners w/in last 60 days need to be treated with doxy and azithromycin
is a genital swab needed for urethritis? what if female?
NO!!!
if a female tho, then need swab of cervix for discharge
