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Urology > Testis & Scrotum Disorders > Flashcards

Testis & Scrotum Disorders Flashcards

1
Q

Define Cryptorchidism

A

Undescended testes or absent testes (agenesis)

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2
Q

Pathology of Cryptorchidism

A

Undescended testicles remain in the lower abdomen or at a point of descent into the inguinal canal
Scrotal sac is empty
Spontaneous decent in first 3 months

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3
Q

Pathologic Changes to the Undescended Testicle Demonstrated at 6-12 Months

A

Delay in germ cell development
Changes in spermatic tubules
Reduces number of Leydig cells
Morphologic changes in contralateral descended testicle

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4
Q

Consequences of Cryptorchidism

A

Infertility
Increased risk of malignancy
Indirect inguinal hernias
Increased incidence of testicular torsions

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5
Q

Cryptorchidism & Infertility

A

Increases if disorder is bilateral
Decreased sperm counts
Poorer quality sperm

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6
Q

Exam & Diagnosis of Cryptorchidism

A

Careful exam of genitalia in male infants
Differentiate from retractable testes
Diagosis: ultrasound, laparoscopy

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7
Q

Treatment Goals of Cryptorchidism

A

Enhance future fertility potential
Placement of the gonad in a favorable place for cancer detection
Improved cosmetic appearance

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8
Q

Treatment of Cryptorchidism

A

Orchiopexy after 6 months of life

Lifelong follow-up: infertility & testicular cancer issues

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9
Q

Define Hydrocele

A

Excess fluid collects between the layers of the tunica vaginalis usually peritoneal fluid due to a weakness in the patent processes vaginalis

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10
Q

Causes of Hydrocele

A

Primary congenital defect

Secondary condition

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11
Q

Primary Congenital Defect with a Hydrocele

A

Associated with indirect inguinal hernia

Persist beyond 2 years: surgical treatment indicated

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12
Q

Secondary Causes of Hydrocele

A 
Trauma
Epididymitis
Testicular torsion
Orchitis
Infection
Testicular cancer
Appendiceal torsion
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13
Q

Hydrocele on Palpation

A

Palpated a cystic masses
Can become quite large
Mass can be mistaken for a solid tumor

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14
Q

Diagnosis of Hydrocele

A

Ultrasound

Trans-illuminate

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15
Q

Define Trans-illumination

A

Shining a light through the scrotum for the purposed of visualizing its internal structures

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16
Q

Ultrasound in Diagnosis of Hydrocele

A

Determination of underlying conditions

Evaluate if can not transilluminate

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17
Q

Hydrocele in a Young Man

A

Should be considered cancer until proven otherwise

Careful evaluation needed to exclude cancer or infection

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18
Q

Hydrocele in an Adult Male

A

Relatively benign condition
Often asymptomatic
Feeling of heaviness in scrotum
Pain in the lower back

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19
Q

Treatment of Primary Causes of a Hydrocele

A

If painful or cosmetically undesirable, surgical correction is indicated
Inguinally or transcrotally

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20
Q

Treatment of Secondary Causes of a Hydrocele

A

Treat condition causing hydrocele

If communicating with peritoneal cavity then surgery is necessary to close the defect

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21
Q

Define Hematocele

A

Accumulation of blood in the tunica vaginalis

Can compromise testicle

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22
Q

Etiologies of a Hematocele

A

Abdominal surgical procedure
Scrotal trauma
Bleeding disorder
Testicular tumor

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23
Q

Define Spermatocele

A

Painless, sperm-containing cyst that forms on the epididymis

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24
Q

Where is a spermatocele located?

A

Above & posterior to the testes

Attached to epididymis

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25
Q

Define Varicocele

A

Varicosities of the pampiniform plexus

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26
Q

Highest incidence of Varicoceles

A

15-35 years old

Rare before puberty

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27
Q

Which side are varicoceles more common?

A

Left due to left gonadal vein inserts into the left renal vein

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28
Q

Symptoms of Varicocele

A 
Asymptomatic
Dull aching
Atrophy
Infertility
Abnormal feeling of heaviness in the left when standing and relieved when recombent
29
Q

Diagnosis of Varicocele

A

Exam with patient in standing & recumbent position
Disappears in supine position
Feels like “a bag of worms”

30
Q

Treatment of Varicocele

A 
Surgical ligation of the gonadal vein
Embolization of veins
Obliteration of the dilated veins
NSAIDs
Scrotal support
31
Q

Benefits of Obliteration of the Dilated Veins

A

Some improvement in infertility
Relief of the “heavy” feeling
Cosmetic improvement

32
Q

Define Testicular Torsion

A

Twisting of the spermatic cord that suspends the testis

33
Q

2 Age Peaks of Testicular Torsion

A

Perinatal

Prepubertal

34
Q

Testicular Torsion in Neonates

A

Less common
Firm, smooth painless scrotal mass
Scrotal skin appears red
Some edema

35
Q

Testicular Torsion in Pediatrics & Adolescents

A

True surgical emergency
Rotates on long axis of the tunica vaginalis
Cuts off blood supply to the testis
Early recognition & treatment essential

36
Q

Symptoms of Testicular Torsion

A 
Severe distress within hours of onset
Accompanied with N/V
Tachycardia
Large, firm & tender testes
Pain radiates to inguinal area
Testicle high inscrotum & in abnormal orientation
Cremasteric reflex frequently absent
Degree of swelling & redness depends on duration of the symptoms
37
Q

Imaging in Testicular Torsion

A

Color doppler ultrasonography
Attempt manual detorsion: “opening a book”
Referral to urology

38
Q

Treatment of Testicular Torsion

A

Surgical detorsion
Orchiopexy
Orchiectomy: when deemed nonviable

39
Q

Two Major Types of Epididymitis

A

STIs

Primary non-sexually transmitted infections

40
Q

Epididymitis Due to STIs

A

Associated with young men, urethritis
Gonorrhea
Chlamydia

41
Q

Epididymitis Due to Primary Non-sexually Transmitted INfections

A

Associated with UTIs, prostatitis, & men over 35
E. coli
Pseudomonas
Gram-positive cocci

42
Q

Other Causes of Epididymitis

A

Post vasectomy: congestion in epididymis

Trauma

43
Q

Define Epididymitis

A

Unilateral pain & swelling in the epididymis over a period of days
Inflammation of the epididymis

44
Q

Symptoms of Epididymitis

A

Erythema & edema of overlying scrotal skin
Tenderness over the groin or lower abdomen
Fever
Dysuria
Urethral discharge (gonococcal)

45
Q

Labs to Identify Epididymitis

A 
CBC
UA & culture
Urethral culture
Urine NAAT
Gram stain
46
Q

Treatment of Epididymitis

A

Scrotal elevation & support
Antibiotics appropriate to age, physical findings, UA, cultures or gram’s stain, sex history
Oral analgesics & antipyretics
Sexual activity or physical strain should be avoided

47
Q

Define Hypogonadism

A

Testosterone deficiency with associated symptoms or signs, deficiency of spermatozoa production or both

48
Q

Etiology of Primary Hypogonadism

A

Failure of testes to respond to FSH & LH
Testosterone is low to inhibit FSH & LH
Klinefelters syndrome

49
Q

Etiology of Secondary Hypogonadism

A

Failure of hypothalamus to produce gonadotropin-releasing hormone (GnRH) or pituitary gland to produce enough FSH & LH

50
Q

3 Categories of Hypogonadism

A

Congenital
Childhood-onset
Adult-onset

51
Q

Congenital Hypogonadism Signs & Symptoms

A

1st trimester: results in inadequate male sexual differentiation
2nd & 3rd trimester: results in microphallus & undescended testes

52
Q

Childhood-onset Hypogonadism Signs & Symptoms

A

Impairs development of secondary sexual characteristics

53
Q

Signs & Symptoms of Childhood-onset Hypogonadism as Adults

A 
Poor muscle development
High-pitched voice
Small scrotum
Decreased penis & testicular growth
Sparse pubic & axillary hair
54
Q

Adult-Onset Hypogonadism Signs & Symptoms

A

Decreased libido
Erectile Dysfunction
Depression & anger

55
Q

Diagnosis of Hypogonadism

A

FSH
LH
Free/total testosterone levels

56
Q

Treatment of Hypogonadism

A

Testosterone replacement therapy (TRT)

57
Q

Adverse Effects of Hypogonadism

A 
Erythrocytosis
Venous thromboembolism
Acne
Gynecomastia
Low sperm counts
58
Q

Administration of Testosterone Replacement Therapy (TRT)

A 
Gel
Transdermal axillary solution
Transdermal patch
Sub-Q implants
IM injections
59
Q

Define Infertility

A

Inability to get pregnant after trying for at least 1 year

60
Q

Causes of Infertility

A

Blockage of the reproductive system
Medicines
Undescended testicles
Infections

61
Q

Male Factors of Infertility

A

Pre-testicular
Testicular
Post-testicular

62
Q

Medical History of Infertility

A

Previous semen analysis
Erectile dysfunction or other sexual dysfunction
Trauma
Previous pregnancies

63
Q

Physical Exam to Determine Infertility

A 
Testicular size
Vas deferens
Spermatic cord
Penis
Rectum
Body habitus
64
Q

Diagnosis of Infertility

A 
Semen analysis
Antisperm antibody test
Hormonal analysis
Transrectal ultrasound
Scrotal ultrasound
65
Q

Semen Analysis

A 
Semen volume: 2-5 mL
pH level: 7.2-7.8
Sperm density: 20M/mL
Motility: >50% forward progressive
Morphology: >60%
66
Q

Treatment of Infertility

A 
Boxer shorts
Avoid hot tubs
Timing of intercourse
Avoid illegal drugs, chemicals & spermicidals
Medications
Surgical
67
Q

Medications for Infertility

A

Clomiphene citrate (Clomid)
Imipramine: retrograde ejaculation
Zoloft: premature ejaculation

68
Q

Surgical Options for Infertility

A

Varicocelectomy
Vasovasostomy
Testicular biopsy (TESE)
Transurethral resection of ejaculatory ducts

Urology (12 decks)

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