The Balls Flashcards
Hypogonadism:
-low T
Hypogonadism etiology:
Primary: Testicular failure (ex. mumps orchitis)
Secondary: Hypogonadotropic hypogonadism (age-related (ADAM), chronic opiates)
Hypogonadism etiology:
increasingly diagnosed
hypogonadism presentation:
-decreased energy/fatigue, ED, decreased force of ejaculation, decreased libido
hypogonadism work-up:
- free and total testosterone
- exam
- if low- DEXA scan
hypogonadism tx:
- Androgen (testosterone) supplementation
- gels, injections, pellets
Hypogonadism follow-up/monitoring:
- PSA, hemogram (H&H), testosterone, review of urinary symptoms, DRE
- 3, 6 and 12 months after initiating, then annual
- Counsel prostate Ca monitoring; CV risks, infertility.
ADAM questionnaire:
This basic questionnaire can be very useful for men to describe the kind
and severity of their low testosterone symptoms.
1. Do you have a decrease in libido (sex drive)? Yes No
2. Do you have a lack of energy? Yes No
3. Do you have a decrease in strength and/or endurance? Yes No
4. Have you lost height? Yes No
5. Have you noticed a decreased “enjoyment of life” Yes No
6. Are you sad and/or grumpy? Yes No
7. Are your erections less strong? Yes No
8. Have you noticed a recent deterioration in your ability to play sports? Yes No
9. Are you falling asleep after dinner? Yes No
10. Has there been a recent deterioration in your work performance? Yes No
If you Answer Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone.
Cryptorchidism:
testis (testes) not in scrotum
- Possibly absent; possibly non-palpable (20%); if palpable, won’t come down
- RARE
Cryptorchidism etiology:
not well understood
-Normal descent is androgen-independent, mediated by “descendin;” passage through inguinal canal begins 28 weeks
Cryptorchidism work-up:
- good physical exam (never forget the penis)
- possible scrotal US
- urologist may pursue more studies
tx of cryptorchidism:
hormonal manipulation (GnRH injection); orchidopexy
Places of cryptorchidism:
Inguinal canal - between internal and external rings
Intra-abdominal (10%) - proximal to inguinal ring
Absent testis (20%)- truly absent, probable vascular event
Ectopic testis - below the internal ring but out of normal path
Retractile testis - reflects exuberant cremasteric reflex
-Follow patient until puberty
Descending of the testis:
Most descend spontaneously in first 3 months
If undescended at 6 months, descent is unlikely
3% of term infants, 30% of premature infants
10% bilateral
3% have one or both testes absent
risk factors of cryptorchidism:
Risk Factors:
Twins, low birth weight, pre-term delivery, family history, Prune Belly syndrome
risks from cryptorchidism:
- Ca
- -CA less likely if undescended testis was in inguinal canal vs. abdomen
- decreased fertility
- Torsion risk is 10% higher
Orchidopexy
putting the ball where it belongs
Hydrocele:
benign accumulation of serous fluid between layers of tunica vaginalis
infant hydrocele presentation:
infant/toddler with hemiscrotal enlargement; volume/size waxes and wanes during day
Infant hydrocele etiology:
patent processus vaginalis (communicating hydrocele)
Infant hydrocele work-up:
clinical diagnosis; scrotal sonogram may be helpful
Infant hydrocele tx:
if persistent after one year, repair via inguinal incision
Adult hydrocele presentation:
scrotal discomfort; scrotal enlargement; possible h/o trauma or infection
adult hydrocele etiology:
idiopathic; post-traumatic; post-infectious
