The Testis Flashcards
___ is the condition of having low testosterone
hypogonadism
What is the range of low testosterone?
< 150-200 ng/dL
What is the etiology of hypogonadism?
Primary: Testicular failure → Mumps orchitis
Secondary: Hypogonadotropic hypogonadism → Age-related (ADAM), chronic opiates
What are some s/s of hypogonadism?
↓ energy/fatigue
ED
↓ force of ejaculation
↓ libido
What do you use in the work-up of hypogonadism?
Exam
Free and total testosterone; If low→ DEXA scan (<100 ng/dL)
What is the tx for hypogonadism?
Androgen (testosterone) supplementation
What are 2 locations that you should not apply testosterone gel?
Nipples
Scrotum
When do you need to f/u w/ a pt being treated for hypogonadism?
3, 6 and 12 months after initiating, then annually
What labs will you order to monitor a pt w/ hypogonadism?
PSA Hemogram (H&H) Testosterone Review of urinary sx DRE
What are important counseling points you should give to a pt being tx w/ hypogonadism?
Prostate CA monitoring
CV risks
Infertility
___ is a testis (testes) not in scrotum; possibly absent or non-palpable (20%), if palpable→ will not come down
Cryptorchidism
What is descent of a testis determined by?
At what age gestation should the testis pass through the inguinal canal?
Androgen-independent, mediated by “descendin”
28 wks
What is the tx for Cryptorchidism?
GnRH injxn
Orchidopexy
What are the 3 true types of cryptorchidism?
Abdominal
Inguinal
Suprascrotal
What are the 5 ectopic types of cryptorchidism?
Prepenile Superficial ectopic Transverse scrotal Femoral Perineal
____ is cryptorchidism that is proximal to the inguinal ring
Intra-abdominal (10%)
____ is cryptorchidism that is truly absent, probably due to a prior gestational vascular event
Absent testis (20%)
___ is cryptorchidism that is below the internal ring but out of normal path
Ectopic testis
____ is cryptorchidism that reflects an exuberant cremasteric reflex
How long should you follow this pt?
Retractile testis
until puberty
Most cryptorchidism descend spontaneously in the 1st __ months
3
Cryptorchidism occurs in __% of term infants and ___% of premature infants
3%
30%
Cryptorchidism is bilateral __% of the time
10%
What are some risk factors for cryptorchidism?
twins low birth wt prr-term delivery FHx Prune belly syndrome
What are complications of cryptorchidism?
CA risk
Decreased fertility
Torsion is x10 higher
___ is the benign accumulation of serous fluid between layers of tunica vaginalis
Hydrocele
What is the presentation of of adult hydrocele?
Scrotal discomfort and enlargement
Possible h/o trauma or infxn
What are some possible etiologies of adult hydroceles?
Idiopathic
post-traumatic
post-infectious
What is included in the work up of an adult hydrocele
Careful exam
Transillumination
Possible scrotal sonogram
What are the tx for adult hydrocele?
Expectant management if asymptomatic
Aspiration/sclerosis assoc. w/ recurrence
Scrotal excision (hydrocelectomy)
What is the presentation of an infant hydrocele?
Hemi scrotal enlargement
Volume/size waxes and wanes during day
What is the etiology for an infant hydrocele?
Patent processus vaginalis (communicating hydrocele)
What is the tx for an infant hydrocele?
If persistent after one year, repair via inguinal incision
___ is congestion of veins around the testis
Varicocele
What age range is most likely to have a varicocele? Least likely?
15-30 y/o
rarely >40 y/o
What is the etiology for varicoceles? What could indicate malignancy?
Reflects valvular anomaly exacerbated (or caused) by gonadal venous anatomy
Rare malignant etiology (consider if R-sided, or in man >40 y/o)
What are the s/s of a varicocele? Majority on L or R side?
Asymptomatic Dull ache Infertility Scrotal enlargement Majority on left
What does the work-up for a varicocele include?
Clinical
“bag of worms” on palpation due to dilatation of veins in pampiniform plexus
R-sided will need to r/o mass (more concerning side for varicocele occurrence)
What is the tx for a varicocele?
Varicocelectomy, embolization
⅔ surgically tx have fertility improvement
___ is the twisting of the spermatic cord causing ischemia of testis
Testicular Torsion
What is the epidemiology for testicular torsion? Unimodal, Bimodal, or Trimodal distribution?
Bimodal distribution
Neonatal (extravaginal) vs. pubertal (intravaginal)
What are some etiologies for testicular torsion?
Bell-clapper deformity
Cryptorchidism
Trauma
Sex
What are the s/s of testicular torsion?
Sudden severe onset
Unilateral scrotal pain
N/V
Abd pain
Sx may be intermittent (intermittent torsion)
What is included in the work-up of testicular torsion?
High riding testes (-) cremasteric reflex scrotal edema TTP Prehn's sign: pain unrelieved by scrotal elevation
Need a high index os suspicion, US are often misleading
What is the tx for testicular torsion? Within what timeframe do you prefer to catch/tx?
Scrotal exploration (untwisting of cord and orchidopexy, contralateral orchidopexy)
High salvage rate if tx w/in 6 hrs
____ is inflammation/infxn of epididymis
Epididymitis
What are some etiologies of epididymitis? What age ranges correlate with what infectious organisms?
Ascending infxn from urethra, prostate, bladder
(<35 y/o C. trachomatis, N. gonorrhoeae
>35 y/o→ E.coli)
Surgery (vasectomy)
Other trauma
What are s/s of epididymitis?
Scrotal pain
Scrotal enlargement
Fever
What is included in the w/u of epididymitis?
UA , Cx, penile swab/probe for STI
What is the tx for epididymitis ?
Abx (empiric by age→ i.e. doxycycline or cipro)
Palliative (scrotal support, NSAID, ice, narcotics)
What are the two types of testicular CA?
Which is more common?
Germ cells (95%)
Non Germ cells (5%)
What are the types of germ cell testicular CA?
Seminoma (90% cure rate)
Non-seminoma (near 100% cure rate)
Mixed
What is the epidemiology for testicular CA?
Trimodal:
Up to 10 yrs (yolk sac)
20-40 yrs (seminoma)
> 60 yrs (spermatocytic seminoma)
How does a pt w/ testicular CA usually present?
Painless testicular mass
Usually incidental by partner or after trauma
Cough or dyspnea secondary to lung metastases
GI sx secondary to retroperitoneal metastases
Gynecomastia
What is included in the tx for testicular CA?
Scrotal sonogram
Tumor markers (AFP, beta-hCG, LDH)
CT to assess the lymph nodes of retroperitoneum
Radical inguinal orchiectomy
____ is an acute inflammatory rxn of the testis 2° to infxn
Orchitis
What are the most common causes/organisms of orchitis?
Most common→ viral mumps infxn in children
Bacterial orchitis→ C. trachomatis, N. gonorrhoeae, E. coli
(most commonly assoc. w/ epididymitis in sexually active males and men >50 w/ BPH)
What are the s/s of orchitis?
Scrotal pain (mild-severe)
Swelling
Overlying skin frequently thickened
Testicle will not move freely in the scrotum, “stuck”
What is the tx for orchitis?
Viral (mumps orchitis)→ no meds; may lead to infertility
Bacterial→ tx suspected organism, exclude/address abscess
