The Testis

Question 1

hypogonadism def

Answer 1

low testosterone
< 150-200 ng/dL
200-300 ng/dL
300+ (normal)

Question 2

what causes primary hypogonadism

Answer 2

testicular failure, mumps orchitis

Question 3

what causes secondary

Answer 3

hypogonadotrophic hypogonadism
age related ADAM
chronic opiates

Question 4

what is a positive adams questionnaire result

Answer 4

if you say yes to any of first 7 questions
or if you say yes more than 3 times
= hypogonadism

Question 5

sx hypogonadism

Answer 5

1. decreased energy / fatigue
2. ED
3. decreased force of ejaculation
4. decreased libido

Question 6

what is workup for hypogonadism

Answer 6

1. androgen supplements - tx
2. get testosterone labs 8-10 am
3. If low (under 100 ng/dL) order DEXA scan

Question 7

where should you avoid application of androgen gels

Answer 7

nipples, scrotum ..too much absorption

Question 8

when and what type of follow up labs do you order?

Answer 8

3, 6 and 12 mo after tx is initiated
PSA, H&H, testosterone, review of urinary sx, DRE

Counsel prostate Ca monitoring

Question 9

cryptorchidism def

Answer 9

testis or testes not in the scrotum

Question 10

if testes are not down by 6 mo then..

Answer 10

descent is unlikely

Question 11

testes begin to pass through inguinal canal at..

Answer 11

28wks …yet most spontaneously go down at 3mo

Question 12

tx cryptorhcidism

Answer 12

hormonal manipulation (GnRH) injection 
orchidopexy to bring testis down

Question 13

complications of cryptorchidism

Answer 13

1. torsion risk is 10x higher
2. decreased fertility
3. contralateral testis increased risk even if descended

Question 14

hydrocele

Answer 14

benign accumulation of serous fluid between layers of tunica vaginalis

Question 15

infant hydrocele presentation

Answer 15

hemiscrotal enlargement, volume changes during the day

Question 16

cause infant hydrocele

Answer 16

patent processus vaginalis (communicating hydrocele)

Question 17

if infant hydrocele is persistant after 1 yr…

Answer 17

do surgery via inguinal incision

Question 18

tx adult hydrocele

Answer 18

aspiration / sclerosis if recurrence

scrotal excision hydrocelectomy

Question 19

bag of worms

Answer 19

varicocele

Question 20

congestion of veins around testis

Answer 20

varicocele

Question 21

ages of varicocele

Answer 21

age 15-30 rarely over 40yo

Question 22

treatment for varicocele

Answer 22

varicocelectomy: inguinal approach, dissect away spermatic cord, ligation of veins but preserve the lymphatics, artery and vas deferns