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CP3 @ UoN - Medicine & Surgery > The Urethra, Penis & Scrotum > Flashcards

The Urethra, Penis & Scrotum Flashcards

1
Q

What is a urethral stricture?

A

Scar of urethral epithelium, extending into corpus spongiosum
Fibroblasts lead to shortening/narrowing of urethra

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2
Q

What are the causes of urethral strictures?

A

Blunt perineal trauma
Traumatic catheter instertion/LTC
Gonococcal/NG Urethritis
Balanitis xerotica obliterans

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3
Q

How do urethral strictures present?

A 
Obstructive voiding sx that worsen
-initial freq/dysuria
-hesitancy/straining
-urinary retention
-splayed stream
O/E - firm areas
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4
Q

What is Phimosis?

A

Narrowing of the preputial orifice –> inability to retract foreskin

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5
Q

What are the causes of Phimosis?

A

Often idiopathic
Congenital
Chronic balantitis
Traumatic forcible retraction of the foreskin

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6
Q

How does Phimosis present?

A

Children - ballooning of foreskin, poor stream in urination

Adults - pain during intercourse, inability to retract foreskin

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7
Q

What is Paraphimosis?

A

Swollen, painful glans resulting from obstructed venous return due to the pulling of a tight foreskin over the glans –> cannot replace foreskin

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8
Q

What are the common causes of Paraphimosis?

A

Tight foreskin pulled over glans

  • after an erection
  • following urethral catheterisation
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9
Q

What is an Epididymal Cyst?

A

Smooth, extratesticular, spherical cysts in the head of the epididymis

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10
Q

What are the causes of Epididymal Cysts?

A

Common, due to cystic degeneration of epididymis

Associated w/ PKD/CF

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11
Q

How do Epididymal Cysts present?

A

Cystic lump, separate from testes, at upper pole
Contained fluid can be clear/contain sperm
Can be painful

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12
Q

What is Hydrocele?

A

Excessive collection of serous fluid in the tunica vaginalis

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13
Q

What are the three types of Hydrocele?

A

Congenital
Primary
Secondary

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14
Q

Describe congenital hydrocele

A

Associated w/ hernial sac & patent processus vaginalis

Spontaneously resolve <1yr

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15
Q

Describe primary hydrocele

A

Vaginalis hydrocele
Idiopathic
Separate from peritoneal cavity

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16
Q

Describe secondary hydrocele

A

Underlying inflammation in epididymis/testes

Underlying cancer

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17
Q

What is the outcome of hydrocele?

A

Typically benign, non symptomatic

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18
Q

What are Varicocele?

A

Varicosities of pampiniform plexus, commonly on L

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19
Q

When do Varicocele first manifest?

A

Adolescence

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20
Q

How do Varicocele present?

A

Dragging sensation & ache

Feels like a ‘bag of worms’ on palpation

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21
Q

What are the complications of Varicoceles?

A

Reduced spermatogenesis & subfertility

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22
Q

What is the underlying process leading to Varicocele?

A

Valvular incompetency at junction of L renal vv

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23
Q

What is testicular torsion?

A

Testicle twists upon pedicle, obstructing venous return

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24
Q

What causes testicular torsion?

A

Congenital abnormality

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25
Q

How does testicular torsion present?

A

Presents in adolescents w/ a history of mild trauma/prev pain

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26
Q

What are the Sx of testicular torsion?

A

Sudden onset severe pain in groin/lower abdomen (T10)

Vomiting

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27
Q

What are the signs of testicular torsion?

A

Unilateral, hot, swollen, tender testis
Testis lies superior and transverse
Absent cremasteric reflex

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28
Q

What investigations are appropriate in suspected testicular torsion?

A

Doppler USS to show lack of blood supply

Surgical exploration

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29
Q

What is the DDx for testicular torsion like presentation?

A

Testicular torsion

Epididymitis

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30
Q

What is epididymo-orchitis?

A

Acute inflammation arising due to an ascending infection via vas def

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31
Q

What are the most common causes of epididymo-orchitis?

A

Gonococcal/non-gonococcal urethritis

E.coli after UTI

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32
Q

How does epididymo-orchitis present?

A

Painful swelling of the epididymis
Secondary hydrocele
History of discharge (STI)/dysuria (UTI)

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33
Q

What are the signs of epididymo-orchitis?

A

Co-existent prostatitis

+ve Phren’s test

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34
Q

How should epididymo-orchitis be investigated?

A

First catch urine MSS
STI screen
USS

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35
Q

What are the two main types of testicular tumour?

A 
Seminomas
Non-seminomatous germ cell tumours
-teratomas
-yolk sac tumours
-choriocarcinomas
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36
Q

What are the risk factors for testicular tumour?

A

Undescended/ectopic testes
Infertility
Hypospadia
Family/personal history

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37
Q

Where do seminomas arise from?

A

Seminiferous tubules in 30-40 yr olds

38
Q

Where do teratomas arise form?

A

Totipotent germ cells in 20-30 yr olds

39
Q

How do testicular tumours spread?

A

Local spread rare
Lymph spread to para-aortic nodes
Haematogenous spread early to lungs/liver

40
Q

How do testicular tumours present?

A 
Painless lump
Hydrocele
Haematospermia
Sx of metastases
Painful, rapidly enlarging swelling
Gynaecomastia
41
Q

What is urethritis?

A

Discharge/discomfort w/i penis

  • gonococccal urethritis
  • non-gonococcal urethritis
42
Q

What is N. gonorrhoea?

A

Gram -ve intracellular diplococcus spread by sexual contact

43
Q

What are the sx of gonococcal urethritis?

A 
Asymptomatic (50% women, 10% men)
Men
   -dysuria
   -urethral discharge
   -epididymitis/prostatitis
Women
   -vaginal discharge
   -pelvic pain
   -dysuria
   -IMB
44
Q

What investigations are appropriate in suspected gonococcal urethritis?

A

Gram stain & culture
Nucleic acid amplification (NAAT) test
Blood culture (?sepsis)
Screen for co-existing pathogens (chlamydia/syphilis)

45
Q

What is the management for gonococcal urethritis?

A

IM ceftriaxone
Repeat cultures 72h post treatment
Trace & treat sexual contacts

46
Q

What is Chlyamydia Trachomatis?

A

Major cause of NGU, often co-exists w/ gonococcus

-obligate intracellular parasite

47
Q

What are the sx of non-gonococcal urethritis?

A 
Asymptomatic (50% men, 80% women)
Men
   -dysuria
   -discharge
   -epididymitis
Women
   -discharge
   -bleeding
   -lower abdo pain (salpingitis)
48
Q

What are the appropriate investigations for NGU?

A 
1st void urine (men)
Endocervical swab (women)
Cell culture (gold standard, takes time)
Direct immunofluorescence/PCR
Screen for co-existing gonorrhoea
49
Q

What are the management options for NGU?

A

1g azithromycin OR
7/7 doxycycline/erythromycin
Trace & treat sexual contacts

50
Q

What is the urethral syndrome?

A

Describes abacteriuric freq/dysuria

51
Q

What are the causes of the urethral syndrome?

A

Post-coital bladder trauma
Atrophic vaginitis
Interstitial nephritis

52
Q

How is urethral trauma managed?

A

Urethral tears –> specialist urological attention

  • partially intact = prolonged catheterisation
  • complete tears = suprapubic catheterisation, formal repair
53
Q

How should suspected urethral strictures be investigated?

A

Uroflowmetry
Urethrogram
Urethroscopy

54
Q

What are the management options for urethral strictures?

A

1st line = optical urethrotomy

Urethroplasty for those that recur (50%)

55
Q

What is the management of phimosis causing troublesome sx?

A

Circumcision

56
Q

What are the management options for paraphimosis?

A

Emergency - local anaesthetic, applying pressure to glans OR slitting foreskin distally
Circumcision (prevents recurrence)

57
Q

How should epididymal cysts be managed?

A

Excision

-drainage often leads to recurrence

58
Q

What is the management of symptomatic hydroceles?

A

Excision of hydrocele sac

-aspiration leads to recurrence

59
Q

What are the management options for varicoceles?

A

Reassure as to benign nature
Radiological embolization of L renal vv OR
Surgical ligation & division of testicular vv

60
Q

What are the appropriate investigations in suspected testicular cancer?

A 
Scrotal USS (-ve USS cannot exclude malignancy)
Tumour markers
   -NSGCTs (AFP, bHCG)
   -seminomas (AFP, bHCG)
   -CT CAP
61
Q

What are the management options for testicular cancer?

A 
Surgical exploration +/- orchidectomy/biopsy
Retroperitoneal lymph node dissection
Post surgical radiotherapy (seminomas)
Post surgical combination chemo (NSCGTs)
Sperm banking
62
Q

What is the prognosis for testicular cancer?

A

Node -ve cases 100% 5yr survival

Overall 5yr survival >90%

63
Q

What are the management options for testicular torsion?

A

Manual distortion under analgesia (temp relief)
Viable testis –> untwist & suture to tunica vaginalis
Non-viable testis –> orchidectomy
Fixation of contralateral testis

64
Q

What are the management options for epididymo-orchitis?

A

6 weeks ciprofloxacin +/- doxycycline (pain relief)

Analgesia

65
Q

What is torsion of testicular appendage?

A

Torsion of embryological remnant

  • less painful, no elevation
  • occurs at start of puberty
66
Q

How does acute bacterial prostatitis present?

A 
Fever/rigors
Perineal pain
Difficulty voiding
UTI sx
Pain on ejaculation/haematospermia
Tender/enlarged prostate
67
Q

How should acute bacterial prostatitis be managed?

A

6 weeks ciprofloxacin

68
Q

What is the aetiology of the carcinoma of the penis?

A 
Rare
Associated w/ 
   -HPV 16/18 (50%)
   -smokers
   -immunosuppressed individuals
69
Q

How does carcinoma of the penis present?

A

Persistent red patch on penis –> infiltrating ulcer

No urethral involvement

70
Q

What are the appropriate investigations in suspected carcinoma of the penis?

A

Punch biopsy

71
Q

How should carcinoma of the penis be managed?

A

Radiotherapy OR penis preserving excision

72
Q

What is priapism?

A

Persistent (hrs-days) erection of corpora cavernosa of penis

73
Q

What are the causes of priapism?

A

Trauma
Sickle cell disease
Intracavernosal injections (for incompetence)

74
Q

What are the management options for priapism?

A 
Ice packs
a-agonist
Selective embolization
Aspiration of corpus cavernosum
Surgical intervention
75
Q

What is Peyronie’s disease?

A

Upward curvature of penis when erect
-affects 1-3% of men
Unknown cause (poss fibrous scarring post trauma)

76
Q

How should Peyronie’s disease be managed?

A

Managing associated depression

Surgical intervention

77
Q

What are the different types of testicular maldescent?

A

Ectopic testes
Undescended testes
Retractile testes

78
Q

Describe ectopic testis

A

Uncommon, testis strays from normal line of descent

-most commonly into superior inguinal pouch

79
Q

Describe undescended testis

A

Common, testis follows normal route of descent but stops short of scrotum
-due to local defect in development

80
Q

How do undescended testes present?

A

As a congenital inguinal hernia

-may descend spontaneously in first few months of life

81
Q

What are the effects of undescended testes on fertility?

A

Spermatogenesis impossible

-2o sex characteristics develop normally

82
Q

Describe retractile testies

A

Normal testes w/ excessive cremasteric reflex

-not technically maldescended

83
Q

What are the management options for maldescended testes?

A

Ectopic/undescended tetes must be surgically placed into scrotum
-done at 6mo

84
Q

What are the potential complications of maldescended testes?

A

Defective spermatogenesis
Increased risk of torsion
Increased risk of malignancy
Increased risk of indirect inguinal hernia (processus vaginalis)

85
Q

What is impotence?

A

Inability to achieve/sustain an erection sufficient for sexual intercourse

86
Q

What vascular factors are required to achieve an erection?

A

Increased arterial inflow
Occlusion of venous outflow
-mediated by parasympathetic fibres from S2-4

87
Q

What are the causes of erectile dysfunction?

A 
Ageing (70% of 70yr olds)
Neurogenic
Vascular
Hormonal (DM, pituitary failure)
Pharmacological
Psychogenic
88
Q

What are the neurogenic causes of erectile dysfunction?

A

Spinal cord lesion
Cerebral infarction
Hypothalamic lesion
Post-surgical nerve damage

89
Q

What are the pharmacological causes of erectile dysfunction?

A

Alcohol
Antihypertensives
Oestrogens
Tranquilisers

90
Q

What are the management options for erectile dysfunction?

A

Treat reversible medical causes
Correct hormonal disturbances
Stop smoking/reduce alcohol intake
Specific medical treatments

91
Q

What are the specific medical treatments for erectile dysfunction?

A

Sildenafil
-causes vasodilation of corpus cavernosum
-contraindicated in pts on hypotensives
Intracavernosal alprostadil (PGE1) injection
Vaccuum condoms
Inflatable intrapenile prostheses

CP3 @ UoN - Medicine & Surgery (135 decks)

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