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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
How does testicular torsion present?
Presents in adolescents w/ a history of mild trauma/prev pain
26
What are the Sx of testicular torsion?
Sudden onset severe pain in groin/lower abdomen (T10) | Vomiting
27
What are the signs of testicular torsion?
Unilateral, hot, swollen, tender testis Testis lies superior and transverse Absent cremasteric reflex
28
What investigations are appropriate in suspected testicular torsion?
Doppler USS to show lack of blood supply | Surgical exploration
29
What is the DDx for testicular torsion like presentation?
Testicular torsion | Epididymitis
30
What is epididymo-orchitis?
Acute inflammation arising due to an ascending infection via vas def
31
What are the most common causes of epididymo-orchitis?
Gonococcal/non-gonococcal urethritis | E.coli after UTI
32
How does epididymo-orchitis present?
Painful swelling of the epididymis Secondary hydrocele History of discharge (STI)/dysuria (UTI)
33
What are the signs of epididymo-orchitis?
Co-existent prostatitis | +ve Phren's test
34
How should epididymo-orchitis be investigated?
First catch urine MSS STI screen USS
35
What are the two main types of testicular tumour?
``` Seminomas Non-seminomatous germ cell tumours -teratomas -yolk sac tumours -choriocarcinomas ```
36
What are the risk factors for testicular tumour?
Undescended/ectopic testes Infertility Hypospadia Family/personal history
37
Where do seminomas arise from?
Seminiferous tubules in 30-40 yr olds
38
Where do teratomas arise form?
Totipotent germ cells in 20-30 yr olds
39
How do testicular tumours spread?
Local spread rare Lymph spread to para-aortic nodes Haematogenous spread early to lungs/liver
40
How do testicular tumours present?
``` Painless lump Hydrocele Haematospermia Sx of metastases Painful, rapidly enlarging swelling Gynaecomastia ```
41
What is urethritis?
Discharge/discomfort w/i penis - gonococccal urethritis - non-gonococcal urethritis
42
What is N. gonorrhoea?
Gram -ve intracellular diplococcus spread by sexual contact
43
What are the sx of gonococcal urethritis?
``` Asymptomatic (50% women, 10% men) Men -dysuria -urethral discharge -epididymitis/prostatitis Women -vaginal discharge -pelvic pain -dysuria -IMB ```
44
What investigations are appropriate in suspected gonococcal urethritis?
Gram stain & culture Nucleic acid amplification (NAAT) test Blood culture (?sepsis) Screen for co-existing pathogens (chlamydia/syphilis)
45
What is the management for gonococcal urethritis?
IM ceftriaxone Repeat cultures 72h post treatment Trace & treat sexual contacts
46
What is Chlyamydia Trachomatis?
Major cause of NGU, often co-exists w/ gonococcus | -obligate intracellular parasite
47
What are the sx of non-gonococcal urethritis?
``` Asymptomatic (50% men, 80% women) Men -dysuria -discharge -epididymitis Women -discharge -bleeding -lower abdo pain (salpingitis) ```
48
What are the appropriate investigations for NGU?
``` 1st void urine (men) Endocervical swab (women) Cell culture (gold standard, takes time) Direct immunofluorescence/PCR Screen for co-existing gonorrhoea ```
49
What are the management options for NGU?
1g azithromycin OR 7/7 doxycycline/erythromycin Trace & treat sexual contacts
50
What is the urethral syndrome?
Describes abacteriuric freq/dysuria
51
What are the causes of the urethral syndrome?
Post-coital bladder trauma Atrophic vaginitis Interstitial nephritis
52
How is urethral trauma managed?
Urethral tears --> specialist urological attention - partially intact = prolonged catheterisation - complete tears = suprapubic catheterisation, formal repair
53
How should suspected urethral strictures be investigated?
Uroflowmetry Urethrogram Urethroscopy
54
What are the management options for urethral strictures?
1st line = optical urethrotomy | Urethroplasty for those that recur (50%)
55
What is the management of phimosis causing troublesome sx?
Circumcision
56
What are the management options for paraphimosis?
Emergency - local anaesthetic, applying pressure to glans OR slitting foreskin distally Circumcision (prevents recurrence)
57
How should epididymal cysts be managed?
Excision | -drainage often leads to recurrence
58
What is the management of symptomatic hydroceles?
Excision of hydrocele sac | -aspiration leads to recurrence
59
What are the management options for varicoceles?
Reassure as to benign nature Radiological embolization of L renal vv OR Surgical ligation & division of testicular vv
60
What are the appropriate investigations in suspected testicular cancer?
``` Scrotal USS (-ve USS cannot exclude malignancy) Tumour markers -NSGCTs (AFP, bHCG) -seminomas (AFP, bHCG) -CT CAP ```
61
What are the management options for testicular cancer?
``` Surgical exploration +/- orchidectomy/biopsy Retroperitoneal lymph node dissection Post surgical radiotherapy (seminomas) Post surgical combination chemo (NSCGTs) Sperm banking ```
62
What is the prognosis for testicular cancer?
Node -ve cases 100% 5yr survival | Overall 5yr survival >90%
63
What are the management options for testicular torsion?
Manual distortion under analgesia (temp relief) Viable testis --> untwist & suture to tunica vaginalis Non-viable testis --> orchidectomy Fixation of contralateral testis
64
What are the management options for epididymo-orchitis?
6 weeks ciprofloxacin +/- doxycycline (pain relief) | Analgesia
65
What is torsion of testicular appendage?
Torsion of embryological remnant - less painful, no elevation - occurs at start of puberty
66
How does acute bacterial prostatitis present?
``` Fever/rigors Perineal pain Difficulty voiding UTI sx Pain on ejaculation/haematospermia Tender/enlarged prostate ```
67
How should acute bacterial prostatitis be managed?
6 weeks ciprofloxacin
68
What is the aetiology of the carcinoma of the penis?
``` Rare Associated w/ -HPV 16/18 (50%) -smokers -immunosuppressed individuals ```
69
How does carcinoma of the penis present?
Persistent red patch on penis --> infiltrating ulcer | No urethral involvement
70
What are the appropriate investigations in suspected carcinoma of the penis?
Punch biopsy
71
How should carcinoma of the penis be managed?
Radiotherapy OR penis preserving excision
72
What is priapism?
Persistent (hrs-days) erection of corpora cavernosa of penis
73
What are the causes of priapism?
Trauma Sickle cell disease Intracavernosal injections (for incompetence)
74
What are the management options for priapism?
``` Ice packs a-agonist Selective embolization Aspiration of corpus cavernosum Surgical intervention ```
75
What is Peyronie's disease?
Upward curvature of penis when erect -affects 1-3% of men Unknown cause (poss fibrous scarring post trauma)
76
How should Peyronie's disease be managed?
Managing associated depression | Surgical intervention
77
What are the different types of testicular maldescent?
Ectopic testes Undescended testes Retractile testes
78
Describe ectopic testis
Uncommon, testis strays from normal line of descent | -most commonly into superior inguinal pouch
79
Describe undescended testis
Common, testis follows normal route of descent but stops short of scrotum -due to local defect in development
80
How do undescended testes present?
As a congenital inguinal hernia | -may descend spontaneously in first few months of life
81
What are the effects of undescended testes on fertility?
Spermatogenesis impossible | -2o sex characteristics develop normally
82
Describe retractile testies
Normal testes w/ excessive cremasteric reflex | -not technically maldescended
83
What are the management options for maldescended testes?
Ectopic/undescended tetes must be surgically placed into scrotum -done at 6mo
84
What are the potential complications of maldescended testes?
Defective spermatogenesis Increased risk of torsion Increased risk of malignancy Increased risk of indirect inguinal hernia (processus vaginalis)
85
What is impotence?
Inability to achieve/sustain an erection sufficient for sexual intercourse
86
What vascular factors are required to achieve an erection?
Increased arterial inflow Occlusion of venous outflow -mediated by parasympathetic fibres from S2-4
87
What are the causes of erectile dysfunction?
``` Ageing (70% of 70yr olds) Neurogenic Vascular Hormonal (DM, pituitary failure) Pharmacological Psychogenic ```
88
What are the neurogenic causes of erectile dysfunction?
Spinal cord lesion Cerebral infarction Hypothalamic lesion Post-surgical nerve damage
89
What are the pharmacological causes of erectile dysfunction?
Alcohol Antihypertensives Oestrogens Tranquilisers
90
What are the management options for erectile dysfunction?
Treat reversible medical causes Correct hormonal disturbances Stop smoking/reduce alcohol intake Specific medical treatments
91
What are the specific medical treatments for erectile dysfunction?
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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