Topics in urology Flashcards
hydrocele definition
a fluid filled sac surrounding a testicle that results in swelling of the scrotum PAINLESS-covers the anterior aspect of the testes
non-communicating hydrocele
closed off from abdominal cavity (fluid collection)
communicating hydrocele
communicates with the peritoneal cavity and has an associated indirect inguinal hernia.
diagnosis of hydrocele
history, nontender, fluid filled sac, transilumination, cremasteric reflex intact, US for large ones to rule out tumor
treatment of hydrocele
- observation, especially in infants
- surgical for symptomatic lesions
- aspiration not appropriate by itself; occasionally done followed by a sclerosing agent.
spermatocele defintion
diverticulum of the epididymis
cystic dilation of the efferent ducts of the epididymis
can be separated from the testes
cremasteric reflex intact
spermatocele treatment
can be surgically removed if they are painful or are large enough to cause significant discomfort. neither hydroceles or spermatoceles cause infertility.
varicocele
dilations of the papiniform plexus.
papiniform plexus on the right drains into the internal spermatic vein and then into the IVC; on the left it drains into the renal vein and has a more acute angle. therefore the left is affected 100% of the time and right sided should be further investigated
-may affect fertility
epididymitis
inflammation of the epididymis may be caused by chemical irritation (reflux of urine into epididymis)
diagnosis of epididymitis
history: recent UTI? sexual practices? urethral discharge? pain (usually acute)
exam: painful palpation of the epididymis; swelling of the epididymis, prehn sign (pain relieved by elevation of the affected testes/epididymis); cremasteric reflex intact
Lab: ua/uc; aspiration may be necessary for definitive diagnosis/tx
most accurate imaging study for diagnosis of epididymitis?
radionuclide scan
treatment of epididymitis
appropriate abx, consider anti-inflammatory medications, scrotal elevation and support to facilitate venous and lymphatic drainage, ice, may cause infertility (scarring)
orchitis definition
acute inflammation of testes and is uncommon, typically with the mumps virus
treatment of orchitis
scrotal support and elevation, hot or cold packs, abx if appropriate, anti-inflam meds including possibly prednisone, may cause infertility or sterility
cryptorchidism
condition of testicular maldescent. should be followed carefully and surgical correction is indicated if not resolved by one year of age.
testicular torsion
twisting of the testis and its spermatic cord resulting in acute ischemia, impeded venous and lymphatic drainage. surgical emergency. occurs at 12-18 y.o. lack of normal attachments to scrotum “bell clapper deformity”
testicular torsion symptoms
acute scrotal pain, n/v and anorexia frequently present, may have a history of milder self reducing episodes, trauma may contribute.
evaluation of testicular torsion
testis “riding high”, abnormal orientation, swelling, extreme tenderness, firmness, absent cremasteric reflex, elevation of the testis doesn’t relieve pain, US with doppler to eval blood flow, radionuclide scan, emergent urology consult
treatment of testicular torsion
manual: untwist right clockwise and left counterclockwise; orchidoplexy must follow (twist toward middle)
cell necrosis time
360 degree rotation- 12-24 hours
1080 degree rotation-2 hours
appendix testes torsion
acute pain, normal testicular orientation, pain over the upper pole of the the testis, blue appearing lesion over the upper pole of the testis when the skin is stretched over it, analgesics