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
testicular malignancy epidemiology
peak incidence between 20-40 yrs
accompanying epididymitis may delay dx
solid tumors don’t transiluminate
most commonly germ cell tumors
carcinoma arises:
from epithelial cells which cover the body or line organs
sarcoma arises:
from connective tissues and are often named for the specific type of tissue
testicular malignancy imaging
abdominal and pelvic ct to evaluate retroperitoneal lymph nodes
treatment of testicular malignancy
external beam radiation, surgery: radical orchiectomy; lymphatics drain into the inguinal nodes [stage dependent]
prostatitis
inflammation of the prostate; classified as acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis (inflammatory), prostadynia.
acute bacterial prostatitis
recovery of bacteria from prostatic fluid, purulence of fluid, and systemic signs of infection
chronic bacterial prostatitis
recovery of bacteria in significant numbers from prostatic fluid in the absence of concomitant urinary infection or significant systemic signs (as in acute bacterial prostatitis)
nonbacterial prostatitis
no recovery of significant numbers of bacteria from prostatic fluid, but the fluid consistently reveals microscopic purulence
prostadynia
no recovery of significant bacteria or purulence in prostatic fluid, but patients have persistent urinary urgency, dysuria, poor urinary flow, and prostatic discomfort
benign prostatic hyperplasia (BPH)
hyperplasia of the prostatic epithelium; it is defined histologically.
Symptoms of BPH
irritative voiding symptoms (dysuria, nocturia, urgency, frequency) and symptoms of bladder outlet obstruction (intermittency, weak stream, post-void dribbling) may lead to acute urinary retention
what to check to dx BPH
PSA elevated
DRE may show an enlarged gland
treatment of BPH
5 a-reductase inhibitors (finasteride) alpha blockers saw palmetto transurethral microwave thermotherapy transurethral resection
prostate cancer
rare before age 50 dre recommended annually after age 40 PSA after age 50? -95% are adenocarcinomas -most common mets are to the pelvic lymph nodes and skeleton; visceral mets occur late and are less common
urethritis
- gonococcal and non gonococcal
- NGU think chlamydia
- caffeine
- spermatocides, lotions, soaps, condoms
non-gonococcal urethritis (NGU) defined by:
urethral discharge or dysuria and urethral inflammation documented by mucopurulent discharge or leukocytes on gram stain
symptoms of NGU
mucoid or watery discharge common
dysuria common
42% asymptomatic
urethritis treatment
appropriate eval and antibiotic treatment (azithro or doxy)
consider trial of metronidazole if symptoms persist (trichamonas)
decrease caffeine
avoid irritants
balanitis
inflammation of the glans penis. usually occurs in conjunction with posthitis (inflammation of the prepuce) and can be associated with poor hygeine
symptoms of balanitis
smegma (glandular secretions), sloughed cells, and mycobacterium smegmatis may collect under the foreskin and cause direct irritation or infection
phimosis
too tight foreskin to retract; hygeine issues; sexual function issues
paraphimosis
too tight to get back to starting point (foreskin) may need emergent circumcision if tourniquet effect cannot be reversed manually
penile cancer
risk factors: hpv infection, smoking, treatment of penile psoriatic lesions with psoralen and uv exposure
usually squamous cell carcinoma
often presents with leukoplakia
often have a significant morbidity and mortality
types of ED
failure to initiate (endocrin, psychogenic, neurogenic)
failure to fill (arteriogenic)
failure to store (venoocclusive dysfunction)
DM atherosclerosis, drugs are about 80% of ED
vasculogenic ED
unrestricted outflow may occur with increased adrenergic activity or decreased parasympathetic tone to the affected area. decreased compressability of the tunical veins
neurogenic ED
spinal cord lesions (lower cord lesions produce higher degree of dysfunction)
multiple sclerosis
peripheral neuropathy
pelvic surgery
endocrinologic ED
testosterone levels are probably a factor (augmentation is not helpful if levels are normal) prolactin excess can depress libido and testosterone estrogen excess (excess fat)
diabetic ED
primarily secondary to vascular and neurologic complications of DM. decreased levels of nitric oxide sythase in neural and endothelial tissues
psychogenic ED
performance anxiety, loss of attraction, relationship conflict, depression, sexual inhibition, fear of STD, pregnancy, commitment. Excess sympathetic tone; blocking of sacral cord reflexogenic activation of the vascular changes in the penis necessary for erection
medication related ED
diuretics antihtn hormones antidepressants H2 blockers ETOH, cocaine, THC others
ED evaluation
history, evidence of vascular disease, evidence of hypogonadism, penile palpation (plaques in corpora), lab exam: prolactin, testosterone, complete metabolic profile, CBC, lipids
