trigger - penile/scrotal disorder Flashcards
needle aspiration of fluid +/- sclerotherapy to tunica vaginalis is the treatment for what condition?
hydroceles!
(high rate of recurrence with this)
reminder! Only treat if:
- communicating
- persists>12-18 mo
- acute onset
- symptomatic!
hydrocelectomy is treatment for what condition?
hydrocele! this is definitive!
reminder! Only treat if:
- communicating
- persists>12-18 mo
- acute onset
- symptomatic!
most surgically correctable cause of male infertility
varicocele
this condition is increased with standing and valsalva and alleviated with supine position.
varicoceles
what positions increase and decrease the presentation of varicoceles?
- increased with standing and valsalva
- may improve w supine position
feels like a bag of worms
varicoceles
what confirms dx of varicoceles
US
bell clapper deformity is a risk for which condition
testicular torsion
cryptorchidism is a risk factor for which conditions
- testicular torsion
- testicular tumor
sudden onset of severe unilateral scrotal pain and swelling
testicular torsion
which conditions present (or can present) with nausea/vomiting
- testicular torsion
- orchitis
- testicular tumor
presents with lack of voiding
- testicular torsion
- priapism (emergent if present)
- phimosis (emergent if present)
negative prehn’s sign
testicular torsion
positive prehn’s sign
- Orchitis
- epididymitis
what treatment MUST be done in testicular torsion
surgical detorsion and fixation of the involved testis and contralateral testis
a patient presents with symptms of N/V and on exam you see a swollen left testicle that is hard to palpation. The affected testicle is at the same level as the contralateral testicle and has an intact cremasteric reflex.
what is this patients TWIST score and what is his risk for testicular torsion
this patient has a TWIST score of 5, this puts him at high risk.
blue dot sign is seen in which condition
testicular appendage torsion
US shows small hyperechoic region adjacent to the testis
testicular appendage torsion
in older adults can be d/t chronic balanoposthitis from diabetes
phimosis
ballooning of prepuce during urination
phimosis
what is the treatment of phimosis caused by infection
- fungal → topical clotrimazole or nystatin or oral fluconazole
- Bacterial → topical bacitracin, oral metronidazole (Flagyl)
- Cellulitis or extends to shaft → cephalexin (Keflex)
if acute, treat with hemostat dilation, catheter, and topical steroids
phimosis
(called the frenar stretch)
if this doesnt work then you can surgically incise the dorsal slit
complications of this condition includes preputial calculi and squamous cell carcinoma
phimosis
a cause of this condition is plasmodium falciparum
paraphimosis
“donut sign”
paraphimosis
what is the treatment for phimosis
- emergent urology consult for manual reduction!!!! (manual pressure on glans for 5 min to reduce edema then push glans proximally while pulling prepuce distally!)
- refractory to manual reduction may need needle decompression, dorsal slit of foreskin, or osmotic agents.
- circumcision after inflammation subsides!
true or false. priapism is often associated with sexual stimulation
FALSE
not commonly associated with sexual stim
MCC of priapism in children
sickel cell and other hematologic diseases
what type of priapism is assocaited with physiologic obstruction of venous drainage
low flow!
high flow is associated with loss of penile arterial regulation
pt presents with prolonged erection. Among penile aspiration, the blood has high O2 and low CO2. which type of priapism is this
HIGH flow
low flow will have low O2 and high CO2
treated with narcotics or epidural/spinal anesthesia
priapism
also used:
subcutaneous terbutaline and corporal aspiration of viscous blood with irrigation
treated with subcutaneous terbutaline
priapism
also used:
narcotics, epidural/spinal anesthesia and corporal aspiration of viscous blood with irrigation
when is the winter procedure used
refractory priapism
creates a fistula between corpora cavernosa and spngiosum
also used in treatment: excision of tunica albuginea, cavernosa-spongiosum shunt, saphenous vein cavernous shunt.
when would we treat with excision of tunica albuginea, cavernosa-spongiosum shunt, or saphenous vein cavernous shunt.
refractory priapism
also used: winter procedure
peyronies disease causes fibrosis of what part of the penis
tunica albuginea
which disease is associated with vasculitis, connective tissue disease, and DM
peyronie’s
also assocaited with: smoking, ETOH, hypercholesterolemia
presents with palpable lesions on penis and inguinal LAD
penile cancer
bone pain, cough, skin lesions
metastatic penile cancer
can be caused by STDs, infections, or amiodarone!
epididymitis
which conditions present with fever
- epididymitis
- orchitis
prevention includes minimizing use of foley catheters
- orchitis
- epididymitis
can be caused by viruses
orchitis
when do we treat with ceftriaxone and levo
for men with orchitis who practice anal sex
this is associated with DES use during pregnancy and Von Hippel-Lindau disease
epididymal cyst
epididymal cyst>2cm
spermatocele
risks include exogenous estrogen use during pregnancy and infertility
testicular tumors
also see;
fam hx
HIV
cryptorchidism (10%)
painless enlargement of the testis is the MC symptom of what
testicular tumor
