Urogenital Flashcards
What is an epididymal cyst/spermatocele?
- Cyst in the epididymis containing fluid.
What are the key diagnostic procedures for an epididymal cyst/spermatocele?
- Usually just clinical examination.
- Transillumination to show the cyst contains fluid.
- USS can be used to rule out tumour if unsure.
What is the treatment for an epididymal cyst/spermatocele?
- Usually none as it is harmless.
What is a hydrocele?
- Fluid collection between the membranous layers that surround the testes (tunica vaginalis).
What are the two types of hydrocele?
- Communicating hydrocele. Connection between the abdomen and the tunica vaginalis, which allows peritoneal fluid into the scrotal membrane.
- Non-communicating hydrocele. No connection between the abdomen and the tunica vaginalis. Caused by more fluid being produced than is being absorbed within the tunica vaginalis.
How is hydrocele diagnosed?
- Physical examination (swollen testes).
- Transillumination shows the swelling is fluid-filled.
- USS is gold standard but rarely used.
What is the treatment for hydrocele?
- Observation if asymptomatic.
- Surgery if symptomatic.
What is a varicocele?
- Dilation of the internal spermatic veins.
Which testicle does varicocele normally occur in?
- 90% are left sided.
How is varicocele diagnosed?
- Physical examination.
- USS if needed.
What is the treatment for varicocele?
- Surgical correction.
What is the main complication of varicocele?
- Potential infertility.
What is testicular torsion?
Twisting of the testicle on the spermatic cord, leading to occlusion of blood flow, ischaemia and potentially necrosis of testicular tissue.
MEDICAL EMERGENCY.
What is the clinical presentation of testicular torsion?
- Severe, acute onset testicular pain.
- Nausea/vomiting.
- Pain is not relieved by scrotal elevation (this would be indicative of epididymitis).
What is the treatment for testicular torsion?
- Urgent corrective surgery (detorsion).
- Sometimes testicle will be lost. Here, consider a prosthetic device.
What is epididymitis? What is the most common cause of epididymitis?
Inflammation of the epididymis.
Most commonly due to infection with N.gonorrhoea.
How is epididymitis treated?
- Ceftriaxone.
Which group is testicular cancer the most common malignancy in?
- Young men (20-34 YO).
What is the appearance of testicular cancer?
- Smooth, firm nodules firmly attached to one testis.
What is the diagnostic investigation for testicular cancer?
- USS testis.
What is the treatment for testicular cancer?
- Inguinal orchiectomy (surgical).
What are the key presenting features of bladder cancer?
- Haematuria (either microscopic or gross).
- Dysuria (pain or difficulty urinating).
What is the most common type of bladder cell cancer?
- Over 90% are transitional cell carcinomas (now called urothelial carcinomas).
What is the first line investigation for bladder cancer?
What is the diagnostic investigation for bladder cancer?
- Urinalysis (look for haematuria) is 1st line.
- Cystoscopy is diagnostic.
What is the treatment for bladder cancer?
- Transurethral bladder resection.
What is the precursor condition to prostate cancer?
- PIN.
What is the presentation of prostate cancer?
Often asymptomatic.
In later stages may cause:
- Dysuria.
- Urgency.
- Nocturia.
- Hesitancy.
- Haematuria.
What are the investigations used in BPH/prostate cancer screening?
How does DRE vary in prostate cancer vs BPH?
- PSA measurement.
- DRE. Look for hard, craggy mass (prostate cancer) or smooth, rubbery, enlarged prostate (BPH).
- DRE will show asymmetry in cancer and symmetry in BPH.
What is the diagnostic investigation used for prostate cancer?
-Prostate biopsy.
What is the management for prostate cancer?
- If low level cancer, observation and regular PSA testing/DRE.
- If higher level, radiotherapy or radical prostatectomy.
What is the RED FLAG symptom for prostate cancer rather than BPH?
- Haematuria.
What is BHP?
- Hyperplasia of the prostate cells.
What is the presentation of BPH?
Voiding symptoms:
- Hesitancy.
- Post void dribbling.
- Weak stream.
Storage symptoms:
- Nocturia
- Frequency
- Urgency
What investigations are used for BPH?
- Monitor with DRE/PSA.
- Urinalysis (check for haematuria and infection).
- Prostate biopsy if cancer suspected.
What is the treatment for BPH?
- Doxazosin (alpha blocker). This will relax muscles of the prostate and bladder neck.
- Consider radical prostatectomy.
