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The Abdomen > Urological Surgery > Flashcards

Urological Surgery Flashcards

1
Q

Most common cause of PID

A

STIs - e.g. chlamydia

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2
Q

Sequelae of PID

A
  • Tubal damage = ectopic pregnancy or infertility
  • Chronic pelvic pain
  • Recurrent PID
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3
Q

Pathological consequences of PID

A
  • Salpingitis
  • Pyosalpinx
  • Hydrosalpinx
  • Acute pelvic peritonitis
  • Salpingo-oophoritis
  • Tubo-ovarian abscess
  • Adhesions
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4
Q

Causes of chronic PID

A
  • Inadequately treated acute disease

- TB

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5
Q

Diagnostic size of retention ovarian cyst

A

> 2cm

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6
Q

Describe the structure of follicular ovarian cysts

A
  • Inner layer of granulosa cells
  • Contain clear fluid
  • May be multiple
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7
Q

Which ovarian cyst is most likely to rupture and cause minor haemorrhage into the peritoneal cavity

A

Luteal cyst

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8
Q

Describe psuedomyxoma peritonei

A

Occurs secondary to rupture of benign mucinous cystadenoma which releases tumour cells into the peritoneum that continue to produce mucous

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9
Q

Treatment of pseudomyxoma peritonei

A

Peritonectomy (Sugarbaker procedure)

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10
Q

Most common malignant ovarian tumour

A

Serous carcinoma (epithelial tumour)

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11
Q

Prognosis of ovarian serous carcinoma

A

Poor - 15% 5-year survival

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12
Q

Describe Dermoid ovarian cysts

A
  • Occur in younger patients
  • Contain hair, sebaceous material and teeth
  • May undergo torsion
  • Malignant transformation is rare
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13
Q

What is Meig’s syndrome

A

Ascites and pleural effusions in patients with ovarian fibromas

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14
Q

What is a Krukenberg tumour

A

Ovarian malignancy that has metastasised from another site - typically the stomach

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15
Q

Complications of fibroadenoma

A
  • Cystic degeneration
  • Red degeneration (necrosis with haemorrhagic infarction)
  • Dystrophic calcification
  • Sarcomatous change
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16
Q

Risk factors for endometrial carcinoma

A
  • Obesity
  • HTN
  • DM
  • Nulliparity
  • Long-term Tamoxifen therapy
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17
Q

Causes of stress incontinence

A
  • Pressure denervation of the. pelvic floor
  • External sphincter damage e.g. post-TURP
  • Trauma of posterior urethra e.g. pelvic trauma
  • Post-menopause
  • Obesity
  • Constipation
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18
Q

Causes of urge incontinence

A
  • Idiopathic detrusor instability (irritable bladder)
  • Infection
  • Loss of cortical control e.g. dementia
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19
Q

Causes of continuous incontinence

A
  • Females = fistula
  • Males = overflow in chronic retention
  • Anatomical abnormality e.g. epispadias, ectopic ureter
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20
Q

Define secondary nocturnal enuresis

A

Nocturnal enuresis following period of night-time dryness for 6-12 months

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21
Q

Investigations for incontinence

A
  • Exclude infection/DM
  • Bladder diary for 3 days
  • Flow cystometry (urodynamic studies) if surgery considered and cause unclear
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22
Q

Treatment for stress incontinence

A
  1. Pelvic floor exercises for 3 months

2. If fails, consider surgery

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23
Q

Treatment for urge incontinence

A
  1. Bladder training for 6 weeks
  2. If fails, Oxybutynin
  3. Sacral nerve stimulation
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24
Q

Surgical options for stress incontinence

A
  • Burch colposuspension
  • Needle suspension of the bladder neck (Stamey procedure)
  • Pubovaginal slings: Autologous uses rectus fascia, Synthetic with TVT
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25
Q

Effect of cerebrovascular disease on the bladder

A

Detrusor hyper-reflexia - results in frequency and urgency

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26
Q

Effect of spinal lesions above the sacral cord

A
  • Fibres passing from sacrum to pons are interrupted
  • Results in detrusor sphincter dyssynergia
  • Bladder contracts against closed sphincter
  • Causes renal damage
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27
Q

Symptoms of urinary fistulae

A
  • Recurrent UTI
  • Pneumaturia
  • Passive incontinence
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28
Q

Treatment of small bladder fistula

A
  1. Catheter

2. Antibiotics

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29
Q

Bacteriuria

A

Presence of bacteria in the urine

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30
Q

Pyuria

A

Presence of WBC in the urine

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31
Q

Sterile pyuria

A

Pyuria without bacteriuria - warrant evaluation for TB, stones, cancer

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32
Q

Define recurrent UTI

A

More than 3 infections in 1 year

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33
Q

Most common bacterial cause of UTI

A

E. coli

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34
Q

Significance of pseudomonas UTI

A

Likely foreign body

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35
Q

Significance of proteus spp UTI

A
  • Hydrolyses urea to form ammonia
  • Increases pH of urine
  • Predisposes to stone formation
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36
Q

Most common cause of epididymo-orchitis in men <35

A

Chlamydia and gonorrhoea

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37
Q

Iatrogenic cause of epididymo-orchitis

A

Amiodarone

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38
Q

Most common cause of epididymitis in older men

A

Bacterial infection of the urine - usually E. coli and associated with bladder outflow obstruction

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39
Q

Symptoms of epididymo-orchitis

A
  • Acute onset of testicular pain and scrotal swelling
  • Symptoms of UTI sometimes
  • Systemic upset sometimes
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40
Q

Investigations in epididymo-orchitis

A
  1. Urinalysis

2. USS to R/O abscess

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41
Q

Cause of prostatitis

A

Inflammation secondary to bladder outflow obstruction. In some cases no bacterial cause is found

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42
Q

Symptoms of prostatitis

A
  • Fever
  • Purulent discharge
  • Tender prostate
  • Pain on ejaculation
  • Haemospermia
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43
Q

Investigations for prostatitis

A
  1. Culture - blood and urine

2. TRUS - R/O abscess

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44
Q

Bacterial cause of Fournier’s gangrene

A

Polymicorbial - E.coli and bacteroides acting in synergy

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45
Q

Female cystitis predisposing features

A
  • Short urethra
  • Urethral trauma during intercourse
  • Pregnancy
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46
Q

Pathogenesis of acute pyelonephritis

A
  • Haematogenous spread
  • Retrograde ureteric spread
  • Organisms include e. coli, proteus, enterobacter, klebsiella, pseudomonas
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47
Q

Clinical features of pyelonephritis

A
  • Loin pain/tenderness
  • Malaise
  • Fever
  • Dysuria
  • Urgency of micturition
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48
Q

Complications of acute pyelonephritis

A
  1. Pyonephrosis - pus in the renal collecting system

2. Perinephric abscess - pus around the kidney, may rupture and reach adjacent organs

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49
Q

Treatment of pyonephrosis

A

Percutaneous nephrostomy

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50
Q

Treatment of perinephric abscess

A

Surgical or US-guided drainage

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51
Q

Associations of chronic pyelonephritis

A
  • VUR

- Obstructing lesions during childhood

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52
Q

Consequence of chronic pyelonephritis

A
  • Renal scarring

- Xanthogranulomatous pyelonephritis (granulomatous mass that is difficult to distinguish from renal tumour)

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53
Q

Characteristics of interstitial cystitis

A
  • Mucosal ulceration and fissures
  • Histological chronic inflammatory change
  • Carcinoma must be excluded
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54
Q

Difference between congenital and acquired bladder diverticula

A
  • Congenital = full thickness of bladder wall involved

- Acquired = mucosal outpouching only

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55
Q

Antibiotic prophylaxis for transrectal prostate biopsy

A

Oral ciprofloxacin

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56
Q

Antibiotic prophylaxis required prior to endoscopic urological surgery

A

Gentamicin or cephalosporin

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57
Q

Investigations for acute pyelonephritis

A
  1. Urine culture
  2. BC
  3. Plain X-Ray KUB to RO stones
  4. USS to RO obstruction
  5. IVU
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58
Q

Renal stone recurrence rate

A

35-75% at 10 years

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59
Q

Most common renal stone

A

Calcium oxalate - 35%

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60
Q

Most radiodense renal stone

A

Calcium phosphate

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61
Q

Characteristics of calcium oxalate stones

A
  • Mulberry stones covered in sharp projections
  • Occur in alkaline urine
  • Cause bleeding
  • Often black from blood
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62
Q

Characteristics of struvite stones

A
  • Staghorn calculus
  • Very alkaline urine
  • Smooth and dirty white
  • Enlarge rapidly
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63
Q

Characteristics of urate stones

A
  • Arise in acidic urine
  • Light brown
  • Radiolucent
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64
Q

Characteristics of cystine stones

A
  • Usually multiple
  • Acidic urine
  • Metabolic in origin due to reduced cystine reabsorption
  • Radio-opaque from sulfur content
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65
Q

List the stones occurring in acidic urine

A
  • Urate

- Cystine

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66
Q

List the stones occurring in alkaline urine

A
  • Calcium oxalate (variable)
  • Struvite
  • Calcium phosphate
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67
Q

Stone most likely to be seen in those with inherited recessive condition

A

Cystine

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68
Q

Pathophysiology of struvite stones

A
  • Occur as a result of urease producing bacteria

- Associated with chronic infections

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69
Q

Stones associated with renal tubular acidosis

A

Calcium phosphate

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70
Q

List the stones that are radiolucent

A
  • Urate

- Xanthine

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71
Q

Which stones give a ‘ground-glass’ radiographic appearance

A

Cystine

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72
Q

Which infections predispose to staghorn (struvite) stones

A
  • Proteus

- Ureaplasma urealyticum

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73
Q

3 most common sites of stone impaction

A
  1. PUJ
  2. SIJ
  3. VUJ
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74
Q

Proportion of patients with renal stones with haematuria

A

90%

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75
Q

Primary investigation for renal stones

A

Non-contrast CT KUB

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76
Q

Supportive treatment in renal colic

A
  1. Rectal Diclofenac
  2. Antiemetics
  3. Rehydration
  4. Alpha-blockers
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77
Q

Preferred method of stone management if septic

A

Percutaneous nephrostomy (retrograde stenting may be performed but carries increased risk of septicaemia)

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78
Q

Likelihood of stones <4mm passing naturally

A

90%

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79
Q

Likelihood of stones >6mm passing naturally

A

5%

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80
Q

Management of renal stones <5mm

A

Conservative - will typically pass within 4 weeks

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81
Q

Management of renal stones <10mm

A

ESWL

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82
Q

Management of renal stones 10-20mm

A

ESWL or ureteroscopy

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83
Q

Management of renal stones >20mm (including staghorn calculi)

A

PCNL

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84
Q

Management of ureteric stones <5mm

A

Watchful waiting

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85
Q

Management of ureteric stones 5-10mm

A

ESWL

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86
Q

Management of ureteric stones 10-20mm

A

Ureteroscopy

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87
Q

Management of patients with both renal and ureteric stones

A

Flexible ureterorenoscopy and laser lithotripsy

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88
Q

Mechanism of action of PCNL

A

Electrohydraulic lithotripsy and ultrasonography

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89
Q

Contraindications to ESWL

A
  • Pregnancy
  • Aortic aneurysm
  • Urosepsis
  • Uncorrected coagulopathy
90
Q

In whom with renal stones should nephrectomy be considered

A

Symptomatic stones and kidney contributing <15% to overall function

91
Q

Management of bladder stones

A
  • Lithoclast fragmentation

- Open surgery if >5cm

92
Q

Weight of the prostate

A

20g

93
Q

Lymphatic drainage of the prostate

A

Internal iliac nodes

94
Q

List the 3 most common causes of upper urinary tract obstruction

A
  1. Stones
  2. Malignancy
  3. PUJ obstruction
95
Q

Most common causes of lower urinary tract obstruction

A
  • BPH

- Urethral stricture

96
Q

What investigation confirms renal tract obstruction

A

MAG-3 scan (shows how well each kidney is draining/functioning)

97
Q

Where does BPH occur

A
  • Transitional zone

- Nodular hyperplasia of glandular and stromal elements

98
Q

Symptoms of BPH

A
  • Voiding = hesitancy, poor stream, straining, terminal dribbling
  • Storage = frequency, urgency, nocturia, incontinence
99
Q

Score to assess severity of prostate symptoms

A

International prostate symptom score (IPSS)

100
Q

What causes haematuria in BPH

A

Ruptured bladder neck veins

101
Q

Complications of BPH

A
  • Hypertrophy of bladder muscle
  • Hydroureter
  • Hydronephrosis
  • Pyonephrosis
  • Pyelonephritis
102
Q

Uroflowmetery result indicating obstruction

A

<10ml/s

103
Q

USS post-void volume indicative of chronic retention

A

> 300ml

104
Q

Lifestyle advice for BPH

A
  • Reduce caffeine

- Reduce fluid intake at night

105
Q

Medical management of BPH and MOA

A
  • Alpha-1 blockers - relax bladder neck and prostatic smooth muscle
  • 5-Alpha-Reductase inhibitors - block conversion of testosterone to dihydrotestosterone
106
Q

Surgical management of BPH

A
  1. TURP

2. Open retropubic prostatectomy (prostate >90g)

107
Q

Investigating BPH

A
  1. DRE
  2. Urinalysis
  3. Uroflowmetry
  4. Bladder scanning
108
Q

Cause of TURP syndrome

A

Absorption of large volumes of irrigation fluid through the prostatic venous plexus

109
Q

Expected biochemistry in TURP

A
  • Hyponatraemia

- Hypervolaemia

110
Q

Symptoms of TURP syndrome

A
  • Visual disturbance (cerebral oedema)
  • Nausea
  • Vomiting
  • Confusion
  • Seizures
  • Bradycardia
  • Hypertension
111
Q

Prevention of TURP syndrome

A

Minimise operating time to <1 hour

112
Q

Treatment of TURP syndrome

A
  1. Supportive
  2. Diuretics
  3. Fluid restrict
113
Q

Outline procedure for suprapubic catheter insertion

A
  1. Ensure palpable bladder
  2. Prepare lower half of abdomen
  3. Inject LA a fingersbreadth above the pubic symphysis
  4. Make small skin incision and insert trocar with plastic sheath
  5. Introduce 16Fr catheter
114
Q

Contraindications to suprapubic catheter insertion

A
  • Previous abdominal surgery which risk small bowel adhesions
  • History of bladder TCC due to risk of seeding
  • Bleeding tendency
115
Q

Definition of chronic urinary retention

A

Residual urinary volume >300ml

116
Q

How does low-pressure chronic retention present

A

Overlfow incontinence

117
Q

How does high-pressure chronic retention present

A

Renal failure

118
Q

What causes leg twitching during TURP

A

Obturator nerve is closely related to the bladder

119
Q

Most common drug-induced cause of haemorrhagic cystitis

A

Cyclophosphamide

120
Q

Most common cause of weak stream in children

A

Posterior urethral valves

121
Q

What drug reduces the risk of retention in BPH

A

Finasteride

122
Q

Renal cell carcinoma colour

A

Yellow/Brown

123
Q

Macroscopic characteristics of renal cell carcinoma

A
  • Full of fat
  • Very vascular
  • Circumscribed by pseudocapsule of compressed normal renal tissue
124
Q

Outline the spread of renal cell carcinoma

A
  1. Direct extension:
    - Perinephric fat and fascia
    - Wall and lumen of renal
    vein/IVC
    - Adrenal gland
  2. Haematogenous Metastasis:
    - Cannonball to lung
    - Bone
    - Brain
125
Q

Risk factors for non-familial renal cell carcinoma

A
  • Acquired renal cystic disease (90% of dialysis patients)
  • Smoking
  • Lead, cadmium, asbestos, polycarbons
126
Q

Most common histological cell type in renal cell adenocarcinoma

A

Clear cell adenocarcinoma (>50%)

127
Q

List the potential histology of renal cell adenocarcinoma

A
  • Clear cell
  • Papillary
  • Chromophobe
128
Q

Classic presenting triad in renal cell carcinoma

A
  1. Pain
  2. Mass
  3. Haematuria
129
Q

Proportion of renal malignancies made up by renal cell carcinoma

A

85%

130
Q

Investigating renal cell carcinoma

A
  1. USS
  2. CT TAP with contrast
  3. Biopsy if ablative therapy planned (not indicated if nephrectomy planned)
131
Q

Management of T1a renal cell carcinoma

A

Partial nephrectomy (ablasive treatments may be considered in unfit patients)

132
Q

Management of >=T2 renal cell carcinoma

A

Radical nephrectomy

133
Q

Management of renal TCC

A

Nephroureterectomy with disconnection of the ureter at the bladder

134
Q

Is adjuvant chemotherapy required in R0 renal cell carcinoma resections

A

No

135
Q

Potential biochemical results due to paraneoplasia in renal cell carcinoma

A
  • Hypercalcaemia

- Polycythaemia

136
Q

What is Stauffer syndrome

A

Liver dysfunction arising due to renal cell carcinoma

137
Q

Prognosis for T1 renal cell carcinoma

A

90% 5-year survival

138
Q

Presentation of renal sarcoma

A
  • Accounts for 1-2% of renal neoplasms
  • Commonly Leiomyosarcoma
  • Presents in 5th decade
  • Flank pain and weight loss
  • Treat with radical nephrectomy
139
Q

Which tumours metastasise to the kidney

A
  • Lung - 20%
  • Breast - 12%
  • Stomach - 11%
  • Lymphoma - rare
140
Q

Associations of angiomyolipoma

A
  • Tuberous sclerosis
  • Epilepsy
  • Adenoma sebaceum
141
Q

How is diagnosis of angiomyolipoma made

A

CT - high confidence due to high fat content

142
Q

Management of angiomyolipoma

A
  • <4cm = conservative
  • > 4cm = enucleation or partial nephrectomy
  • Acute bleeding = embolisation or nephrectomy
143
Q

Where do oncocytomas develop from

A

Intercalated cells of the collecting duct

144
Q

Distribution of urothelial tumours

A
  • 95% bladder

- 5% upper tract

145
Q

Bladder TCC risk factors

A
  • Smoking
  • Occupational - dye, rubber, textile, PVC, beta-naphtaline
  • Congenital abnormalities
146
Q

SCC Bladder associations

A
  • Schistosomiasis

- Indwelling catheters

147
Q

What bones are encountered during posterior approach to the kidney

A

11th and 12th ribs

148
Q

GOLD standard investigations for bladder cancer

A

Flexible cystoscopy

149
Q

What ‘T’ stages remain superficial in bladder cancer

A
  • Ta = non-invasive papillary carcinoma
  • Tis = carcinoma in situ
  • T1 = tumour invades sub epithelial connective tissue
150
Q

Management of superficial bladder cancer

A

TURBT

151
Q

Management of recurrent or higher grade superficial bladder cancer

A
  • Mitomycin for 6 weeks

- BCG for 6 weeks (standard for Grade 3 pT1 tumours)

152
Q

Management of T2-3 non-metastatic bladder cancer

A

Radical cystectomy with urinary diversion via ileal conduit

153
Q

Management of invasive bladder cancer in those not fit for surgery

A

Radical radiotherapy

154
Q

Management of metastatic bladder cancer

A
  • Platinum-based chemotherapy

- Prognosis of 1 year

155
Q

Presentation of bladder cancer

A
  • Painless haematuria

- Irritative bladder symptoms

156
Q

Where do adenocarcinomas occur in the bladder

A

At the vault at the site of the urachal remnant and the tumour itself grows outside the bladder

157
Q

Diagnosis of upper tract TCC

A

IVU is recommended

158
Q

What percentage of those diagnosed with upper tract TCC will have bladder TCC

A

50%

159
Q

Risk factors for prostate cancer

A
  • Saturated fats, phyto-oestrogens
  • Genetics
  • African origin
160
Q

Most common histological type of prostate cancer

A

Adenocarcinoma - 95%

161
Q

Describe the Gleason scoring system

A
  • Histological assessment
  • Grades two predominant areas of the tumour
  • Gleason 1 = well differentiated
  • Gleason 5 = poorly differentiated
  • Total score out of 10
162
Q

GOLD standard investigation for the diagnosis of prostate cancer (and its mets)

A
  1. TRUS biopsy + MRI if surgery planned

2. Bone scan

163
Q

In whom is watchful waiting used for the management of prostate cancer

A
  • Elderly (life exp <10)
  • Multiple comorbidity
  • Low Gleason score 3+3

(Require at least 10 biopsies to be taken and ideally a repeat biopsy)

164
Q

Management of localised prostate cancer

A
  • Radical prostatectomy with removal of the obturator nodes

- OR/ Radical radiotherapy

165
Q

Complications of radical prostatectomy

A

Erectile dysfunction

166
Q

Complications of prostate radiotherapy

A
  • Radiation proctitis

- Rectal malignancy

167
Q

How do LHRH agonists work

A
  • Act on pituitary to inhibit LH production

- Lack of LH means testosterone not produced by Leydig cells of testes

168
Q

Side effects of LHRN agonists

A
  • Lack of energy
  • Loss of libido
  • Hot flushes
169
Q

How do anti-androgens work

A

Compete with testosterone at the androgen receptor to block its action

170
Q

Management of hormone-escaped prostate cancer

A
  • Palliative
  • Diethylbestrol or prednisolone
  • Radiotherapy for bone pain
  • Docetaxel
171
Q

Most common genetic abnormality in bladder cancer

A

Deletion of chromosome 9

172
Q

Risk factors for testicular cancer

A
  • White
  • Undescended testes (x10 increase)
  • Klinefelter’s
  • Mumps orchitis
  • Family history
  • Infertility
173
Q

Most common testicular cancer subtype

A

Seminoma (50%)

174
Q

Seminoma tumour markers

A
  • AFP = normal
  • HCG = elevated in 10%
  • LDH = raised in 10-20%
175
Q

Pathological appearance of seminomas

A

Sheet like lobular pattern of clearcells with substantial fibrous component. Fibrous septa contain lymphocytic inclusions and granulomas may be seen.

176
Q

Investigating testicular cancer

A
  • Scrotal USS
  • CXR/CT TAP to exclude chest mets
  • Testicular tumour markers
177
Q

Age distribution for seminoma

A

30-40

178
Q

Management of testicular cancer

A
  1. Orchidectomy via inguinal approach
179
Q

Non-Seminomatous Germ cell tumour markers

A
  • AFP = elevated in 70%
  • HCG = elevated in 40%
  • Other markers rarely helpful
180
Q

Extratesticular features of Leydig cell tumours

A

Gynaecomastia

181
Q

Postoperative management of seminomas

A
  • Confined to testes = CT surveillance and single shot carboplatin
  • Lymph node mets = radiotherapy with combination chemo if N3/metastatic
182
Q

Postoperative management fo non-seminomatous germ cell tumours

A
  • Confined to testes = close surveillance (20% have retroperitoneal lymph node involvement)
  • Metastatic = combination chemo
183
Q

Pathology of penile carcinoma

A

SCC

184
Q

Risk factors for penile carcinoma

A
  • HPV

- Unretractable phimosis

185
Q

How should patients with penile cancer and palpable lymph nodes be managed and why

A
  1. If remain palpable after antibiotics

2. Bilateral inguinal lymphadenectomy with en-bloc dissection (because the glans drains bilaterally)

186
Q

Describe testicular torsion

A

Occurs when the spermatic cord and its contents twist within the tunica vaginalis

187
Q

Peak incidence of testicular torsion

A
  • Neonates

- 12-25 years

188
Q

Anatomical variation predisposing to testicular torsion

A

Horizontal lie of the testes = bell-clapper deformity (lacks normal attachment to the tunica vaginalis)

189
Q

Presentation of testicular torsion

A
  • Acutely painful hemiscrotum
  • Pain radiates to groin/loin
  • Vomiting
  • Very tender on palpation
  • Loss of cremasteric reflex
190
Q

What is the Hydatid of Morgani

A

Remnant of the Mullerian duct and is a common testicular appendage

191
Q

Difference in presentation between testicular torsion and torsion of the Hydatid Morgani

A
  • Cremasteric reflex is preserved in Hydatid of Morgani torsion
  • Less erythematous scrotum
  • Normal lie of the testes
  • Blue dot in upper half of hemiscrotum
192
Q

Investigating testicular torsion

A

Clinical diagnosis warrants exploration

193
Q

Outline the treatment of testicular torsion

A
  • Scrotal exploration
  • Untwist torsion
  • Soak in warm saline for 15 minutes if dusky after torsion
  • If doubt over viability then orchidectomy (via scrotal approach)
  • If viable, fix both testes via orchiopexy
194
Q

Pathology of hydrocele in children

A

Patent processus vaginalis (primary hydrocele)

195
Q

Management of hydrocele in children

A

Inguinal approach to ligate processus

196
Q

Features of hydrocele

A
  • Painless scrotal swelling
  • Able to palpate cord above
  • Transillumable
  • Not separate from testes
197
Q

Investigating hydrocele

A
  • USS in young men to exclude tumour

- Not necessary in older men

198
Q

Surgical management of hydrocele in adults

A

Lord Repair - scrotal approach to plicate tunica vaginalis

199
Q

Pathology of epididymal cyst

A

Fluid-filled scrotal mass arising from congenital diverticula in the epididymal tubes

200
Q

Features of epididymal cyst

A
  • May be multiple
  • Usually tense, spherical
  • Transilluminable
  • Testis can be felt separately
  • Lie above and behind testis
  • Possible to ‘get above lump’
201
Q

How are epididymal cysts distinguished from hydroceles on examination

A

Epididymal cysts can be felt separately from the testis

202
Q

Management of epididymal cysts

A
  • None if asymptomatic

- Surgical excision if there is pain (scarring may affect fertility and pain may persist)

203
Q

Pathology of varciocele

A

Dilatation of the pampiniform plexus that runs within the spermatic cord

204
Q

Which side is varicocele more likely to occur and why

A

Left side - testicular vein drains into renal vein and is under higher pressure

205
Q

Outline the 3 grades of varicocele

A
  1. Subclinical = detectable on doppler USS
  2. Palpable when standing
  3. Visible swelling, palpable when lying
206
Q

What must you be wary of in and elderly man presenting with varicocele

A

May be sign of renal malignancy

207
Q

Management of varicocele

A
  • Ligation of the veins of the groin

- Embolization

208
Q

Recurrence rate of varicocele

A

20% - due to collateral circulation or failed venous ligation

209
Q

Pathology of Peyronie’s disease

A

Fibromatosis of unknown aetiology that affects focal areas of the tunica albuginea of the corpus cavernosum

210
Q

Associations of Peyronie’s disease

A
  • Dupuytren’s contracture

- Plantar fascial contracture

211
Q

Features of Peyronie’s disease

A
  • Penile pain on erection
  • Gradual deviation of erection
  • Pain resolves after 6-9 months
212
Q

Management of Peyronie’s disease

A
  • Conservative for 1 year
  • ESWL can be used to soften the penile plaque
  • Nesbit operation - plication with excision of the tunica albugenia
213
Q

Management of acute haematocele

A

Surgical exploration and evacuation of clot

214
Q

Outline the timeline of priapism

A
  • 3-4 hours = pain
  • 12 hours = interstitial oedema
  • 24-48 hours = necrosis
  • > 1 week = fibrosis and erectile dysfunction
215
Q

Management of priapism

A
  • Ice packs/cold shower

- If due to low flow then blood may be aspirated from copora

216
Q

Types of priapism

A
  1. Low flow = due to veno-occlusion and is most painful type requiring emergency treatment if >4 hours
  2. High flow = due to unregulated arterial blood flow
217
Q

Causes of recurrent priapism

A

Typically seen in sickle cell disease, most commonly of the high flow type

218
Q

Medical treatment of erectile dysfunction

A
  1. Phosphodiesterase-5 inhibitors (viagra)
  2. Dopamine agonsists
  3. Prostaglandin E1 intracorporeal injection
219
Q

When should the foreskin be retractable by

A

95% by 16

220
Q

Most common cause of true pathological phimosis

A

Balanitis xerotica obliterans (BXO)

221
Q

Management of pathological phimosis

A

Circumcision

222
Q

Management of paraphimosis

A
  1. Reduce swelling with ice and squeezing oedematous tissue
  2. Attempt reduction
  3. Penile or ring block can be used
  4. Occasionally necessary to drain oedema with needle
  5. Circumcision is recommended

The Abdomen (8 decks)

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