Urology 1- Disorders of Male Genitalia Flashcards
Definition of which condition?
Collection of fluid around the testicle b/w the parietal tunica vaginalis and the visceral tunica vaginalis
Hydrocele
What are 3 possible etiologies of hydroceles discussed in lecture?
- Epididymitis
- Torsed Appendix testis
- Idiopathic (Majority)
Presentation of which condition?
- Unilateral scrotal enlargement
- +/- pain
- +/- history of GU trauma
- Transillumination
Hydrocele
How do you treat a hydrocele if the pt is asymptomatic or minimally symptomatic?
reassurance and monitoring
What are the 2 treatment options for a hydrocele that is bothersome?
Elective tx:
- Needle aspiration w/ injection of sclerosing agent- done in office but my recur
- Hydrocelectomy- Definitive tx (not likely to recur) but done in OR
Definition of which condition?
- Dilated veins of the pampiniform plexus
Varicocele
The following are effects of which condition?
- Pain (usu. asymptomatic)
- Testis damage- decreased spermatogenesis
- Testis atrophy
- Infertility
Varicocele
What condition is described as feeling like a “bag of worms” on physical exam?
Varicocele
What is considered a Grade I Varicocele?
- Small size
- Not grossly visible
- Only palpable during valsalva
What is considered a Grade II Varicocele?
- Size: moderate
- Not Grossly visible
- Palpable while standing
What is considered a Grade III Varicocele?
- Large size
- Grossly visible
Is a varicocele usually on the left or the right?
LEFT
If on the right side (and rapid onset)–> sign of renal malignancy
How do you manage a young male patient with a palpable varicocele w/ normal semen analysis?
Semen analysis every 1-2yrs
How do you you manage a varicocele in a Child or pre-sexual adolescent w/ nml testis size?
Measure testicular size annualy
(to detect decrease)
What are the 3 indications for surgical management of a varicocele?
(surgery= ligation of vein to redirect venous outflow via open or laporoscopic sx)
- Symptomatic
- Palpable varicocele w/ abnormal semen analysis (in eval of infertile couple)
- Varicocele with small testis
T/F: Surgical repair can reverse atrophy in a patient that has a varicocele w/ small testis
TRUE
____ to ____ months after varicocele repair, improvement in semen quality is seen in 70% of men?
3 to 6 months
What is the difference b/w Phimosis and Paraphimosis? Which is an emergency?
- Phimosis- Prepuce stuck distal to glans
- Paraphimosis- Prepuce stuck proximal to glans, unable to be reduced–> EMERGENCY
If paraphimosis is left untreated, what can result?
Penile necrosis
UROLOGIC EMERGENCY
What is the tx for phimosis?
Circumcision
How do you treat Paraphimosis?
REDUCTION
- +/- pain meds/ sedation, topical anesthetic/penile block
- Squeeze edema out of glans
- Push w/ thumbs (glans), pull w/ fingers (prepuce)
**If reduction not successful–> dorsal slit or circumcision
What is the main complication of paraphimosis?
Fournier’s Gangrene (Urologic Emergency)
What are the 2 main risk factors of testicular torsion?
- Cryptorchidism (undescended testis)
- “Bell Clapper” deformity
What age is testicular torsion MC in?
12-18 y/o
Which condition?
- Acute onset
- Severe testicular pain
- NO scrotal swelling
Testicular torsion
(epididymitis would also be painful but would have assoc. swelling)
What is seen on Physical exam in testicular torsion? (7)
- Tender, firm testis
- High riding testis
3. Horizontal lie
- ****_Absent cremaster reflex*****_
5. No pain relief with elevation
- Thick/knotted sperm cord
- Epididymis not posterior to testis
Which urologic condition has an absent cremaster reflex?
Testicular torsio
How do you dx testicular torsion? (3)
- Clinical suspicion
- Doppler ultrasound (decreased blood flow on affected side)
- Nuclear testicular scan (decreased radiotracer activity)- not usu done
What is seen on doppler ultrasound in testicular torsion vs acute epididymitis/orchitis?
- Testicular torsion: minimal blood flow
- Acute epididymitis/orchitis: increased blood flow
What is seen on nuclear testicular scan in testicular torsion vs acute epididymitis/orchitis?
Testicular torsion: Decreased radiotracer activity
Acute epididymitis/orchitis: Increased radiotracer activity
How do you tx Testicular Torsion?
- EMERGENCY (must detorse w/in 6hrs)
- Tx= Surgery (if testis viable- orchiopexy of both sides; not viable- orchiectomy and orchiopexy of contralateral testis)
- Manual detorsion: “Open the book”
Testicular Torsion:
- If detorsion
- If detorsion >___hrs, most non-viable
- If detorsion <6 hrs, most viable
- If detorsion >24 hrs, most non-viable
T/F: Hydroceles can be reactive, associated with inflammatory conditions and resolve with resolution of underlying condition
True
