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F3 E1 Shea > Urology 1- Disorders of Male Genitalia COPY > Flashcards

Urology 1- Disorders of Male Genitalia COPY Flashcards

1
Q

Definition of which condition?

Collection of fluid around the testicle b/w the parietal tunica vaginalis and the visceral tunica vaginalis

A

Hydrocele

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2
Q

What are 3 possible etiologies of hydroceles discussed in lecture?

A
  1. Epididymitis
  2. Torsed Appendix testis
  3. Idiopathic (Majority)
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3
Q

Presentation of which condition?

  • Unilateral scrotal enlargement
  • +/- pain
  • +/- history of GU trauma
  • Transillumination
A

Hydrocele

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4
Q

How do you treat a hydrocele if the pt is asymptomatic or minimally symptomatic?

A

reassurance and monitoring

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5
Q

What are the 2 treatment options for a hydrocele that is bothersome?

A

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
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6
Q

Definition of which condition?

  • Dilated veins of the pampiniform plexus
A

Varicocele

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7
Q

The following are effects of which condition?

  • Pain (usu. asymptomatic)
  • Testis damage- decreased spermatogenesis
  • Testis atrophy
  • Infertility
A

Varicocele

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8
Q

What condition is described as feeling like a “bag of worms” on physical exam?

A

Varicocele

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9
Q

What is considered a Grade I Varicocele?

A
  • Small size
  • Not grossly visible
  • Only palpable during valsalva
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10
Q

What is considered a Grade II Varicocele?

A
  • Size: moderate
  • Not Grossly visible
  • Palpable while standing
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11
Q

What is considered a Grade III Varicocele?

A
  • Large size
  • Grossly visible
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12
Q

Is a varicocele usually on the left or the right?

A

LEFT

If on the right side (and rapid onset)–> sign of renal malignancy

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13
Q

How do you manage a young male patient with a palpable varicocele w/ normal semen analysis?

A

Semen analysis every 1-2yrs

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14
Q

How do you you manage a varicocele in a Child or pre-sexual adolescent w/ nml testis size?

A

Measure testicular size annualy

(to detect decrease)

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15
Q

What are the 3 indications for surgical management of a varicocele?

(surgery= ligation of vein to redirect venous outflow via open or laporoscopic sx)

A
  • Symptomatic
  • Palpable varicocele w/ abnormal semen analysis (in eval of infertile couple)
  • Varicocele with small testis
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16
Q

T/F: Surgical repair can reverse atrophy in a patient that has a varicocele w/ small testis

A

TRUE

17
Q

____ to ____ months after varicocele repair, improvement in semen quality is seen in 70% of men?

A

3 to 6 months

18
Q

What is the difference b/w Phimosis and Paraphimosis? Which is an emergency?

A
  • Phimosis- Prepuce stuck distal to glans
  • Paraphimosis- Prepuce stuck proximal to glans, unable to be reduced–> EMERGENCY
19
Q

If paraphimosis is left untreated, what can result?

A

Penile necrosis

UROLOGIC EMERGENCY

20
Q

What is the tx for phimosis?

A

Circumcision

21
Q

How do you treat Paraphimosis?

A

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

22
Q

What is the main complication of paraphimosis?

A

Fournier’s Gangrene (Urologic Emergency)

23
Q

What are the 2 main risk factors of testicular torsion?

A
  1. Cryptorchidism (undescended testis)
  2. “Bell Clapper” deformity
24
Q

What age is testicular torsion MC in?

A

12-18 y/o

25
Q

Which condition?

  • Acute onset
  • Severe testicular pain
  • NO scrotal swelling
A

Testicular torsion

(epididymitis would also be painful but would have assoc. swelling)

26
Q

What is seen on Physical exam in testicular torsion? (7)

A
  1. Tender, firm testis
  2. High riding testis

3. Horizontal lie

  1. ****_Absent cremaster reflex*****_

5. No pain relief with elevation

  1. Thick/knotted sperm cord
  2. Epididymis not posterior to testis
27
Q

Which urologic condition has an absent cremaster reflex?

A

Testicular torsio

28
Q

How do you dx testicular torsion? (3)

A
  • Clinical suspicion
  • Doppler ultrasound (decreased blood flow on affected side)
  • Nuclear testicular scan (decreased radiotracer activity)- not usu done
29
Q

What is seen on doppler ultrasound in testicular torsion vs acute epididymitis/orchitis?

A
  • Testicular torsion: minimal blood flow
  • Acute epididymitis/orchitis: increased blood flow
30
Q

What is seen on nuclear testicular scan in testicular torsion vs acute epididymitis/orchitis?

A

Testicular torsion: Decreased radiotracer activity

Acute epididymitis/orchitis: Increased radiotracer activity

31
Q

How do you tx Testicular Torsion?

A
  • 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”
32
Q

Testicular Torsion:

  • If detorsion
  • If detorsion >___hrs, most non-viable
A
  • If detorsion <6 hrs, most viable
  • If detorsion >24 hrs, most non-viable
33
Q

T/F: Hydroceles can be reactive, associated with inflammatory conditions and resolve with resolution of underlying condition

A

True

F3 E1 Shea (14 decks)

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