Urology

Question 1

Undescended Testes

Answer 1

Cryptorchidism
Present elsewhere other than scrotum along the path of descent vs ectopic testes present outside the path of descent
Will descend max by 3months. Full descent after that is uncommon.
R>L
20% b/l
Intraabdominal, intracanalicular, extracanalicular, ectopic
Size of undescended testes smaller than normal- loss of leydig cells, degenerative of sertoli cells, low spermatogen

Consequences:
Infertility
CA- M/c seminoma- 2-3x more risk if orchidopexy done before puberty, 5-6x if done after puberty
Hernia- 90% have patent processus vaginalis
Testicular torsion

Retractile testes

Dx:
USG
MRI
Laparoscopy

Rx:
Orchidopexy 6-18 months of age

Question 2

Torsion testis

Answer 2

Twisting of spematic cord and its contents- compromising vascular supply to the testes.

Normally, testes is held in place by the tunica vaginalis being attached to the scrotal wall. If not, a mobile testes predisposes it for torsion.

1. Bell clapper testes- high attached tunica vaginalis
2. Pedicle between epididymis and testes.

720/ 360 degree torsion
360- if Sx within 6 hrs (from onset of pain)- 100% salvage rate of testes. If >24hrs 20% salvage rate.

Sudden onset groin pain, N/V, tender swollen scrotum and testes. No fever.
Cremasteric reflex lost

DX- Clinical- doppler (not routinely done)

Surgical emergency- Fix opposite side also

Question 3

Varicocoele

Answer 3

Abnormal dilatation of venous plexus draining testes.

L>R. Left testicular vein drains into left renal vein (High pressure)- IVC. Right test vn drains directly into the IVC (low pressure)

Pathophysiology:
1. Absent anti reflux valve at the point where the testicular veins drain into left renal vein/ IVC.
2. Nutcracker effect- Left testicular vein stuck between SMA and Aorta
3. Angulation- left test vn and left renal vn
4. If on the right- rule out RCC.

Dragging discomfort in scrotum/ groin, bag of worms, COUGH IMPULSE.

USG

Grades
1. Palpable only with Valsalva
2. Palpable at rest. Not visible at rest.
3. Visible at rest

Percut embolisation
Ligation of veins.

Question 4

Hydrocoele

Question 5

Hydrocoele

Question 6

Epididymo- orchitis

Answer 6

Retrograde infection from UTI/ prostate/ seminal vesicles.

Ascending infection:
STD in young- m/c chlamydia> Gono
UTI in elderly

Tail of epididymis affected 1st.

Groin pain, fever

Ur R/E, C/S
NAAT
Urethral swab
Usg Scrotum

Question 7

Prostate

Answer 7

Transitional zone
Central zone
Peripheral zone

Question 8

Prostate

Answer 8

Transitional zone
Central zone
Peripheral zone

Question 9

Effects of BPH

Answer 9

1. Elongates prostatic urethra
2. Bladder wall hypertrophy

Question 10

LUTS

Answer 10

Voiding- HDP
Storage- FUNE