Urology Flashcards
Buldge either in the suprapubic or scrotal area that increases in size with crying or straining?
Inguinal hernia
What are findings with an incarcerated inguinal hernia?
- Irritability
- Tender abdomen
- Vomiting
- Mass is tense
- Can’t be reduced
What are 2 conditions that might be confused with an incarcerated inguinal hernia?
- Hydrocele
2. Inguinal lympadenitis
How does a hydrocele present?
Scrotal enlargement
How does inguinal lymphadenitis present?
Tender mass, skin overlying is red and warm to touch, history of infection distal to the node
2 year old in ED with abdominal pain. On peritoneal dialysis, afebrile, immunizations up to date, diaylsis drainage normal, crusted edges around catheter site, large mass in left lower abdomen lateral to catheter- no rebound or guarding…?
Hernia- Children on PD frequently develop abdominal hernias because of increased intraperitoneal pressure
Infant with painless swelling of the scrotum, transilluminates on exam
Hydrocele
What side is a varicocele usually on?
Left
What is described as a heavy sensation or a “bag of worms”?
Varicocele
When does the swelling of a varicocele decrease?
When the patient is lying down
Is the swelling in a varicocele painful or painless?
Painless
What happens to fertility if you have an undescended tesicle?
Goes down
Why do we do orchiopexy?
- Improves fertility
2. Make it palpable to do testicular exams to find cancer earlier
True or False: Doing an orchiopexy eliminates risk of malignancy in the testicle?
False- doesn’t completely eliminate the risk of malignancy
True or False: Only the undescended testicle is at risk for malignancy?
False- Descended testicle on other side has a higher malignancy risk too, but not as high as the undescended one
What is important to counsel boys on at puberty with a history of undescended testicle?
Importance of testicular self-exams
True or False: HCG and testosterone can be used to treat undescended testicles?
FALSE- Not conisdered effective treatment
When should infants with undescended testicles be referred to urology?
By 3-6 months if they haven’t descended
At what age should an orchiopexy be done by for an undescended testicle?
12-18 months
Doing a routine physical on a 3 year old that’s new to you. Can’t palpate right testicle, but see in old records bilateral descended testicles have been documented in past… what next?
Retractile testicles (overactive cremaster muscle)- Re-examine the patient in the “tailor position” or “frog-leg position” (crossed legs with knees out)
True or False: Once testicles descend, they can’t re-ascend?
False- There is such a thing as retractile testes that re-ascend and stay there (have to follow-up retractile testicles to ensure they are both descended or refer to Urology)
What must be done if you have non-palpable testes in a newborn?
Urology evaluation and testicular US prior to discharge
What can non-palpable testes in a newborn be a presentation of?
Ambiguous genitalia/CAH
What is a congenital condition in males in which the opening of the urethra is on the underside of the penis?
Hypospadias
What type of renal anomalies are associated with a distal hypospadias?
None- the incidence of renal anomalies is low
What intervention is needed for a distal hypospadias?
None
Name the 4 syndromes hypospadias can be associated with.
SLOB:
- Silver Russell Syndrome (Russell Silver Syndrome)
- Laurence-Moon-Biedl Syndrome
- Opitz Syndrome
- Beckwith Wiedemann Syndrome
When should surgical correction of hypospadias be done by?
First year of life (usually at 6 months)
True or False: Patients with hypospadias can get circumcised
False- Circumcision shouldn’t be done in a patient with hypospadias
What is the triad for Prader-Willi syndrome?
- Micropenis
- Poor feeding
- Hypotonia
Name 5 things micropenis is associated with
- Prader-Willi syndrome
- Kallmann syndrome
- GH deficiency
- Septo-optic dysplasia
- Hypoglycemia
What length of penis in infant can you reassure families is normal?
At least 2.5cm you can reassure
What should be done if you have a male infant whose penis length is less than 2.5cm (one inch)?
Endocrine and/or genetic workup (micropenis)
What do you have to be careful of when measuring an infants penis?
Fat pad- if they have a big suprapubic fat pad you need to gently stretch the penis to full length and measure from the pubic symphysis
What is the typical presentation for epididymitis?
Unilateral scrotal pain, dysuria, fever (you will not have testicular mass or urethral discharge)
True or False: The cremasteric reflex is absent in epididymitis?
False- it is present
If a male is sexually active, what is epididymitis usually due to?
- Chlamydia
2. Neisseria gonorrhea
What is the main difference in presentation between epididymitis and orchitis?
Orchitis doesn’t have dysuria
How does testicular torsion present?
Sudden, severe scrotal pain
True or False: The cremasteric reflex is absent in testicular torsion?
True
- Cremaster reflex present
- Testicle is low lying
- White cells noted in urine
- Milder more insidious pain often after activity
Epididymitis
- Manipulation makes pain worse
- Cremaster reflex absent
- Testicle is high or retracted
- Abrupt onset of severe pain
Testicular torsion
What deformity results in a higher risk of testicular torsion?
Bell Clapper deformity
True or False: Testicular torsion can be bilateral
True
What needs to be done in cases of suspected testicular torsion?
Urgent US with Doppler flow
16 year old from Panama, febrile, 2 days of right testicular pain, testicle is swollen, tender, overlying skin erythematous. No urethral discharge or dysuria. No sexual history. US is negative- normal B/L blood flow. Most appropriate next step?
Mumps serology- Orchitis (occurs in mumps 30% of the time)
What is the inability to retract the foreskin?
Phimosis
After what age is phimosis abnormal?
3
What is treatment for phimosis?
Topical steroid cream along with periodic gentle retraction- If this doesn’t work, circumcision might be needed
What is paraphimosis?
Foreskin that once retracted can’t be brought back to its normal position- results in constriction and severe pain
Which is a surgical emergency- Phimosis or paraphimosis?
Paraphimosis
What 2 things is urethritis usually due to?
- Gonorrhea
2. Chlamydia
15 year old male, unprotected sex, dysuria, swelling of foreskin, UA with 3+ WBCs, gram stain negative, conjunctivitis… other physical findings?
Arthritis- Reactive arthritis can be an autoimmune response to chlamydia infections
What is the memory aid for reactive arthritis (used to be called Reiter syndrome)?
- Hurts when you see (conjunctivitis)
- Hurts when you pee (urethritis)
- Hurts in your knee (arthritis)
*Can’t see, Can’t pee, Can’t climb a tree
What is a common cause of non-sexually transmitted urethritis?
Urethral instrumentation following a surgical procedure
What should be done if you suspect a bladder infection?
UA and culture
4 year old male, tiny white bumps on tip of penis, what’s the cause?
Inclusion cysts
What should you think if you get a male whose parents noticed “pus” around the head of the penis?
Smegma under the prepuce- This is normal in an uncircumcised child up until age 3, no treatment
What is any firm painless solid scrotal mass until proven otherwise?
Testicular cancer
How should testicular masses be evaluated?
Bilateral US (even is the mass is unilateral)
What are 3 important labs to get when you suspect testicular cancer?
Lactate dehydrogenase, B-HCG, and alpha-fetoprotein
What race is more likely to get testicular cancer?
Caucasians
Name 5 things that are high risk factors for testicular cacncer
- Cryptorchidism
- Gonadal dysgenesis
- Previous testicular cancer
- Family history
- Klinefelter syndrome
