Urology Flashcards
Describe a hydrocele
Abnl collection of fluid around testicle bw the parietal and visceral tunica vaginalis layers; should only be potential space
Hydrocele etiology
majority idiopathic
can be reactive associated with inflammatory condition e.g epididymitis, testicular torsion and resolves w resolution of underlying condition
H&P hydrocele
History:
trauma, prior hx of same and tx, pain?, interference w ADL
(if not bothersome don’t have to do anything about it)
Physical:
palpation, transillumination, scrotal ultrasound (fluid will be black on US)
Tx options for hydrocele
If asymptomatic/mild sxs - reassurance and monitoring
if bothersome…
- Needle Aspiration (after fluid aspirated, use sclerosing agent Doxycycline, this sticks the visceral and parietal layers together)
- Hydrocelectomy - done in O.R, advantage not likely to recur
Describe hydrocelectomy
Trans-scrotal incision made
Hydrocele sac opened and fluid aspirated
Opening enlarged, tunica vaginalis everted, marsupialized
Penrose drain may be sutured in place to drain scrotum overnight
Define varicocele and describe possible effects or consequences
Dilated veins of the Pampiniform Plexus;
usually on the left side due to indirect venous network, if on right side consider malignancy
possible pain, testis atrophy, testis damage w fibrosis and decreased spermatogenesis, infertility
Classic board description of varicocele
feels like a “bag of worms”
physical exam performed with pt supine, standing, and valsalva while standing
Describe 3 Grades of varicocele
Grade I: small, not grossly visible, only palpable during Valsalva
Grade II: moderate size, not grossly visible, palpable while standing
Grade III: large size, grossly visible
Indications for varicocele repair, surgical management
if pt symptomatic
palpable varicocele w abnl semen analysis in an infertile couple. semen quality improved 3-6 months after repair in most men
varicocle w small testis - repair can reverse atrophy
What do you call, the prepuce (foreskin) of penis getting stuck DISTAL to glans ?
Phimosis
may result in difficulty voiding, balanitis (inflammation of the glans penis)
Tx is circumcision
Describe Paraphimosis
Medical emergency
prepuce gets stuck PROXIMAL to glans
reduction necessary, push/pull
if manual reduction not successful, dorsal slit or circumcision
monitor closely for Fournier’s gangrene - another med emergency
Describe testicular torsion presentation, tx, risk factors, and Ddx
Acute onset of severe pain
Age 12-18 yr old male most common; no swelling
if <6 hrs most viable, manual detorsion “open like a book” and surgical detorsion w orchipexy of both sides (stick to wall so won’t move again)
> 24 hrs most non-viable- would req orchiectomy
Risk factors: undescended testis (cryptorchidism), Bell clapper deformity (misaligned epididymitis)
Ddx epididymitis, acute orchitis
Testicular torsion physical exam findings
Absent cremasteric reflex
No pain relief with elevation
tender, firm testis high riding testis horizontal lie epididymitis not posterior to testis thick knotted sperm cord
Describe the diagnostic tools you could use to differentiate testicular torsion from acute epididymitis
Doppler US:
Torsion: minimal blood flow
Acute epidid: increased blood flow
Nuclear testicular scan:
Torsion: decreased radiotracer activity
Acute epidid: increased radiotracer activity
What findings would you expect to see on a UA in a lower UTI/cystitis infection?
Leukocyte esterase positive
Nitrite positive (for most bacteria except strep)
pyuria
bacteria
